The pediatric mandible: I. A primer on growth and development

Background: In this, the first of two articles addressing the surgical management of pediatric mandibular fractures, the authors provide a detailed discussion of mandibular development and anatomy during the fetal period, infancy, and childhood. Methods: A review of the pertinent literature was performed. The changing structure of the developing mandible is discussed, with particular attention to surgically relevant structures. Results: Throughout development, key anatomical structures with relevance to surgical therapy change markedly in position. The mandible undergoes significant change in its bony structure and the composition of its surrounding soft tissues. The mandible's bony structure becomes more robust, with an increasingly acute gonial angle and enlargement of the ramus and body. Furthermore, the mandible provides the bony structure from which tooth buds erupt as the deciduous and permanent dentition-a process that generates significant growth on the alveolar process. As a consequence, the distance between the developing dentition and the inferior mandibular border increases in size. While the canal of the inferior alveolar nerve undergoes significant superior displacement, the mental foramen becomes positioned more posteriorly over time. Conclusions: Mandibular growth provides the basis for normal occlusal relations and the generation of increasingly large masticatory force. A working knowledge of the changing mandibular anatomy is a prerequisite for effective clinical management of traumatic injury.