Patterns of paediatric facial fractures in a hospital of São Paulo, Brazil: a retrospective study of 3 years

A meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies among children and adolescents

AIMS

Children and adolescents who are affected by trauma may have complications that are more serious and dangerous. Herein, a meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies according to the geographic regions of the world among children and adolescents was conducted.

MATERIALS AND METHODS

A comprehensive search was performed in four databases of PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2006 until July 7, 2021. To evaluate the quality of included articles, an adapted version of the Newcastle-Ottawa scale was used. The prevalence of maxillofacial trauma was estimated by event rates and 95% confidence intervals in relation to etiology and geographic region of study population.

RESULTS

Through search in the databases and the electronic sources, 3071 records were identified, and 58 studies were eligible for inclusion in the meta-analysis. A total of 264,433 maxillofacial trauma cases were reported by all included studies. Globally, the overall prevalence of maxillofacial trauma was highest due to Road Traffic Crashes (RTC) (33.8%) followed by falls (20.7%), violence (9.9%), and sports (8.1%) in children/adolescents. The highest prevalence of maxillofacial trauma were observed in African population (48.3%) while trauma due to falls was most prevalent in Asian population (44.1%). Maxillofacial trauma due to violence (27.6%) and sports (13.3%) were highest in North Americans.

CONCLUSION

The findings demonstrate that RTC was the most prevalent etiology of maxillofacial trauma in the world. The prevalent causes of maxillofacial trauma differed between the regions of study population.

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.

The Etiology and Epidemiology of Pediatric Facial Fractures in North-Western Romania: A 10-Year Retrospective Study

Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. This research aimed to identify the main factors involved in the etiology of pediatric facial fractures, as well as the epidemiology of pediatric facial fractures in a sample of children and adolescents from North-Western Romania. This 10-year retrospective study was performed in a tertiary center for oral and maxillofacial surgery in North-Western Romania. Medical files of patients that were admitted between 1 January 2002 and 31 December 2022 were analyzed. Pediatric patients aged 0 to 18 years were included in this study. The final sample consisted of 142 children and adolescents diagnosed with facial fractures, with this number representing 14.1% of all patients affected by facial fractures. Most frequently, fractures were identified in the 13–18 age group (78.9%, n = 112), which were more often associated with fractures caused by interpersonal violence than caused by road traffic accidents, falls or animal attacks. Boys were more affected (88%, n = 125), and were more frequently associated with fractures caused by interpersonal violence. The most frequently identified etiological factors included interpersonal violence (50%, n = 71), falls (18.3%, n = 26) and road traffic accidents (11.3%, n = 16). In terms of location, the mandible was the most affected facial bone structure (66.2%, n = 94), and patients with mandibular fractures were more frequently associated with fractures caused by interpersonal violence. The incidence of pediatric facial fractures should be lowered because they may interfere with the proper development of the facial skeleton. Establishing measures aimed at preventing interpersonal violence, as well as other causes involved in the etiology of facial fractures is imperative.

Injury patterns and outcomes in bicycle-related maxillofacial traumata: A retrospective analysis of 162 cases

The objective of the current study is to retrospectively evaluate cycling related dental and maxillofacial injuries and to gain insight into the epidemiology and results of these accidents. Data of patients who were admitted due to the maxillofacial injuries between April 2018 and September 2020 were retrospectively evaluated regarding the patients' characteristics, helmet wearing, type of radiological assessment required for diagnosis and therapy, injury patterns, duration of hospitalization and concomitant injuries. Data of 162 patients were included. 86 (53.08%) patients presented with at least one maxillofacial fracture. A total of 186 maxillofacial bones were fractured. Zygomatico-maxillary complex was the most commonly affected region (n:103, 55,36%). Analysis of the dental traumata revealed that crown fracture without pulp exposure was the most commonly observed entity (n:37, 32.46%) and upper central incisors (n:61, 53.50%) were the most commonly affected teeth. The overall ratio of the number of the fracture line/fracture case was 2.80. However, this ratio was statistically higher in e-bike cases (4.25) compared to non-e-bike riders (2.34) (p:0.014). Bicycle related maxillofacial injuries could correlate with specific morbidity rates and result in severe injuries of the maxillofacial region.

Injury Patterns in Pediatric Facial Fractures Unique to an Urban Environment

This study aimed to define better the clinical presentation, fracture patterns, and features predictive of associated injuries and need for surgery in pediatric facial trauma patients in an urban setting. Charts of patients 18 years or younger with International Classification of Disease 9th and 10th revision (ICD-9/ICD-10) codes specific for facial fractures (excluding isolated nasal fractures) at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017 were retrospectively reviewed. Of 204 patients, most were referred to the emergency department by a physician's office or self-presented. Children (age 0-6 years) were most likely to have been injured by falls, while more patients 7 to 12 years and 13 to 18 years were injured during sporting activities (p < 0.0001). Roughly half (50.5%) of the patients had a single fracture, and the likelihood of surgery increased with greater numbers of fractures. Older patients with either orbital or mandibular fractures were more likely to undergo surgery than younger ones (p = 0.0048 and p = 0.0053, respectively). Cranial bone fractures, CSF leaks, and intracranial injuries were more common in younger patients (p < 0.0001) than older patients and were more likely after high energy injuries; however, 16.2% of patients sustaining low energy injuries also sustained cranial bone, CSF leak, or intracranial injury. In an urban environment, significant pediatric facial fractures and associated injuries may occur after nonclassic low kinetic energy traumatic events. The age of the patient impacts both the injuries sustained and the treatment rendered. It is essential to maintain a high index of suspicion for associated injuries in all pediatric facial trauma patients.

Epidemiology of maxillofacial soft tissue injuries in an oral emergency department in Beijing: A two-year retrospective study

BACKGROUND/AIMS

Maxillofacial soft tissue injuries (STIs) may differ in epidemiological characteristics from other maxillofacial injuries. The aim of this study was to investigate the epidemiology of maxillofacial STIs in a public oral emergency department in Beijing, China, from 2017 to 2018.

MATERIAL AND METHODS

In this retrospective study, 5949 patients with maxillofacial STIs and complete medical records were evaluated. Gender, age, etiology, visit date and time, interval between accident and treatment, anatomic injury site, treatment modality, and the number of associated maxillofacial bone fractures or tooth injuries were analyzed.

RESULT

There were 3831 males and 2118 females (ratio 1.81:1). Patients younger than 10 years were the most frequently seen group (44.2%). Among adults, 20- to 29-years-old (16.2%) was the most prominent age group. The month of May (11.8%) had the highest incidence of maxillofacial STIs, and February (4.5%) had the lowest incidence. The average number of daily visits was significantly higher on holidays than on workdays. Of the 5949 patients, 45.9% attended at night, 2021 patients had dental trauma, and 31 had jaw fractures. The lips were the most common site of STIs, followed by the chin and gingiva. Lip and gingival STIs were more common in the 0- to 10-years-old group. Chin STIs were more common in the 20- to 39-years-old group. A fall was the leading cause of injury, especially in patients younger than 10 years and older than 70 years. Approximately 56.7% of the falls resulted in injuries to the lower one-third of the face. Sports injuries were more common among 10- to 29-years-old individuals.

CONCLUSION

STIs of the maxillofacial region were most likely to occur at night, in May and during holidays. Males, children younger than 10 years and 20- to 29-years-old adults were high-risk populations. Most maxillofacial STIs involved the lips, and one-third of the patients had dental trauma.

Our Treatment Approach in Pediatric Maxillofacial Traumas

BACKGROUND

Maxillofacial injuries in children are rarer in proportion in comparison to adult facial injuries, and they constitute 1% to 15% of all facial bone fractures. The causes and incidence of maxillofacial injuries in children differ based on social, cultural, and environmental factors.

AIM

The purpose of this study is to investigate the etiology, epidemiology, and type of injury in pediatric facial injuries, as well as analyzing types of fractures, related injuries, and treatment options.

MATERIALS AND METHODS

The study obtained the approval of the local ethics board to include 55 pediatric patients in the age group of 0 to 18 years who received inpatient treatment or surgical interventions owing to maxillofacial trauma at an Esthetic, Plastic and Reconstructive Surgery Clinic between January 2016 and December 2018. The patients were examined under 5 groups based on their causes of injury: motorized vehicle accidents (MVA); bicycle; falls (from height or ground level); assault; firearm injuries. They were examined under 6 groups based on the location of their fractures: mandibula, maxilla, orbita, frontal bone, zygomatic arch, nasal bone.

RESULTS

The study included 55 patients of the ages 0 to 18 with the mean age of 11.6 ± 3.2 years. Thirty-seven of the patients (67.2%) were male, whereas 18 (32.7%) were female. Among the causes of injury, the highest number of patients was 25 (45.4%) with MVA. The most frequent location of the fractures was the mandible.

CONCLUSIONS

Consequently, experiences regarding pediatric maxillofacial traumas are limited, and there is no complete consensus on treatment. In difference to the interventions in adults, the dental structure in pediatric patients need to be definitely considered, the least invasive intervention form should be preferred, and observation and follow-up should be practiced in minimally displaced fractures rather than surgical interventions.

The impact of major league baseball on the incidence of operative hand and facial trauma at a level 1 trauma center

Background

Professional affiliation between medical centers and professional sports teams can be mutually beneficial in the provision of healthcare and marketing strategy. Anecdotal evidence suggests a link between trauma volume and sporting events; however, there is limited data. This study aims to characterize the incidence of operative hand and facial trauma during professional baseball home games.

Methods

A retrospective review of surgical cases for traumatic hand or facial injuries at a level 1 center between 1999 and 2012 was performed. Demographic information including date of injury, admission status, and operative repair were collected. Patients were grouped based on whether their trauma occurred on the date of a home game.

Results

Operative hand and facial trauma occurred at a rate of 33.4 injuries per 100 days with home games, compared to 22.2 injuries per 100 days (incidence rate ratios, 1.50; 95% confidence interval, 1.34–1.69). When home games were played, patients were more likely to present as a result of motorcycle accidents (3.1% vs. 1.5%; P=0.04) or bicycle accidents (5.0% vs. 2.6%; P=0.01). Other mechanisms of trauma were not statistically different. There was an increase incidence of injuries during home games in August; weekly variability showed an increased incidence during the weekends.

Conclusions

There was an increased rate of operative hand and facial injuries on dates with professional home games. The incidence of injuries during home games was higher in the late summer and on the weekends. Further analysis may allow improved resource allocation and strategies for injury prevention and treatment.

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.

MAXILLOFACIAL TRAUMA, ETIOLOGY AND PROFILE OF PATIENTS: AN EXPLORATORY STUDY

Objective:

To describe the profile of patients with facial trauma admitted in a hospital located in a metropolitan area of Northeast Brazil.

Methods:

A cross-sectional and exploratory study was performed. A total of 244 cases were in agreement with the eligibility criteria. The variables include the sociodemographic characteristics of patients, etiology, type of trauma, treatment modalities, length of stay in a hospital and quarter of care. Descriptive statistics and Cluster Analysis were performed.

Results:

The average age of patients was 31.16 years (SD = 15.17 years) and average hospitalization was 6.32 days (SD = 7.75 days). It was verified the automatic formation of four clusters with different profiles of patients. The variables which most contributed to the external differentiation between clusters were: length of stay in a hospital (p <0.001), etiology (p <0.001), type of facial trauma (p <0.001), presence of associated trauma (p <0.001), treatment modalities (p <0.001) and quarter of care (p <0.001).

Conclusion:

The most of patients were men, victims of traffic accidents, which suffered fracture of zygomatic complex and underwent surgery. Level of Evidence III, Retrospective Study.

Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents

PURPOSE

This study aimed to determine via systematic review and meta-analysis the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents.

METHODS

A systematic review of articles published from 2006 to 2015 (10 years) in English language was performed. The following databases were used: PubMed/MEDLINE, Scopus, and Web of Science. Observational studies reporting the number of children and/or adolescents who suffered maxillofacial trauma resulting from different etiologies were included. Studies were selected by two independent reviewers (Kappa = 0.737). A proportion meta-analysis using random-effect models was performed to estimate the pooled prevalence and the 95% confidence intervals (CI) using Der-Simonian and Laird weights. Heterogeneity among studies was assessed using the I ² statistics.

RESULTS

A total of 27 studies remained after qualitative analysis including 402,339 patients. The male/female ratio ranged from 1.5:1 to 3.5:1. Road traffic accidents corresponded to the main etiology agent of maxillofacial trauma (34%; 95% CI, 25-44), followed by falls (31%; 95% CI, 25-37), violence (11%; 95% CI, 4-19), sports (4%; 95% CI, 3-5), and others (5%; 95% CI, 2-8). Heterogeneity among studies was high, even stratifying by world region. The adapted version of the Newcastle-Ottawa scale for observational studies showed an intermediate score for most of the included studies.

CONCLUSIONS

Results suggest that road traffic accidents represent the main cause of maxillofacial trauma among children and adolescents. However, results should be interpreted with caution due to the high heterogeneity.

Epidemiology and cause-specific outcomes of facial fracture in hospitalized children

PURPOSE

Facial fractures in the pediatric population have a significant impact on public health. Although some demographic data exists regarding the overall epidemiology of facial fractures, little attention has been paid to the patterns of facial fractures based on the etiology of the trauma.

MATERIAL AND METHODS

The Kids' Inpatient Database 2000-2009 was utilized to analyze pediatric facial fractures. A total of 21,533 patients were identified. Associations of patient characteristics with outcomes of interest were assessed.

RESULTS

The top three etiologies were motor vehicle accident (MVA), intentional trauma (IT), and falls. There was a decrease in the incidence of facial fractures due to MVAs and an increase in injuries due to IT and falls. Concomitant injuries were present in 58.8% and the mortality rate was 2%. The rate of concomitant injuries increased during study period. Age was significantly associated with concomitant injury, mortality, and LOS.

CONCLUSION

The increasing rate of IT and falls with concomitant injury warrants special consideration to reduce undiagnosed accompanying injuries. Further programs should be put in place to protect children younger than 5 years of age, who have increased risk of concomitant injury and mortality following intentional trauma.

Current management of facial fractures in the preadolescent

PURPOSE OF REVIEW

This article reviews the trends in management of preadolescent facial fractures - a challenging population because of the need to consider growth, dynamic changes in dentition, and evolving fracture patterns.

RECENT FINDINGS

Recent findings are a more thorough understanding of fracture patterns and distribution because of recent comprehensive studies isolating the preadolescent age cohort; the role of rigid internal fixation for significantly displaced fractures; and the potential applications and indications for the use of resorbable hardware for fracture fixation in the preadolescent.

SUMMARY

As preadolescent fractures occur in a period of growth and evolving dentition in the facial skeleton, it is mandatory for the treating surgeon to have a thorough knowledge of standard and alternative treatment options to optimally manage these patients.