Tuesday, September 2, 2014
Face and Jaw Surgery
My 6 yr old son was in a MVA in August 2005. He suffered a broken jaw, his jaw was wired shut for 2 weeks and had titanium plates inserted. He has recently had a swollen jaw and redness in the gums where the incision was made. He also has a permanent tooth that is positioned sideways and coming in through his lower gums(the front), not where it is suppose to be. Any ideas as to why this is happening. He has seen an oral surgeon, I just want another opinion as to what is the best treatment and what might be causing this. Thank you.
From you question it appears you are looking for answers to two concerns:
1. Swelling of the gums at the incision site.
2. The eruption of the permanent tooth at a different site and/or direction.
Swelling of the gums at the surgical site from the history you provided appears to be from infection or inflammation. This could for different reasons:
- tooth infection at the fracture site
- loose screws or plates
- injured or damaged permanent tooth due to fracture, or fixation.
It is highly unlikely for the fractures to not heal in pediatric patients, which could be another reason for infection.
I cannot suggest treatment without evaluating further as it is different for different causes. If you have concerns, I suggest an oral and maxillofacial surgeon whose focuses or interest is in pediatric facial injuries. Usually these surgeons are associated with major Children's hospitals.
The eruption of a permanent tooth at a different location is unlikely due to injury or fixation of fracture. Children at this age having teeth erupt with some rotations, malpositions is not unusual. These teeth do straighten in some due to the tongue and lip muscle forces. If you still have concerns you should see a pediatric dentist who can guide you further regarding this issue.
Likith V Reddy, MD, DDS, FACS
College of Medicine
University of Cincinnati