Pediatric facial fractures: recent advances in prevention, diagnosis and management

Abstract

During the last 25 years, there have been considerable advances in the prevention, diagnosis and management of craniomaxillofacial injuries in children. When compared to adults, the pattern of fractures and frequency of associated injuries are similar but the overall incidence is much lower. Diagnosis is more difficult than in adults and fractures are easily overlooked. Clinical diagnosis is best confirmed by computed tomographic (CT) scans. Treatment is usually performed without delay and can be limited to observation or closed reduction in non-displaced or minimally displaced fractures. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. Open reduction and rigid internal fixation is indicated for severely displaced fractures. Primary bone grafting is preferred over secondary reconstruction and alloplastic materials should be avoided when possible. Children require long-term follow-up to monitor potential growth abnormalities. This article is a review of the epidemiology, diagnosis and management of facial fractures in children.

Maxillofacial Injuries in Children: A 10 year Retrospective Study

“…In similar series, Holland et al [8] reported that 3 % of children presenting to the emergency department with facial trauma, had a 2:1 male to female ratio. This was in accordance with earlier studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…The site and pattern of fracture depend upon the interrelationship between cause of injury, force of the injury and the unique anatomic features of the child's stage of development [11]. Our study shows the highest incidence of dentoalveolar injuries accounting for 40 % of maxillofacial trauma.…”

Pediatric Maxillofacial Trauma Outcomes Based on a Survey of 65 Patients: A Prospective Study of Etiology, Incidence and Methods of Treatment

“…Decreased total blood and stroke volumes predispose them to greater risk of hypothermia, hypotension and hypoxia after blood loss [1].…”

“…At birth, the ratio between cranial volume and facial volume is approximately 8:1. By the completion of growth, this ratio becomes 2.5:1 [1]. This translates into higher percentage of cranial trauma in younger age group of less than 3 years and a shift to higher incidence of maxillofacial trauma in children after 3 years of age as facial growth starts to overtake the cranial growth due to developing dentition and sinus pneumatisation.…”

Unfolding the Hidden Facts of Paediatric Maxillofacial Trauma

“…Among adolescents, an increase in risk-taking behaviour and a reduction in parental supervision result in an increase in the rate of facial fractures. Still, the overall incidence of facial fractures in the paediatric population is less than 15% of all facial fractures [4].…”