Differences in the Management of Pediatric Facial Trauma

Extreme midface injury and superior maxillary impaction in an adolescent

We present a case of an adolescent who sustained multiple facial fractures following a high-speed, head-on skiing collision. The patient presented to a level 1 trauma centre with bilateral LeFort I, LeFort II, naso-orbital ethmoid fractures and superior maxillary displacement to the level of the orbits requiring a staged operative approach to (1) disimpact the maxillary LeFort I segment and (2) reduce and fixate the multilevel facial fractures. The patient was discharged home with close follow-up, and after 1 year, had preservation of appropriate facial proportions without complications. This case study focuses on the triage, management and surgical planning of paediatric midface fractures, which are relatively uncommon to treat. Special considerations for repairing facial fractures in adolescents are discussed.

Impact of COVID-19 pandemic on the dynamic of patients with oral and maxillofacial trauma: interrupted time-series analysis

Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.

Maxillofacial Trauma in Pediatric Patients: A Retrospective Study

Objective

The study was conducted to analyze the pattern, etiology and management of maxillofacial trauma in children up to 16 years of age.

Study Design

Records of the patients who sustained maxillofacial trauma from 2013 to 2018 were retrospectively evaluated for age, gender, etiology, pattern of injuries and their management. Children were divided into three groups-primary (0-5 yrs), mixed (6-11 yrs) and permanent dentition group (12-16 yrs). Maxillofacial trauma was observed as midface fracture, mandible fractures, soft tissue injuries and associated tooth fractures. SPSS software version 19.0 was used for the data analysis.

Result

A total record of 99 children were evaluated. Gender-wise distribution was reported twice in male than females. Fall was observed as the major etiological factor (73.7%) with a significant p value of 0.012 using chi-square test. The highest frequency of maxillofacial trauma is noted in mixed dentition group (47.4%). Mandible fracture was most frequently observed followed by associated soft tissue injury. Conservative approach/closed reduction for management was executed for the majority of cases.

Conclusion

Knowledge gained from the present study would help in assessing the effectiveness of present preventive modalities and facilitate elaboration of future preventive measures and new research works as well.

Pediatric Facial Soft Tissue Repair and Reconstruction

There are unique considerations for the management, repair, and reconstruction of pediatric facial soft tissue injuries. Conventional methods for the repair and reconstruction of facial soft tissue injuries can be successfully applied in children with considerations for anatomic and physiologic differences and the growth potential of a child. Attention to correct form, framework, and esthetics guides the proper reconstruction of individual regions on the face. Choice of approach ultimately depends on and the size, severity, location of injury, and surgeon's preferences.

A review on artificial intelligence for the diagnosis of fractures in facial trauma imaging

Patients with facial trauma may suffer from injuries such as broken bones, bleeding, swelling, bruising, lacerations, burns, and deformity in the face. Common causes of facial-bone fractures are the results of road accidents, violence, and sports injuries. Surgery is needed if the trauma patient would be deprived of normal functioning or subject to facial deformity based on findings from radiology. Although the image reading by radiologists is useful for evaluating suspected facial fractures, there are certain challenges in human-based diagnostics. Artificial intelligence (AI) is making a quantum leap in radiology, producing significant improvements of reports and workflows. Here, an updated literature review is presented on the impact of AI in facial trauma with a special reference to fracture detection in radiology. The purpose is to gain insights into the current development and demand for future research in facial trauma. This review also discusses limitations to be overcome and current important issues for investigation in order to make AI applications to the trauma more effective and realistic in practical settings. The publications selected for review were based on their clinical significance, journal metrics, and journal indexing.

Pediatric Head and Neck Trauma

The pediatric patient population has unique anatomic characteristics that bring challenges and increased risk to management. The purpose of this article is to guide the head and neck trauma surgeon in decision making for the treatment of pediatric head and neck trauma with an emphasis on facial fracture management.

Motorcycle Accidents are the Strongest Risk Factor for Panfacial Fractures Among Pediatric Patients

Study Design

A retrospective cohort study was conducted using the Kids' Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture.

Objective

The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population.

Methods

The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures.

Results

Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (P < .01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (P < .01) to result in panfacial fractures while car accidents were over two times more likely (P < .01) to result in panfacial fractures. Falls were less likely (OR, .39; P < .01) to result in panfacial fractures.

Conclusions

Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle.

Pediatric Panfacial Fractures

Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.

Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire

PURPOSE

The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.

METHODS

A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.

RESULTS

Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.

CONCLUSION

The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.

Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study

Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13-18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular-86.2%; midface-91.7%; combined-66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy.

Paediatric condylar trauma - primary management considerations - A review

Children are not simply ''small adults'', and the application of adult-type treatment can be inappropriate in many circumstances. Their craniomaxillofacial (CMF) structure changes dramatically as children grow and develop. This anatomical change also changes the location, pattern, and nature of CMF injury. Similarly, condylar architecture and anatomy also differ in children, due to which the management of paediatric condylar fractures is strikingly different from adult condylar fractures. In addition to this physiological, and behavioural differences pose an additional challenge to a surgeon. Paediatric condylar fracture also considers conservative/non-operative treatment as an effective treatment option. However, the decision between operative and non-operative management compromises paediatric facial growth, precise reduction, and rigid fixation. This decision is crucial and is guided by many factors. Improper treatment protocol can have a devastating effect on a child facial growth and development. It can lead to various deforming complications mainly ankylosis. Hence treatment of paediatric condylar fracture should be well planned and executed.

The current regenerative medicine approaches of craniofacial diseases: A narrative review

Craniofacial deformities (CFDs) develop following oncological resection, trauma, or congenital disorders. Trauma is one of the top five causes of death globally, with rates varying from country to country. They result in a non-healing composite tissue wound as they degenerate in soft or hard tissues. Approximately one-third of oral diseases are caused by gum disease. Due to the complexity of anatomical structures in the region and the variety of tissue-specific requirements, CFD treatments present many challenges. Many treatment methods for CFDs are available today, such as drugs, regenerative medicine (RM), surgery, and tissue engineering. Functional restoration of a tissue or an organ after trauma or other chronic diseases is the focus of this emerging field of science. The materials and methodologies used in craniofacial reconstruction have significantly improved in the last few years. A facial fracture requires bone preservation as much as possible, so tiny fragments are removed initially. It is possible to replace bone marrow stem cells with oral stem cells for CFDs due to their excellent potential for bone formation. This review article discusses regenerative approaches for different types of craniofacial diseases.

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.

Malar and maxillary fractures among pediatric patients and the risk factors for mortality

BACKGROUND/AIMS

No studies have characterized the morbidity and mortality of maxillary & malar fractures on a national scale. The aim of this study was to examine the risk factors for mortality in pediatric patients who had sustained maxillary and malar fractures by using a national pediatric hospital inpatient care database.

MATERIALS AND METHODS

This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the cause of injury. The primary outcome variable was mortality rate. Additional predictor variables included age, gender, race, income, payer information, year and place of injury, number of facial fractures, concomitant facial fractures, other fractures of the body, and intracranial/internal organ injury. Univariate and multivariate regression models were performed to assess risk factors for mortality. Statistical significance was set to a p-value <.05.

RESULTS

A total of 5859 patients met the inclusion criteria. The most common age group was 13-17 years of age (n = 3816, 65.1%). Motor vehicle accidents were the most common mechanism of injury (n = 2172, 37.1%). The presence of cranial vault (OR = 2.81, p = .017), skull base (OR = 2.72, p < .001), and vertebral column fractures (OR = 2.13, p = .016), as well as sub-arachnoid hemorrhage (OR = 4.75, p = .005), traumatic pneumothorax/hemothorax (OR = 2.16, p = .015), and heart/lung injury (OR = 3.37, p < .001) were each independently associated with increased odds of mortality.

CONCLUSIONS

Patients in their late teens most commonly sustained malar and maxillary fractures, likely due to general trends in craniomaxillofacial development. The presence of other fractures located in close proximity to the mid-face increased the risk of mortality among pediatric patients with malar and maxillary fractures. This may be explained by the anatomical approximation of the mid-face to vital neurovascular structures of the head, which, when damaged, may prove fatal.

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.

Adolescent Orofacial Trauma

Facial and dental-related trauma is common in the pediatric population. Appropriate evaluation and management techniques should be followed. Initial evaluation of the medical condition of the patient should be completed with acute management of any medical-related problems as a priority. ABCDEs of pediatric trauma should be followed and a thorough head and neck and oral examination completed with appropriate imaging if indicated. Newer dental trauma treatment protocols developed by the International Association of Dental Traumatology should be followed for best outcomes. Pediatric traumatic dental injuries generally have good prognosis by attempting to retain and stabilize teeth.

Acquired Facial, Maxillofacial, and Oral Asymmetries—A Review Highlighting Diagnosis and Management

Facial asymmetry refers to the absence of, or the deviation from the regular mirror image of facial structures, relative to a referenced midline axis. It can be attributed to a wide spectrum of deformities, including congenital, developmental, or acquired conditions, which can originate either prenatally or postnatally. Though highly prevalent, asymmetry commonly goes undiagnosed due to its subtle or relative nature. Among the spectrum of conditions, acquired cases are triggered postnatally, in previously normal individuals, thus subjecting them to sudden, eventful psychological and psychosocial disharmony. When detected early, timely management may help intervene progressive growth of these conditions. This, therefore, emphasizes the need for a thorough diagnostic workup including medical/dental history, clinical examinations, study models, photographic and radiographic records for a case-by-case basis to prevent severe functional and aesthetic complications. Recently, advanced diagnostic procedures, such as stereophotogrammetry, 3D stereolithographic models, skeletal scintigraphy (radionucleotide scans), 3D computed tomographic scans, cone-beam computed tomography, and magnetic resonance imaging, have provided innovative diagnostic instruments for numerous craniofacial defects. This descriptive review aims at focusing on the factors leading to frequently encountered conditions of acquired facial asymmetry and highlights their clinical evaluation, conservative and surgical interventions by a multi-disciplinary team of clinicians.

Aquatic Activity-Related Craniofacial Injuries Presenting to United States Emergency Departments, 2010 to 2019

PURPOSE

Aquatic activities are some of the most widely enjoyed sports and recreational activities in the United States. This study aimed to analyze the risks and types of craniofacial injuries associated with various aquatic activities.

METHODS

We retrospectively analyzed aquatic activity-related craniofacial injuries between 2010 and 2019 using the National Electronic Injury Surveillance System database. Aquatic activities included swimming, diving, surfing, water skiing, and water tubing. Risks and types of craniofacial injuries were analyzed according to the types of aquatic activities, age, and sex.

RESULTS

Among 48,112 patients with aquatic activity-related injuries, 9,529 (19.8%) had craniofacial injuries. In decreasing order of frequency, the causes of craniofacial injuries were swimming (79.6%), diving (7.5%), surfing (5.9%), water skiing (3.6%), and water tubing (3.5%). The proportion of craniofacial injuries among all injuries was higher in males than in females (22.8 vs 16.3%, P < .001), and decreased with age: 27.7% in 0 to 5 years, 21.5% in 6 to 11 years, 20.5% in 12 to 17 years, and 15.2% in ≥18 years (P < .001). Additionally, the proportion of craniofacial injuries was highest in diving (38.7%), and lowest in swimming (18.1%, P < .001). The male-to-female ratio in the proportion of patients with craniofacial injuries was highest in swimming at 1.42, and close to unity (0.97-1.13) in other activities. The most common type of craniofacial injury was laceration (43.5%), followed by concussion/internal organ injury (38.9%), contusion/abrasion (11.3%), and fracture (3%). Among all craniofacial injuries, the proportion of craniofacial fractures was highest in water tubing (8.5%) and lowest in swimming (2.2%, P < .001).

CONCLUSIONS

Craniofacial injuries are a frequent cause of morbidity related to aquatic activities. Substantial variability exists in the risk and pattern of craniofacial injuries depending on the type of activity, age, and sex. These findings may aid in instituting educational programs and preventive measures against aquatic activity-related craniofacial injuries.

National Trends in Pediatric Facial Fractures: The Impact of Health Care Policy

BACKGROUND

Traumatic injuries are significant sources of morbidity and mortality in the pediatric population. Using a national database, this study aims to characterize pediatric facial fracture management and the effect of health care policy changes on populations receiving treatment.

METHODS

A retrospective cohort study was performed using Healthcare Cost and Utilization Project Kids' Inpatient Database databases from 2000 to 2016. Pediatric patients admitted with a facial fracture diagnosis were included. Clinical outcomes include mortality, reduction of fracture during hospital stay, and open fracture reduction. The impact of the Affordable Care Act on patient demographics and management was assessed.

RESULTS

Between 2000 and 2016, 82,414 patients were managed for facial fractures, 8.3 percent of whom were managed after implementation of the Affordable Care Act (n = 6841). Mean age was 15.2 years, and the male-to-female ratio was 2.9:1. Significant racial disparities were identified before the Affordable Care Act: African American and Native American patients had decreased odds of having facial fracture reduction during the initial hospital stay (OR, 0.84 and 0.86, respectively), and identifying as either Hispanic or Native American was associated with higher odds of mortality (OR, 1.4 or 2.4, respectively). Race was not contributory to patient mortality after the Affordable Care Act. Before Affordable Care Act implementation, patients receiving care with no charge (including charity care/charity research) had lower odds of having an open reduction or any reduction; insurance status was not contributory to management after the Affordable Care Act.

CONCLUSION

Although the Affordable Care Act may have increased access to care for certain populations, race- and sex-associated differences in mortality rate and fracture management should be further investigated to ensure a national standard of equitable patient care.

The Association of Zygomaticomaxillary Complex Fractures with Naso-Orbitoethmoid Fractures in Pediatric Populations

BACKGROUND

Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures alone. However, there is a paucity of information on this complex fracture pattern in the pediatric population. This study investigated the cause, treatment, and outcomes of combined zygomaticomaxillary complex and naso-orbitoethmoid fractures versus isolated zygomaticomaxillary complex fractures in pediatric patients.

METHODS

This was a 25-year retrospective cohort study of pediatric patients who presented to a single institution with zygomaticomaxillary complex fractures. Baseline patient demographics and clinical information, and concomitant injuries, treatment/operative management, and postoperative complications/deformities were recorded and compared between patients with combined zygomaticomaxillary complex and naso-orbitoethmoid fractures and patients with isolated zygomaticomaxillary complex fractures.

RESULTS

Forty-nine patients were identified to have had zygomaticomaxillary complex fractures in the authors' 25-year study period, of whom 46 had adequate clinical documentation and follow-up. Seventeen patients had combined zygomaticomaxillary complex-naso-orbitoethmoid fractures, of whom six had panfacial fractures. Both patient groups (zygomaticomaxillary complex only and combined zygomaticomaxillary complex-naso-orbitoethmoid fractures) were similar in terms of demographics. However, a significantly greater proportion of combined fracture patients experienced postoperative complications compared to isolated zygomaticomaxillary complex fracture patients, even after excluding those with panfacial fractures (87.5 percent versus 35.3 percent; p < 0.001). Enophthalmos (37.5 percent) and midface growth restriction (37.5 percent) were the two most common complications/deformities in all combined fracture patients.

CONCLUSIONS

High-impact trauma can lead to zygomaticomaxillary complex fractures with associated naso-orbitoethmoid fractures in children. This injury pattern was found to cause significantly greater postoperative morbidity than isolated zygomaticomaxillary complex fractures alone. Thus, pediatric patients presenting with this complex facial fracture pattern should be closely monitored.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Early Pediatric Multiple Facial Fractures Treatment With Resorbable Fixation

ABSTRACT

The facial skeleton in pediatric patients can undergo several changes during development, according to their growth zones and the traumas they suffer. Thus, some of these traumas can lead to multiple complications if not treated properly. Epidemiology can vary according to the social, cultural, and environmental aspects of each individual. Therefore, each case must be treated individually, and it is important to consider age-specific aspects, such as the high osteogenic potential, which leads to faster bone healing. The use of resorbable fixation materials in facial fractures of pediatric patients is widespread, with good acceptance and great advantages over conventional titanium materials, mainly for the elimination of a second surgery to remove the materials. The present study aims to report a series of clinical cases of infants, who suffered trauma and evolved with fractures in the facial bones. Surgical treatment was instituted to reduce and fix fractures, using the resorbable system. Patients are followed up with periodic outpatient follow-up visits and have a good case evolution.

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.

Characteristics of pediatric maxillofacial fractures in Kuwait: A single-center retrospective study

BACKGROUND

Pediatric maxillofacial fractures always present a challenge due to the unique nature of the facial skeleton anatomy and development. The aim of this study was to investigate the incidence, etiology, site of fracture, and management modalities of pediatric maxillofacial fractures in Kuwait.

METHODS

A retrospective cross-sectional study was conducted. The records of all pediatric patients who were diagnosed with maxillofacial fractures and admitted to one of the major hospitals in Kuwait between January 2007 and March 2020 were reviewed.

RESULTS

A total of 186 patients aged between 0 and 13 years old were included. An average of 13 patients was seen each year between 2007 and 2020. The leading cause of the pediatric maxillofacial trauma was road traffic accidents (RTA) that accounted for 38.2% of the patients followed by 22% falls from height (FFH). Male patients were more affected than females, with a ratio of 2.3:1. More than half of the children had mid-face fractures, of which 57% were in multiple sites. Conservative management was the main approach for 52.2% of the patients.

CONCLUSIONS

Pediatric maxillofacial fractures were mainly attributed to road traffic accidents in Kuwait. Mid-face bone fractures were reported more than mandibular fractures and were mostly managed conservatively.

Motor Vehicle Collision Injuries: An Analysis of Facial Fractures in the Urban Pediatric Population

PURPOSE

Motor vehicle collisions (MVC) are a leading cause of unintentional death and injury in the US pediatric population. Compliance with prevention measures such as seatbelts and child safety seats varies considerably with patient demographics. In this study, the authors examine facial fracture secondary to MVC in an urban pediatric population.

METHODS

A retrospective chart review was performed of all facial fractures as a result of MVC in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies.

RESULTS

Seventy-five patients met inclusion criteria for the authors' study. Mean age was 14 years old. Common fracture sites included orbital, mandible, nasal bone, and frontal sinus. Patients were more likely to incur fracture of the zygoma, orbit, nasal bone, frontal sinus, and nasoorbitoethmoid (NOE) if involved in an MVC compared to all other etiologies. Common concomitant injuries included traumatic brain injury, intracranial hemorrhage, and skull and long bone fractures. Open reduction and internal fixation with titanium plates was the most common surgical procedure indicated.

CONCLUSION

Motor vehicle collisions related injury has significant health implications in the urban pediatric population. Orbital, zygoma, and nasal facial fractures and TBI are injuries commonly associated with MVC. The facial fractures are likely due to lack of proper utilization of safety equipment and airbags. Development of effective prevention techniques relies heavily on analysis of injury patterns and management strategies.

Facial Fractures and Mixed Dentition - What Are the Implications of Dentition Status in Pediatric Facial Fracture Management?

INTRODUCTION

The stage of maturation of the pediatric facial skeleton at the time of injury has a significant impact on both facial fracture patterns and management strategies. For instance, the relative prominence of the pediatric cranium during the early years of life affords protection to the structures of the midface, whereas delayed aeration of the frontal sinuses may predispose younger patients to frontal bone fractures. The dentition status of a pediatric patient may have similar implications in the setting of facial fracture. In this study, the authors examine the effect of dentition status on facial fracture patterns and management strategies at an urban, level 1 trauma center.

METHODS

A retrospective chart review was performed for all cases of facial fracture occurring in the pediatric patient population at a level 1 trauma center (University Hospital in Newark, NJ) between 2002 and 2014. A database including patient demographics, facial fracture, and concomitant injury patterns, and operative management data was constructed and analyzed.

RESULTS

A total of 72 patients with mixed dentition met inclusion criteria for our study and were compared against patients with primary (n = 35) and permanent (n = 349) dentition. The mean age at presentation was 9.2 years, with a male predominance of 68%. The most common fracture etiology was pedestrian struck accident (n = 23), fall (n = 21), motor vehicle collision (n = 12), and assault (n = 9). The most frequently identified facial fractures were that of the orbit (n = 31), mandible (n = 21), nasal bone (n = 19), and frontal sinus (n = 14). Additionally, 8 Le Fort and 4 nasoorbitoethmoid fractures were identified. Twenty-one patients (29%) required operative management for 1 or more facial fractures. Operative intervention was required in 38% of mandibular fractures, with 6 patients requiring only maxillomandibular fixation and 2 requiring open reduction and internal fixation with titanium plating. Nine cases of orbital fracture (29%) were managed operatively - 4 with absorbable plates, 3 with Medpor implants, and 8 with titanium plating. Management of all nasal fractures requiring operative intervention was accomplished through closed reduction. Concomitant injuries included traumatic brain injury (TBI) (n = 35), skull fracture (n = 24), intracranial hemorrhage (ICH) (n = 20), and long bone fracture (n = 12). Seventeen patients required admission to the intensive care unit. Patients with mixed dentition were significantly more likely to sustain frontal sinus and Le Fort fractures (P < 0.01), as well as skull fracture, ICH, and TBI (P < 0.01) as compared to those with permanent dentition.

CONCLUSIONS

The dentition status of a pediatric patient may have significant implications in both patterns of injury and operative management strategies in the setting of acute facial trauma. Our study finds that Le Fort and frontal sinus fractures were significantly more common in patients with mixed dentition. Severe concomitant injuries such as ICH and TBI were also significantly more likely in this cohort. A patient's dentition status may also play a role in the decision for ridged fixation of mandibular and orbital fractures, as well as the method of maxillomandibular fixation in maxillary and mandibular alveolar fracture.

Patterns of pediatric cervical spine fractures in association with mandibular and facial fractures

OBJECTIVES

To determine the incidence, demographics, and outcomes of concurrent cervical spine (C-spine) fractures in pediatric facial trauma.

METHODS

The Kids' Inpatient Database (KID) from the 2016 Healthcare Cost Utilization Project (HCUP) was queried for various facial fractures using International Classification of Diseases Tenth Revision (ICD-10) diagnosis codes. Mandible fractures were further subdivided into fracture site. Patients aged 0-18 were included, and rates of C-spine fracture were analyzed with regards to demographic factors, length of stay, total charges, mortality rate, hospital characteristics, and concurrent facial fractures.

RESULTS

Of 5568 patients included, 4.18% presented with C-spine fracture. Children with C-spine fractures were significantly older (15.02 vs 12.76 years, p < 0.001) and length of stay was significantly longer (11.33 vs 6.44 days, p < 0.001). There was no difference in rate of C-spine fracture when stratified by gender, time of week/year, hospital location/type, or facial fracture other than subcondylar fractures. Subcondylar fractures were positively associated with C-spine fractures (OR 2.08, p = 0.002). C-spine fractures were associated with significantly higher mortality, length of stay, rate of tracheostomy, transfer out of index hospital, and total hospital charges.

CONCLUSIONS

A significant association exists between subcondylar mandible and C-spine fractures. Awareness of this information is vital for clinicians who manage pediatric facial trauma and alerts them to the need to rule out C-spine fractures in this group as these patients have significantly higher lengths of stay, total mean hospital costs, mortality and tracheostomy rates.

Conservative management of pediatric mandibular distal fractures-A retrospective study

BACKGROUND/AIM

Pediatric mandibular distal fractures present unique treatment challenges which are usually managed with open reduction and internal fixation (ORIF) with the risk of developing tooth bud injuries. Conservative management through maxillomandibular fixation (MMF) with orthodontic bracket-elastic as an out-patient department (OPD) service has been used for these fractures presenting with derangement of occlusion. The aim of this study was to retrospectively analyze MMF with orthodontic bracket-elastic as a treatment method and its outcome for management of pediatric mandibular distal fractures.

METHODOLOGY

Data of seventeen pediatric cases diagnosed with displaced mandibular distal fractures managed with MMF with orthodontic bracket-elastic over a period of 5 years were analyzed. In this technique, two weeks of immobilization and one week for guiding elastics were used.

RESULTS

The mean age of patients was 7.6 ± 1.6 years with a mean follow-up of 24 months. All fractures healed uneventfully with satisfactory occlusion. The cases included 23.5% minimally displaced, and 64.7% moderately displaced and 11.8% significantly displaced fractures with step deformity with successful remodeling of the lower border contours over a duration of 18 months ± 1 month. The developing tooth buds in the fracture line showed no complications except for root dilacerations/malformation (n = 3).

CONCLUSION

MMF with orthodontic bracket-elastic is a viable and conservative technique for the management of pediatric mandibular distal fractures which need to be verified through randomized trials for generalization of the results.

Assessment of Panfacial Fractures in the Pediatric Population

PURPOSE

Management of panfacial fractures is critical and often difficult in adults; however, there is little to no literature regarding these fractures in the pediatric population. In this study, we present our experience to provide insight and further investigation regarding prevention and management strategies within the pediatric population.

PATIENTS AND METHODS

We performed a retrospective chart review of all panfacial fractures in the pediatric population between 2002 and 2014 treated at an urban, level 1 trauma center (University Hospital, Newark, NJ). Data including patient demographic characteristics, mechanisms of injury, locations of fractures, concomitant injuries, and surgical management strategies were collected.

RESULTS

We identified 82 patients aged 18 years or younger who had sustained a panfacial fracture. The mean age at the time of injury was 12.9 years, with a male predominance of 64.9%. A total of 335 fractures were identified on radiologic imaging. The most common etiologies were motor vehicle accidents and pedestrians being struck. Orbital, frontal sinus, nasal, and zygoma fractures were the most common fractures. The mean score on the Glasgow Coma Scale on arrival was 12.0. A total of 29 patients were intubated on arrival-or before arrival-at the trauma bay. A surgical airway was required in 9 patients. The most common concomitant injuries were traumatic brain injury, intracranial hemorrhage, and skull fracture. Surgical repair was required in 38 patients. The cephalic-to-caudal approach was used most, followed by caudal to cephalic, medial to lateral, and lateral to medial. Within a year of the initial surgical procedure, 4 patients underwent reoperations for complications. Four patients died.

CONCLUSIONS

Pediatric panfacial fractures are rare occurrences; however, the impact of these injuries can be devastating, with concomitant life-threatening injuries and complications. Given the lack of literature, as well as the preventable nature of these injuries, we hope this study can address primary prevention strategies and provide insight toward the management and characteristics of these fractures.

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.

Pediatric Maxillofacial Trauma Patterns Among Different Types of Road Traffic Accidents

BACKGROUND

Traffic accidents are one of the most leading cause of maxillofacial trauma. Defining the bone fracture patterns in different type of traffic accidents may enable for appropriate surgical approach.

OBJECTIVES

This study research the pattern of pediatric maxillofacial fractures in terms of different type of traffic road accidents and age groups.

METHODS

The data on road traffic accidents that caused maxillofacial trauma between May 2014 and January 2019 was gained from the University of Gaziantep hospital data system. Road accident type, age groups, and the type of fractures were the evaluation parameters.

RESULTS

A total of 61 patients meet the criteria and 41 of those were boys. The midface bones of orbital, maxillar, and frontal are the most fractured structures with a total number of 48. The least fractured bone was mandibula with a number of 4. The comparisons of these fractures among the different type of road traffic accidents and age groups were found to be statistically significant.

CONCLUSION

Car-pedestrian and car-passengers type of road traffic accident mostly seem to cause midface fractures at the primary and secondary school-aged children.

Wet and wounded: Pediatric facial trauma from swimming and diving

OBJECTIVES

Swimming has been reported as the most common recreational activity among American youths, while diving remains a popular youth activity as well. We characterize the most common facial injuries occurring during these activities and evaluate facial fracture mechanisms and demographic trends, as this information may be helpful in preventative counseling as well as diagnosis.

METHODS

The National Electronic Injury Surveillance System was assessed for swimming- and diving-related facial injuries in children from 2007 to 2016. Estimates of national injury incidence were recorded, and patient diagnoses, demographics, and injury mechanisms were evaluated.

RESULTS

In the 10-year period assessed, 789 NEISS entries extrapolated to an estimated 27,709 patients nationwide were analyzed. The yearly incidence fluctuated but steadily rose from 2013 to 2016. Males comprised a majority of injuries (58%), and laceration was the most common diagnosis (65%), followed by abrasion/contusion (22%) and fracture (9%). Facial fractures were most likely to involve the nasal bones (87%). Swimming injuries were more numerous overall (74%), but a greater proportion of diving injuries resulted in fracture (12% vs. 7%). Teenagers were also more likely to suffer fractures than were younger children involved in the same activities.

CONCLUSION

Most analyses of swimming and diving injuries have focused on spinal and orthopedic trauma. Nevertheless, the nature of headfirst diving and swim strokes suggest facial trauma is an underappreciated concern for clinicians. These findings reinforce the need for safer swimming and diving practices and serve as a useful resource for physicians managing pediatric facial injuries.