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Hassan B, Liang F, Grant MP. Pediatric Orbital Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:585-596. [PMID: 37302946 DOI: 10.1016/j.coms.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA.
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TABAKAN İ, KOKAÇYA Ö, ESER C, GENCEL E. Epidemiologic analysis of pediatric maxillofacial trauma. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.920560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Heitz C, Louzada GP, Conci RA, Rodrigues RL, Fritscher GG. Primary Repair of a Complex Panfacial Fracture by Dog Bite. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1719. [PMID: 29876169 PMCID: PMC5977943 DOI: 10.1097/gox.0000000000001719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
Facial fractures due to dog attacks have an unknown incidence rate. To date, only 41 cases of canine bite trauma in a pediatric patient, associated with facial fracture, have been reported in the literature. As major species of involving dogs are the American pitbull terrier and rottweiler. Due to the intense kinematics of this trauma, the treatment becomes complex. Thus, attention to the primary repair of such complex lesions ensures satisfactory results, which is the focus of this discussion. The purpose of this review was to analyze how different ways to approach this type of trauma in children for clarification or correct management. In addition, we address the treatment plan of a complex case of panfacial fracture by a canine bite in a 4-year-old patient. According to a review addressed, the main involved are orbit, nasal, and zygomatic. Antibiotic therapy is indicated for infected bite wounds and wounded considerations at risk of infection, with high complexity and when involving important structures such as bones, vessels, and joints. The state of tetanus immunization and the risk of rabies infection should be routinely addressed in the management of the bite wound.
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Affiliation(s)
- Cláiton Heitz
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Guilherme Pivatto Louzada
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ricardo Augusto Conci
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
| | | | - Guilherme Genehr Fritscher
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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An institutional experience in the management of pediatric mandibular fractures: A study of 74 cases. J Craniomaxillofac Surg 2015; 43:995-9. [DOI: 10.1016/j.jcms.2015.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 01/13/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022] Open
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Qing-Bin Z, Zhao-Qiang Z, Dan C, Yan Z. Epidemiology of maxillofacial injury in children under 15 years of age in southern China. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:436-41. [DOI: 10.1016/j.oooo.2012.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 03/24/2012] [Accepted: 04/03/2012] [Indexed: 10/27/2022]
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Incidence and pattern of maxillofacial fractures in children and adolescents: a 10 years retrospective cohort study. Int J Pediatr Otorhinolaryngol 2013; 77:494-8. [PMID: 23318124 DOI: 10.1016/j.ijporl.2012.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/13/2012] [Accepted: 12/15/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate and compare the demographic characteristics of maxillofacial fractures between children and adolescents. METHODS The sample was composed of all children (less than 12 years) and adolescents (between 13 and 18 years old) who presented with maxillofacial fractures during a 10-year period (2000-2009). The age, gender, time of injury, mechanism of trauma, location and pattern of fracture, associated injuries, and treatment methods were recorded and analyzed. Data analysis included Chi-Square test, Fisher exact test. p less than 0.05 was considered significant. RESULTS Seventy-nine children (male-to-female ratio, 1.63:1) and 113 adolescents (male-to-female ratio, 3.52:1) sustained 389 maxillofacial fractures. Children were more involved in falls compared to adolescents (44.3% versus 23.9%, p=0.003), while adolescents sustained more assault-related injuries (13.3% versus 2.5%, p=0.010) and motorcycle accidents (22.1% versus 8.9%, p=0.015) compared to children. Children suffered mandibular fractures proportionally higher than adolescents (93.1% versus 64.5%, p<0.001). Adolescents sustained mid-facial fractures more frequently than children (35.5% versus 6.9%, p<0.001). Severe facial fractures occurred more in adolescents compared to children (35.4% versus 14.1%, p=0.001). Open reduction was done more in adolescents than in children (92.3% versus 74.6%, p<0.001). CONCLUSIONS The incidence and pattern of maxillofacial fractures in children were remarkably different from that in adolescents. Preventive measures and treatment plan should be designed with differences between the two groups in mind.
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Cançado RP, Cardoso ES, Bourguignon Filho ADM, Borges HOI, de Oliveira MG, Heitz C. Morphometric analysis of the effects of LactoSorb bioabsorbable plates on the craniofacial growth of rabbits using computed tomography. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2006; 17:945-8. [PMID: 16977392 DOI: 10.1007/s10856-006-0184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 08/23/2005] [Indexed: 05/11/2023]
Abstract
This study investigated the effect of bioabsorbable plates and titanium microscrews on the growth of the craniofacial skeleton of rabbits (Oryctolagus cuniculus) in the neonatal period. All animals underwent surgery at seven weeks of age and were killed at twenty-four weeks. In the study group, LactoSorb plate and PROMM titanium microscrews were positioned across the coronal suture. In the control group, only PROMM titanium microscrews were attached to the cranium. Computed tomography was used to obtain morphometric measurements of volume. Results showed no significant intergroup (P < or = 0.05) or intragroup (control group P < or = 0.01; study group P < or = 0.05) differences in craniofacial volume. Under the experimental conditions of this study, bioabsorbable plates did not affect neonatal growth of craniofacial volume in rabbits.
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Affiliation(s)
- Renata Pittella Cançado
- Graduate Program in Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Smartt JM, Low DW, Bartlett SP. The Pediatric Mandible: II. Management of Traumatic Injury or Fracture. Plast Reconstr Surg 2005; 116:28e-41e. [PMID: 16079655 DOI: 10.1097/01.prs.0000173445.10908.f8] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the changing epidemiology of mandibular fractures in children and adolescents. 2. Discuss the appropriate use of internal fixation in the treatment of pediatric mandibular fractures. 3. Describe the difficulties posed by the deciduous dentition in the use of interdental wiring. 4. Understand reasons why techniques specific to adult fractures may not be applicable to the growing mandible. 5. Understand the etiology and epidemiology of pediatric mandibular fractures. 6. Understand the reasons for conservative (closed) versus aggressive (open) treatment of mandibular injury. BACKGROUND Fractures of the pediatric mandible are complicated by the anatomic complexity of the developing mandible, particularly by the presence of tooth buds and the eruption of deciduous and permanent teeth. Traditional methods of fracture reduction and fixation employed in adults have little applicability in the pediatric population. METHODS The authors describe the surgical techniques that have been used at their institution and those that can be used safely in the pediatric setting. RESULTS In most cases, "conservative" management is the preferred option, especially in the treatment of condylar fractures. In cases requiring surgical intervention, interdental wiring, drop wires in combination with circummandibular wires, and acrylic splints are suited well to specific phases of dental maturation. CONCLUSION Open reduction and internal fixation using monocortical screws and microplates or resorbable plates and screws are acceptable techniques in the pediatric patient, but they require special safeguards. Algorithms are presented to simplify management of these complicated injuries.
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Affiliation(s)
- James M Smartt
- Division of Plastic Surgery, Department of Surgery, The University of Pennsylvania Medical Center, The Children's Hospital of Philadelphia, Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, PA 19104, USA
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Abstract
Pediatric craniofacial fractures are distinct from adult fractures because of the anatomical differences that result in unique fracture patterns and challenges in management. The unanswered question remains the outcome with regards to subsequent growth and development. Upon review of all primary craniofacial fractures treated at the Children's Hospital of Philadelphia, the authors find that the majority are associated with favorable long-term outcome. Severe centrofacial bony and cartilaginous injury may result ingrowth and developmental anomalies in up to 40% of patients.
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Affiliation(s)
- Davinder J Singh
- Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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Klenk G, Kovacs A. Do We Need Three-Dimensional Computed Tomography in Maxillofacial Surgery? J Craniofac Surg 2004; 15:842-50; discussion 850. [PMID: 15346028 DOI: 10.1097/00001665-200409000-00026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In a retrospective clinical study (2000-2003), 121 patients' radiographs and computed tomography scans were reviewed to establish the clinical value of three-dimensional computed tomography. Eighty patients had computed tomography scans; 48 had three-dimensional computed tomography scans for diagnosing facial fractures, 3 for diagnosing temporomandibular joint ankylosis, 1 for tumor with bone destruction, and 1 for a mandibular cyst. It is concluded that axial, coronal, and three-dimensional computed tomography is of crucial importance and should be mandatory for all suspected comminuted and displaced midface fractures instead of plain radiographs. Three-dimensional computed tomography is also recommended for comminuted mandibular fractures and temporomandibular joint ankylosis. Three-dimensional computed tomography is not recommended for the diagnosis of minimally displaced fractures.
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Affiliation(s)
- Gusztav Klenk
- Department of Maxillofacial Surgery, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates.
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Williams JK, Ellenbogen RG, Gruss JS. State of the art in craniofacial surgery: nonsyndromic craniosynostosis. Cleft Palate Craniofac J 1999; 36:471-85. [PMID: 10574666 DOI: 10.1597/1545-1569_1999_036_0471_sotaic_2.3.co_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Craniosynostosis refers to the premature fusion of one of the six major sutures of the cranial vault. Functionally, craniosynostosis may be defined as the premature conversion of the dynamic region of growth and resorption between two adjacent bones of the cranium into a static region of bony union. Molecular analysis has blurred the traditional categories of nonsyndromic and syndromic synostosis to some extent, but, in general, the distinctions between the two groups still hold true. The complexity of the congenital anomalies may be limited with the former, whereas the latter usually requires reoperations and correction of the facial skeleton. This article briefly outlines the characteristic deformities produced from nonsyndromic craniosynostosis. Various approaches to surgical correction of the deformities are described. Finally, new biomaterials that are used in the correction of nonsyndromic craniosynostosis are reviewed.
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Affiliation(s)
- J K Williams
- Center for Craniofacial Disorders, Scottish Rite Children's Medical Center, Atlanta, Georgia, USA
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Duhaime AC, Eppley M, Margulies S, Heher KL, Bartlett SP. Crush injuries to the head in children. Neurosurgery 1995; 37:401-6; discussion 407. [PMID: 7501102 DOI: 10.1227/00006123-199509000-00005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Although the majority of head injuries in children and adults involve dynamic loading conditions, some patients suffer static loading. Static loading occurs when forces are applied slowly to the head, and it produces a much different pattern of injuries. Crush injuries are usually described in the context of industrial accidents, but in our experience, these injuries are not rare in children. We report a series of seven crush injuries in young children admitted during a period of 29 months and describe our experience in the evaluation and treatment of this complex entity. Patient ages ranged from 15 months to 6 years. In four cases, the child's head was run over by a motor vehicle backing up in a driveway or parking lot. In the three other patients, the static loading occurred when the child climbed or pulled on a heavy object, which then fell over with the child and landed on the child's head. One child with cervicomedullary disruption died shortly after his arrival at the hospital. The others showed varying degrees of soft tissue injury to the face and scalp, with Glasgow Coma Scale scores ranging from 7 to 15. Computed tomograms and magnetic resonance images showed multiple and often extensive comminuted calvarial fractures, as well as subarachnoid and parenchymal hemorrhages. All patients had basilar cranial fractures. There was one cervical spine injury but no major vascular injuries. One child had pituitary transection, four had cranial nerve palsies, and another developed a delayed cerebrospinal fluid rhinorrhea 18 months after injury. All children made good cognitive recoveries, with some having relatively mild fixed focal deficits.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A C Duhaime
- Division of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA
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Beirne OR, Myall RW. Rigid Internal Fixation in Children. Oral Maxillofac Surg Clin North Am 1994. [DOI: 10.1016/s1042-3699(20)30748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Oral trauma is commonly observed in the emergency department, and the emergency physician has the opportunity to greatly improve prognosis for these types of injuries through prompt and appropriate initial management. Injuries resulting from oral trauma can be physically and psychologically devastating to patients, and initial treatment must often be accomplished before dental consultation is available. This article provides the emergency physician with guidelines for diagnosis, initial management, and referral for oral injuries.
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Affiliation(s)
- C Bringhurst
- Department of Surgery, University of Utah Medical Center, Salt Lake City 84132
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