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

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study

BACKGROUND/AIM

Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts.

MATERIALS AND METHODS

This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities.

RESULTS

A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries.

CONCLUSIONS

The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

Policy of fourteen maxillofacial divisions towards titanium plates removal after internal fixation of paediatric maxillofacial fractures: A World Oral Maxillofacial Trauma (WORMAT) project

INTRODUCTION

The aim of this 11-year retrospective multicentric study is to evaluate the policy of 14 maxillofacial surgery divisions in terms of titanium plate removal from paediatric patients who had undergone open reduction and internal fixation (ORIF) to treat maxillofacial fractures.

MATERIAL AND METHODS

Patients ≤ 16 years undergoing surgical treatment for fractures of middle and lower third of the face between January 2011 and December 2022, with a minimum follow-up of 6 months, were included. Age (group A: ≤ 6 years, B: 7-12 years, C: 13-16 years), sex, fracture location and type, surgical approach, number, and location of positioned and removed plates, timing and indications for removal were recorded.

RESULTS

191/383 (50 %) patients (median age, 10 years; M:F ratio 2.1:1) underwent removal of 319/708 (45 %) plates. Maxillary dentoalveolar process (91 %), angle/ramus (63 %) and mandibular body (61 %) had a significantly higher removal rate than other fracture sites (p < 0.001). A significant decreasing trend in removal with increasing age was observed, from 83 % in Group A to 24 % in Group C (p < 0.001). On the total of positioned plates, 11 % were removed for symptomatic reasons (5 % infections, 6 % discomfort/pain) and 34 % for other reasons (28 % scheduled removal).

DISCUSSION

This multicentric study showed that plate removal was not performed routinely in the paediatric population. The incidence and causes of symptomatic plates removal were consistent with the literature, while the plate removal rate from asymptomatic patients was lower. A correlation was found between increasing age and a reduction in the frequency of plate removal procedures.

Characteristics, Treatment, and Prognosis of Pediatric Symphyseal/Parasymphyseal-Condylar Fractures

BACKGROUND

Pediatric condylar fractures combined with symphyseal or parasymphyseal fractures are common but challenging to manage. The authors present fracture characteristics, propose a treatment algorithm, and evaluate the treatment prognosis of pediatric symphyseal/parasymphyseal-condylar fractures.

METHODS

A retrospective review was conducted on pediatric patients who underwent treatment for symphyseal/parasymphyseal-condylar fractures in a trauma center between January of 2006 and January of 2021. Demographic and fracture characteristics were recorded. Complications and functional evaluations, including maximum interincisal opening, Helkimo anamnestic index, and clinical dysfunction index, were assessed after at least 1 year of follow-up.

RESULTS

After screening, 104 participants met the inclusion criteria. Among them, 50.96% received open reduction and internal fixation for symphyseal/parasymphyseal fractures and closed treatment for condylar fractures, 45.19% were treated by liquid diet and functional exercise, and the remaining 3.85% with severe malocclusion were treated with the assistance of orthodontic appliances. During follow-up, the average maximum interincisal opening of the patients increased from 17 ± 6.29 mm to 41.64 ± 6.33 mm. No subjective symptoms were observed in 86.54% of the patients and 79.81% showed no or mild clinical symptoms. Except for 1 patient who developed temporomandibular joint ankylosis, no other severe complication was reported. Postfracture remodeling of the nonfractured condyle was noted in 3 cases.

CONCLUSIONS

Pediatric symphyseal/parasymphyseal-condylar fractures present unique biomechanical and anatomic challenges that require special consideration during management. In this study, satisfactory functional prognosis was achieved following implementation of the treatment algorithm.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

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.

Maxillofacial Traumatic Fractures in a Saudi Pediatric Subpopulation: A 10-Year Retrospective Study

AIM

The primary objective of this study was to analyze the patterns and etiology of maxillofacial fractures among hospitalized pediatric patients.

METHODS

A retrospective analysis was conducted on pediatric trauma cases admitted to King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 1, 2010 to December 31, 2020. Data extracted from medical records was utilized to identify and establish correlations with various variables, including age, gender, trauma etiology, and the type of sustained fracture.

RESULTS

The study involved a total of 167 patients. The mean age of the patients was 11.79 years, with the youngest and oldest patients being 2 and 17 years old, respectively. The majority of participants (70.7%, n = 118) were male. A total of 257 fractures were identified, with the highest number (n = 173, 67.3%) occurring in the lower third of the face.

CONCLUSION

Road traffic accidents (RTAs) emerged as the primary cause of trauma in our study, accounting for 73% (n = 122) of cases, followed by falls at 16.8% (n = 28). All instances of polytrauma were linked to RTAs. Fractures in the lower third of the face constituted over two-thirds (67.3%, n = 173) of the total fractures observed. Among the fractures, condyle fractures were the most frequently observed (19.8%, n = 51) in our study.

Maxillofacial Fractures: A Four-Year Retrospective Study of 1828 Cases in West China

OBJECTIVE

To analyze the epidemiological and clinical characteristics of maxillofacial fracture cases in a stomatological center in southwest China.

METHODS

This study includes 1828 cases of maxillofacial fractures treated in our hospital from January 2018 to December 2021. We analyzed the gender, age, causes of injury, fracture sites, concomitant injuries, treatment, and postoperative infection of these cases. Our data are also compared with those from similar domestic studies.

RESULTS

Among the 1828 cases, the male-to-female ratio was 2.48:1 with an average age of 34.55 ± 16.36 years. The highest incidence of fracture was 21-50 years old, and the most common cause of injury was falls (38.95%). There was a statistically significant difference in the composition of injury causes among different age groups(P<0.05). Mandible (37.56%) was the most easily fractured site, and limb injury (17.89%) was the most common concomitant body injury. In all cases, 85.23% of patients were treated with open reduction and internal fixation.  Conclusions: Maxillofacial fractures often occur in the mandible of young and middle-aged men. Falls and traffic accidents are the main causes of injury, often accompanied by limb and brain injuries. Open reduction and internal fixation is still the most commonly used treatment. There are some differences in the results reported by different domestic hospitals.

Oral and maxillofacial emergencies: A retrospective study of 5220 cases in West China

BACKGROUND/AIM

There are no epidemiological reports focused on the oral and maxillofacial surgery emergency department in the West China Hospital of Stomatology. The aim of this study was to analyse the epidemiological characteristics of emergency patients admitted for Trauma and Plastic Surgery Department of the West China Hospital of Stomatology from 2016-2019.

MATERIALS AND METHODS

In this retrospective study, 5220 patients with complete medical records were evaluated. The following data were collected: gender, age, etiology, disease type distribution, anatomic injury site and treatment modality.

RESULTS

There were 3046 males and 2174 females (ratio 1.40:1), with an average age of 16.2 years. The largest group was children aged between 3 and 6 years old (28.3%). Maxillofacial injuries were the most common condition (87.3%), which mostly occurred on the forehead (29.7%), followed by the lips (27.8%). A fall was the leading cause of injury (59.9%), especially in patients younger than 6 years old. There were 327 cases of maxillofacial space infections (MSI), and the mandibular third molars were the most common tooth associated with odontogenic infections (36.2%). Univariable analysis identified that multiple-space infection, visit time and systemic conditions were the risk factors for being admitted to the hospital for treatment. There were 116 patients (2.2%) with bleeding as the main complaint, and most of the maxillofacial bleeding patients could be stopped by compression (52.6%).

CONCLUSION

Males and children aged younger than 6 years were the highest risk populations. Trauma accounted for the majority of emergency patients in maxillofacial surgery. Most maxillofacial injuries involved the forehead and were mainly caused by accidental falls. The proportion of MSI was not high, but serious cases may be life-threatening. The causes of bleeding were diverse, and the bleeding was easy to control.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Analysis of Pediatric Maxillofacial Fractures: A 10-year Retrospective Study

BACKGROUND

The aim of this study is to analyze patterns of maxillofacial fractures in children and adolescent in southeast of China,in a period of 10 years.

MATERIAL AND METHODS

In this retrospective study, the medical records of 162 hospitalized patients under 18 years old were analyzed in the Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Wenzhou Medical University, China. Age, gender, etiology, site, and type of fracture, monthly distribution, weekly distribution, dental complications, and treatment were evaluated. The cases were divided into 3 age groups: group A: 0 to 6 years, group B: 7 to 12 years, and group C: 13 to 18 years.

RESULTS

Three hundred thirty-four maxillofacial fractures in 162 patients younger than 18 years were analyzed. The male to female ratio was 2.24:1 and mean age of these patients was 9.85 years old . Falls were the leading cause of maxillofacial fractures.The most frequent fracture site was mandible. Most patients with maxillofacial fractures were treated by open reduction. And it was done more in adolescents than in children.

CONCLUSIONS

Falls were the main reason for maxillofacial fracutres in childern, and traffic accidents was the leading cause in adolescent. Preventive measures should be applied to reduce occurrences of pediatric facial fractures .Children can not be left at home alone, and monitoring is very necessary when children play in the high place. The government can consider related e-bike driving skills training. Teenagers must pass the relevant electric vehicle test before they can drive. Make the law that the driver of e-bike must wear a safety helmet. Our study shows that open reduction was a good choice for pediatric facial fractures, but usually conservative treatment is a better choice for condylar fractures.

Indications and complications regarding titanium osteosynthesis in pediatric maxillofacial trauma: A scoping review and critical appraisal

With the advent of biodegradable osteosynthesis material, titanium osteosynthesis for ORIF in pediatric maxillofacial trauma is not as indisputable as before. The aim of this study was to conduct a scoping review to assess the indications, complications of ORIF with titanium osteosynthesis material in pediatric maxillofacial trauma. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, gray literature (ICTRP and clinicaltrials.gov) for studies published until April 2022. 3436 studies were screened and finally 13 articles, compromising a sample of 340 pediatric patients were included after full text reading. Reported complications were infection (6.5% of population), malocclusion (5% of population) and dental maleruption (8% of population). Influence on future growth could not be assessed due to short and heterogeneous follow-up periods. Eight of the thirteen studies concluded to a positive and predictable outcome using titanium ORIF for displaced/complex pediatric maxillofacial fractures. Results of this review suggest that titanium ORIF for maxillofacial fractures in the pediatric population is a reliable treatment. The surgeon must be committed to following these patients longitudinally. Interpreting the results should, however, be done with great care, as most articles have a medium to high risk of bias and limited follow-up.

A Retrospective Study Examining the Presentation and Management of Maxillofacial Soft Tissue Injuries Over 3 Years at a Regional Children's Hospital and the Introduction of a Maxillofacial Laceration Grading Scale

Pediatric trauma has been affected by COVID-19, school closures, and stay at home advice. Health seeking behavior has decreased. The aim of this study is to assess trends in the presentation of maxillofacial soft tissue injuries and subsequent management within a regional pediatric hospital. Retrospective study over a 3-year period (from 2019 to 2021 between the months of January and April). Inclusion of all pediatric patients seen by Oral and Maxillofacial Surgery team. Between 2019 and 2021, the total number of patients dropped by over half. The average age dropped from 5.9 in 2019 to 3.8 in 2021. Males were more commonly seen. Falls are the most common cause of injuries across 2019 to 2021. Extraoral injuries increased by 21%. Intraoral injuries reduced by 8%. Lip lacerations accounted for most injuries. In 2020, there was 21% reduction in conservative management of injuries. Wound closure under local anesthetic peaked in 2020, by 12%. Wound closure under general anesthetic has increased by 5%, and accounts for nearly a third of all injuries in 2020 and 2021. Patients are becoming younger and more likely to be male. Conservative management is most common but closure under local anesthetic and general anesthetic has increased. This may indicate an increase in the severity of soft tissue injuries or a trend toward operative management. We also introduce a laceration grading scale for clinician use to assist in assessing and documenting injury severity. Further research is needed to assess whether these trends continue or revert to prepandemic trends.

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study

Background/Aims

Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1‐year period.

Methods

The following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.

Results

Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001).

Conclusion

The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.

Mandibular Fractures: Diagnosis and Management

Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.