Changes in the characteristics of facial fractures in children and adolescents in Portugal 1993–2012

Epidemiology and Pattern of Pediatric Maxillofacial Trauma: A 5-Year Retrospective Study

PURPOSE

To analyze the epidemiology, pattern, and prevent measurement of pediatric maxillofacial trauma in Xinjiang, China.

PATIENTS AND METHODS

Clinical records of patients aged 0 to 18 years with maxillofacial trauma over the 5 years were reviewed. Epidemiological features of data were collected for the cause of injury, age and sex distribution, frequency and type of injury, localization and frequency of soft tissue injuries, facial bone fractures, and presence of associated injuries. Statistical analyses performed included descriptive analysis, χ 2 test, and logistic regression analyses.

RESULTS

Among the 450 patients, 333 were male and 117 were female, with a male-to-female ratio of 3.8:1, the mean age was 9.2±5.4 years; 223 cases were soft tissue injuries and 227 cases were maxillofacial fractures. The 16 to 18-year-old group was the highest, with the prevalence of maxillofacial fractures. The most common cause of pediatric maxillofacial trauma was traffic injuries.

CONCLUSION

The incidence of maxillofacial trauma in pediatric patients correlates with a number of factors, including age, sex, and etiology of trauma. The 16 to 18-year-old group is the most prevalent group for maxillofacial trauma in pediatric patients, and traffic accidents are the leading cause of maxillofacial trauma in pediatric patients.

Analysis of Pediatric Facial Fracture Repair Rates and Complications Using California's Office of Statewide Health Planning and Development Database

BACKGROUND

There exists a paucity of data on which pediatric facial fractures should be surgically repaired and when. In this study, the authors used a California state-wide database to determine the prevalence of facial fractures in the pediatric population and examine, which fractures are repaired. in addition to the timing of the repair, complications and resource utilization of the healthcare system were analyzed.

METHODS

Pediatric patients under the age of 18 were identified using the California Office of Statewide Health Planning and Development patient discharge database for admissions occurring between January 2015 and December 2018. International Classification of Diseases, Version 10 diagnosis codes were used to classify facial fractures. The associated diagnoses, complications, and number of subsequent repairs patients underwent were analyzed to determine the typical course of pediatric facial fractures.

RESULTS

Of the 3058 patients diagnosed with facial fracture, 32% underwent surgical repair (N = 982). The 4 most repaired fractures were mandible (40%), nasal (16.2%), and orbital (15.1%). Surgical intervention steadily increased with age, with a peak in the 12 to 15-year-old cohort.

CONCLUSIONS

Our analysis found that most fractures were managed nonoperatively, but those that did receive an operation did so during their index admission. In addition, the most repaired fractures were mandibular, nasal, and orbital fractures. The present study represents 1 of the largest pediatric samples to have assessed facial fractures, repair rates, and their sequelae.

Pediatric Facial Fractures in South Australia: Epidemiology, Clinical Characteristics, and Outcomes

INTRODUCTION

Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia.

METHODS

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study.

RESULTS

A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P < 0.05). Boys were 2.3 times more likely to have a sport-related facial fracture than girls. Early adolescence were 5.2 times more likely to have an orbitozygomatic fracture than children of early childhood (P < 0.05). Age, associated injuries, and sport-related facial fractures were independently associated with increased length of stay (P < 0.001).

CONCLUSIONS

There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.

Sport and Recreational Causes of Nasal Bone Fractures

OBJECTIVE

Nasal bone fractures are the most common facial bone fractures. However, there is limited literature on the etiology of these fractures, particularly distribution across sports and other recreational activities.

METHODS

The Nationwide Electronic Injury Surveillance System (NEISS) national injury database was queried for emergency department visits involving the diagnosis of nasal or nose fractures associated with sports and recreation activities over the most recent 10 year span available. Demographic, disposition, and weighted incidence were analyzed.

RESULTS

Total incidence of nasal fractures across 10 years was 158 979. The mean age of nasal bone fractures was 20.4 years old. Nasal fractures were more common in males (74.6%) and white patients (54.1%). National estimated incidence of nasal fractures decreased from 21 028 in 2009 to 11 108 in 2018, a reduction of 47.2%. The most common causes among all patients were basketball (23.2%), baseball (17.1%), softball (9.8%), soccer (7.4%), and football (7%). In pediatric patients, the most common cause was baseball (25.1%). The majority (98.1%) of patients were discharged from the emergency department, while 0.9% of patients were admitted.

CONCLUSION

The most common recreational causes of nasal fractures are sports, with the most common being non-contact sports like basketball and baseball. However, the incidence of nasal bone fractures due to recreational causes nationwide has decreased significantly over the past 10 years. This may reflect improved safety protocols among athletes.

Closed versus open reduction of facial fractures in children and adolescents: A systematic review and meta-analysis

Background

Treatment of facial fractures in children and adolescents has always been a challenge for oral surgeon. The choice of treatment type must take into account several factors. This systematic review aimed to evaluate closed versus open reduction of facial fractures for pediatric facial fractures.

Material and Methods

A systematic review of the literature was conducted in three databases (PubMed/MEDLINE, Embase and The Cochrane Library) in accordance with the PRISMA statement. The PICO question was: Conservative treatment is more appropriate than surgical treatment for reducing facial fractures in children and adolescents? The full papers of 41 references were analyzed in detail. Eleven papers were included in this systematic review: one prospective study and ten retrospective studies. All studies evaluated the complication rate.

Results

A total of 73 (7.68%) of the 950 patients experienced complications. Among these patients, 24 (3.85%) had been treated with conservative treatment and 49 (15.03%) with surgical treatment. The fixed-effects model revealed a lower complication rate with conservative treatment than surgical treatment (P<0.00001; RR: 0.18; 95% CI: 0.11-0.28). Heterogeneity was low for the complication rate outcome (X2: 5.64; P = 0.69; I2: 0%).

Conclusions

The present findings show that conservative treatment is more commonly performed for pediatric facial fractures and complications occur more with surgical treatment. Therefore, surgeons must evaluate all variables involved in choosing the most appropriate treatment method to ensure greater benefits to the patient with fewer complications. Key words:Closed fracture reduction, open fracture reduction, pediatrics, treatment failure.

Analysis of pediatric maxillofacial trauma in North China: Epidemiology, pattern, and management

PURPOSE

To analyze epidemiology, pattern, and management of pediatric maxillofacial trauma in North China.

PATIENTS AND METHODS

Clinical records of patients aged 0-18 years with maxillofacial trauma, from January 2008 to December 2016 were reviewed. 390 patients with an average age of 9.8 ±5.8 years (range: 8 months-18 years) and a male:female ratio of approximately 2:1 were included in the study. Epidemiological features (age, sex, etiology), characteristics of injuries (locations, types, associated injuries), treatments, and complications were analyzed.

RESULTS

Among 55 patients with soft tissue injuries, palate was the most common site (32.7%). Among 335 fracture cases, the most common age group was 16-18 years (25.1%); falls was the main cause (38.2%). Overall, there were 450 fractures (1.78 per capita), primarily mandible (69.3%), followed by zygoma (12.9%), maxilla (7.7%) and other sites. Multiple fractures occurred in 61.5% of patients. The most common site of mandibular fractures was condyle. The proportion of mid-face fractures to mandibular fractures increased with age (p < 0.01) and stabilized gradually after 12 (approximately 1.14:1). 77.5% of fractures were treated surgically. There was an independent association of surgical intervention with age older than 6 years old (p < 0.05). Absorbable plates were mainly applied to mandibular fractures in patients aged 0-7 and only 1 was removed because of insufficient fixation strength.

CONCLUSIONS

The primary cause of pediatric maxillofacial fractures in North China was falls; traffic accidents led more multiple fractures and associated injuries. Palate and mandible were the most common sites of pediatric maxillofacial soft tissue injuries and fractures, respectively. The proportion of mandibular fractures to mid-face fractures decreased with the increase of age until 12.

Oral and cranio-maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital

BACKGROUND/AIMS

Very few studies have been performed to evaluate cranio-maxillofacial trauma diagnosed in hospitals in children and adolescents. The aim of this study was to perform an analysis of oral and cranio-maxillofacial trauma in the aforementioned population.

MATERIALS AND METHODS

A hospital-based retrospective study, which reviewed 1438 patient records, was conducted at the "Teresina Emergency Hospital", Brazil. Data regarding demographics, day of the week on which trauma occurred, type of injury, etiology, anatomic trauma site, time of hospital admission, and associated comorbidities (or injuries) were collected.

RESULTS

There were 1092 (75.9%) males and 346 (24.1%) females. The largest group was adolescents aged between 13 and 18 years (956, 66.5%). The majority lived in urban areas (69%). Trauma occurred most frequently during the week. The most prevalent etiology was road traffic accidents involving motorcycles (771, 53.6%) causing facial and skull fractures (598, 41%). The most prevalent soft tissue lesions were facial abrasions (49%), followed by injuries to the cheek (16.7%). Comorbidities associated with craniofacial trauma were present in 82%, with complications from traumatic brain injuries being the most prevalent (65.6%) Dental trauma was recorded in only 81 cases (5.6%).

CONCLUSION

Male adolescents living in urban areas were most affected by craniofacial trauma. The most common cause was road traffic accidents involving motorcycles, resulting in facial and skull fractures. Complications from traumatic brain injuries were the most common associated injuries.

Traumatic Facial Fractures in Children and Adolescents

This study showed a retrospective analysis of the incidence and pattern of traumatic facial fractures in a pediatric and adolescent population (≤18 years old) in China. The authors retrospectively reviewed 154 children and adolescent who had traumatic facial fractures and who were admitted to our university-affiliated hospitals from 2005 to 2010. This study enrolled 109 males and 45 females aged 11.9 ± 5.2 years old. The incidence peaked around the periods of 12 to 18 years in the male, ≤6 and 16 to 18 years in the female. The most common etiologies were motor vehicle collisions (MVCs) (60, 39.0%), followed by high fall (40, 26.0%), low fall (32, 20.8%). The most common fracture sites were mandible (78, 50.6%) and nose (33, 21.4%), followed by orbit (31, 20.1%). A total of 35 (22.7%) patients suffered neurological deficit. The patients in the 12 to 18 age range group accounted for the largest proportion of 54.5%. Fracture incidence showed peaks between the hours of 12:00 to 16:00 PM (33.7%), during the autumn season (30.5%) and on Friday to Sunday (50.0%). The most common etiology and fracture site were MVCs and mandible, respectively. Etiologies and patterns of traumatic facial fractures vary with age. Continued efforts toward injury prevention of traumatic facial fracture among the children and adolescents are warranted.

Oral motor and electromyographic characterization of adults with facial fractures: a comparison between different fracture severities

OBJECTIVES:

To characterize the oral motor system of adults with facial injuries and to compare the oral motor performance/function between two different groups.

METHODS:

An observational, descriptive, cross-sectional study was conducted in 38 patients presenting with facial trauma who were assigned to the Division of Orofacial Myology of a Brazilian School Hospital. Patients were divided into two groups: Group 1 (G1) consisted of 19 patients who were submitted to open reduction of at least one facial fracture, and Group 2 (G2) consisted of 19 individuals who were submitted to closed fracture reduction with maxillomandibular fixation. For comparison purposes, a group of 19 healthy volunteers was recruited. All participants underwent a clinical assessment that included an oral motor evaluation, assessment of the mandibular range of motions, and electromyographic assessment of the masticatory muscles.

RESULTS:

Clinical assessment of the oral motor organs indicated that G1 and G2 presented deficits related to the posture, position, and mobility of the oral motor organs. Patients also presented limited mandibular ranges of movement. Deficits were greater for individuals in G1, especially for maximal incisor opening. Additionally, patients in G1 and G2 presented a similar electromyographic profile of the masticatory muscles (i.e., patients with facial fractures presented lower overall muscle activity and significant asymmetrical activity of the masseter muscle during maximum voluntary teeth clenching).

CONCLUSION:

Patients in G1 and G2 presented similar functional deficits after fracture treatment. The severity of facial fractures did not influence muscle function/performance 4 months after the correction of fractures.