|Year : 2012 | Volume
| Issue : 4 | Page : 337-339
Firecracker explosion in the mouth of a 3-year-old child
D Sardana, A Goyal, K Gauba
Unit of Pedodontics and Preventive Dentistry, Oral Health Science Center, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||19-Mar-2013|
Unit of Pedodontics and Preventive Dentistry, OHSC, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Facial soft tissue injuries are commonly associated with majority of pediatric trauma cases. A rare case of soft tissue trauma caused due to explosion of a firecracker intraorally in a 3-year-old child is being presented.
Keywords: Explosion, firecracker, intraoral, trauma
|How to cite this article:|
Sardana D, Goyal A, Gauba K. Firecracker explosion in the mouth of a 3-year-old child. J Indian Soc Pedod Prev Dent 2012;30:337-9
| Introduction|| |
Diwali (or Deepawali) is a famous festival celebrated in India during the month of October/November. Lots of patients report to the hospitals around Diwali with injuries or burns caused due to fireworks because of negligence. ,, Most of these injuries occur in children due to the lack of safety measures while handling these firecrackers. Various types of firecrackers implicated in injuries are: Groundspinners, flare/fountains, sparklers, string bombs, rockets, etc.  However, no case of intraoral injury has been reported due to popper in a child as young as 3 years. The purpose of this case report is to present a rare case of injury caused due to biting on a firecracker in a 3-year-old female child on the eve of Diwali and highlight the importance of precautions which need to be taken while handling the firecrackers.
| Case Report|| |
A 3-year-old female child was referred by the Unit of Plastic Surgery of the emergency surgical out-patient department to the Unit of Pediatric Dentistry, Oral Health Sciences Center, PGIMER, Chandigarh, for evaluation of dental and oral injuries after intraoral firecracker explosion. The injury had occurred 18 h prior to oral examination, when the patient had chewed upon a firecracker commonly known as popper (also called snapper and snap dragon) thinking of it as toffee or chocolate on the eve of Diwali, which exploded in the oral cavity causing an injury. The patient reported to the Advanced Trauma Center, PGIMER, where full-thickness triangular laceration of the right cheek and lip was sutured layer by layer by a plastic surgeon [Figure 1]. The history revealed that there was loss of consciousness at the time of injury without any bleeding from ear or nose.
|Figure 1: Sutured right cheek and lip laceration at the time of presentation|
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On examination, the patient was alert but irritable. Glasgow coma rating of the child was E 4 V 5 M 6 . General body examination did not reveal any sign of injury elsewhere. Extraorally, the right cheek and lip had interrupted sutures and there was swelling below the right eye. Radiograph of the chest was taken to rule out aspiration of any firecracker piece [Figure 2]. Computed tomography (CT) scan of the head and neck did not reveal any abnormality [Figure 3], and neurological opinion was taken to rule out any injury or trauma to brain. Intraoral examination was carried out with difficulty; there was no sign of any malocclusion or step deformity, thereby ruling out any bony injury. Examination of individual teeth revealed subluxated 51, for which the child was kept under observation and later treated endodontically under conscious sedation after the mobility improved. The patient was recalled after 1 week for further follow-up examination.
|Figure 3: CT scan of the face: Buccal luxation of 51 evident, no other abnormality detected|
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A similar firecracker was procured from the patient and sent to the Central Forensic Science Laboratory (CFSL), Chandigarh, for a detailed physical and chemical analysis. The analysis report revealed it to be locally made cardboard cylinder of length 5 cm and width 1 cm, and consisted of small pieces of stones along with an orange powder. Analysis of this powder was done at CFSL through chemical tests, chromatographic tests, and spectrometric methods, which showed the presence of potassium, antimony, chlorate, and sulfide ions, which are the ingredients of low-grade explosives.
| Discussion|| |
Firework injuries are very common in India around Diwali festival.  Most of the injuries occur either during igniting or mishandling them in an unsafe way, which usually happens when children play with them unsupervised. Flare/fountain firecrackers have been reported to cause most of the injuries and the least injuries have been reported with sparklers,  although in the present case, the injury occurred due to chewing on the popper. There is no previous report of injuries caused to any part of the body due to poppers. Poppers are considered to be one of the safest firecrackers by the parents and others, as these do not need ignition and are relatively of mild intensity. These, when thrown hard on the ground, burst with a sound. Unfortunately, poppers available commercially in India are mostly unstandardized and also sometimes sold in attractive packets for small children without any manufacturer warning and instructions. In the present case, there was soft tissue trauma without any injury to any other important anatomical structures (e.g., bone, eye, or neurovascular bundle) or any damage which could have occurred due to swallowing of firecracker since its contents, viz. sulfides, chlorates, and antimony, are considered to be toxic.
Two such case reports of intraoral firecracker injuries have been reported in the literature. In the first case report, the injury occurred in a 19-year-old male patient, who sustained injuries to the oral cavity, though the relevant history and mechanism of injury were not elaborated.  In the second case report, a 25-year-old male suffered injuries while playing a Russian roulette game.  To the best of our knowledge, this is the first case of injury to oral cavity which occurred due to accidental chewing of a firecracker (popper) by a child as young as 3 years.
| Conclusion|| |
Although rare, similar type of injuries may occur and may be a potential threat to the life of patients or children. Hence, it is important to make the parents aware of the hazards caused by children playing with firecrackers, howsoever safe they might be considered. Also, parents must supervise and ensure adequate safety measures on occasions when children are free to play with firecrackers. Fireworks should be subject to strict standardization and these should be marketed with manufacturer instructions and safety warnings. Although in the present case the patient was referred by a plastic surgeon, as a pediatric dentist, one should be aware of the existence and management of such injuries in their routine practice and must counsel parents for taking adequate safety measures during the use of firecrackers.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]