Maxillofacial Injuries in the Pediatric Patient: An Overview

ABSTRACT Children are uniquely susceptible to craniofacial trauma because of their greater cranial mass-to-body ratio. The pediatric population sustains 1 to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7-80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4-88%). The management of the pediatric patient with maxillofacial injury should take into consideration, the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic and psychological), and the specific injuries and anatomic sites that the injuries affect. The greatest concern when treating the pediatric patient is the effect of the injury or treatment on growth and development. This is both anatomically and psychologically important and may have various effects on management for the different stages of psychological development.

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The Role of Obesity in Motor Vehicle Injuries and Fatalities in the Pediatric Population: A Systematic Review

Journal of Intensive Care Medicine ◽

10.1177/0885066621992738 ◽

2021 ◽

pp. 088506662199273

Author(s):

Zana Alattar ◽

Shelby Hoebee ◽

Eyal Ron ◽

Paul Kang ◽

Eric vanSonnenberg

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Motor Vehicle ◽

Pediatric Population ◽

Extremity Injury ◽

Obese Children ◽

Patients Âgés ◽

Vehicle Accidents ◽

Increased Risk ◽

Extremity Injuries

Purpose: A systematic review done to evaluate obesity as a risk factor for injuries and mortality in motor vehicle accidents (MVAs) in the pediatric population, as there has not been a systematic review done in over 10 years. This study aims to update the literature regarding obesity as a risk factor for injuries in MVAs in the pediatric population. Materials and Methods: A systematic review was conducted according to the PRISMA guidelines with strict inclusion and exclusion criteria, resulting in the use of 3 total articles to analyze obesity as a risk factor for overall injury and mortality in the pediatric population. Results: Zaveri et al demonstrated a statistically significant, but weak, decrease in the odds of extremity injury in overweight patients ages 2 to 17 years old (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-1.0, P ≤ 0.05). On the other hand, Pollack et al and Haricharan et al found an increase in extremity injury in the obese population, in ages 9 to 15 years (OR = 2.54, 95% CI = 1.15-5.59, P ≤ 0.05), and 10 to 17 years (Age 10-13: OR = 6.06, 95% CI = 2.23-16.44, P ≤ 0.05, Age 14-17 OR = 1.44, 95% CI = 1.04-2.00, P ≤ 0.05), respectively. Haricharan et al also found an increase in thoracic injuries in obese children, ages 2 to 13 and increased risk of head/face/neck injury in obese children ages 2 to 5 (OR = 3.67, 95% CI = 1.03-13.08, P ≤ 0.05), but a decreased risk of head injury in obese children ages 14 to 17 (OR = 0.33, 95% CI = 0.18-0.60, P ≤ 0.05). Conclusions: There are sparse data that are conflicting, regarding the effect of obesity on extremity injuries in the pediatric population. Obesity is not protective against thoracic, head, or abdominal injuries. However, it was found to be a risk factor for trunk injuries in ages 2 to 13, as well as head/face/neck injuries for ages 2 to 5. Since the literature is so sparse, further research is warranted in these areas.

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Combat Facial Fractures Sustained During Operation Resolute Support and Operation Freedom’s Sentinel in Afghanistan

Military Medicine ◽

10.1093/milmed/usaa159 ◽

2020 ◽

Vol 185 (9-10) ◽

pp. 414-416

Author(s):

John Breeze ◽

William Gensheimer ◽

Joseph J DuBose

Keyword(s):

Motor Vehicle ◽

Bacterial Load ◽

Trauma System ◽

Gunshot Wounds ◽

High Energy ◽

Facial Trauma ◽

Facial Fractures ◽

Mandible Fractures ◽

Explosive Devices

Abstract Introduction Facial fractures sustained in combat are generally unrepresentative of those commonly experienced in civilian practice. In the US military, acute trauma patient care is guided by the Joint Trauma System Clinical Practice Guidelines but currently none exists for facial trauma. Materials and methods All casualties that underwent surgery to facial fractures between January 01, 2016 and September 15, 2019 at a US deployed Military Treatment Facility in Afghanistan were identified using the operating room database. Surgical operative records and outpatient records for local Afghan nationals returning for follow-up were reviewed to determine outcomes. Results 55 casualties underwent treatment of facial fractures; these were predominantly from explosive devices (27/55, 49%). About 46/55 (84%) were local nationals, of which 32 (70%) were followed up. Length of follow-up ranged between 1 and 25 months. About 36/93 (39%) of all planned procedures developed complications, with the highest being from ORIF mandible (18/23, 78%). About 8/23 (35%) casualties undergoing ORIF mandible developed osteomyelitis, of which 5 developed nonunion. Complications were equally likely to occur in those procedures for “battlefield type” events such as explosive devices and gunshot wounds (31/68, 46%) as those from “civilian type” events such as falls or motor vehicle collisions (5/11, 45%). Conclusions Complications Rates from facial fractures were higher than that reported in civilian trauma. This likely reflects factors such as energy deposition, bacterial load, and time to treatment. Load sharing osteosynthesis should be the default modality for fracture fixation. External fixation should be considered in particular for complex high-energy or infected mandible fractures where follow-up is possible.

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Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111051 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11051

Author(s):

Fang-Yu Hsu ◽

Shih-Hsuan Mao ◽

Andy Deng-Chi Chuang ◽

Yon-Cheong Wong ◽

Chih-Hao Chen

Keyword(s):

Motor Vehicle ◽

Early Recognition ◽

Arterial Embolization ◽

Maxillary Artery ◽

Trauma Patients ◽

Shock Index ◽

Packed Red Blood Cells ◽

Vehicle Accidents ◽

Life Threatening ◽

Craniofacial Trauma

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

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Sports-Related Pediatric Facial Trauma: Analysis of Facial Fracture Pattern and Concomitant Injuries

The Surgery Journal ◽

10.1055/s-0039-1697627 ◽

2019 ◽

Vol 05 (04) ◽

pp. e146-e149 ◽

Cited By ~ 2

Author(s):

Andrew A. Dobitsch ◽

Nicholas C. Oleck ◽

Farrah C. Liu ◽

Jordan N. Halsey ◽

Ian C. Hoppe ◽

...

Keyword(s):

Pediatric Population ◽

Skull Fracture ◽

Management Strategies ◽

Nasal Bone ◽

Fracture Pattern ◽

University Hospital ◽

Facial Trauma ◽

Facial Fractures ◽

Facial Skeleton ◽

Concomitant Injuries

Abstract Objective Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes. Methods Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ). Results Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit (n = 12), mandible (n = 5), nasal bone (n = 5), and zygomaticomaxillary complex (n = 3). The most common concomitant injuries included skull fracture (n = 3), intracranial hemorrhage (n = 4), and traumatic brain injury (n = 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired. Conclusions Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.

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Correção funcional e estética de sequela de fratura fronto-naso-órbito-etmoidal – relato de caso

Full Dentistry in Science ◽

10.24077/2021;1246-7075 ◽

2021 ◽

Vol 12 (46) ◽

pp. 70-75

Author(s):

Dimas Albertiny Barradas de Sousa Varela ◽

Priscila Vital Fialho ◽

Mariana Mendes de Carvalho ◽

Victor Hugo Moraes Salviano ◽

Carlos Vinicius Moreira ◽

...

Keyword(s):

Motor Vehicle ◽

Low Cost ◽

High Energy ◽

Facial Trauma ◽

Imaging Evaluation ◽

Vehicle Accidents ◽

Handling Characteristics ◽

Good Imaging ◽

Late Treatment ◽

Type Of Fracture

Fronto-naso-orbito-etmoidal fractures, known as FNOE fractures, are the result of blunt trauma of high energy in the middle and upper third of the face. Presenting an approximate frequency of 5% to 15% of facial trauma in children and adults, respectively, FNOE fractures are found more commonly after motor vehicle accidents, physical aggression, falls or cycling accidents. The diagnosis and treatment of FNOE fractures are difficult to perform and, for this reason, the performance of a thorough clinical examination associated with a good imaging evaluation is of great importance in these traumas, as incorrect diagnosis and inadequate or late treatment generally result in aesthetic and functional. The treatment of this type of fracture must be defined after the identification of the extension, type of fracture, and affected structures in order to restore function and shape of the middle face. This study aimed to report a case of sequelae of FNOE fracture where there were aesthetic and respiratory complaints, treated with coronal access and subsequent reduction of nasal bones fracture and aesthetic correction of the nasal dorsum and glabella with the use of polymethylmethacrylate cement (PMMA). It was concluded that the early diagnosis of FNOE fractures is of great importance to avoid sequelae, with coronal access being a good access option for the surgical correction of these sequelae and the biocompatibility and handling characteristics, as well as the low cost of cement PMMA is a good option for grafting in corrections of craniofacial deformities.

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A Review of Mandibular Angle Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0031-1272903 ◽

2011 ◽

Vol 4 (2) ◽

pp. 69-72 ◽

Cited By ~ 10

Author(s):

Ramiro Perez ◽

John C. Oeltjen ◽

Seth R. Thaller

Keyword(s):

Motor Vehicle ◽

Treatment Plan ◽

Neck Region ◽

Facial Trauma ◽

Mandibular Fractures ◽

Mandibular Angle ◽

Vehicle Accidents ◽

Appropriate Treatment ◽

Common Causes ◽

Angle Fractures

After studying this article, the reader will be able to: (1) review the incidence and etiology of mandibular angle fractures; (2) gain an understanding of patient evaluation and general management principles; and (3) discuss indications and available techniques for management of mandibular angle fractures. Angle fractures represent the highest percentage of mandibular fractures. Two of the most common causes of mandibular angle fractures are motor vehicle accidents and assaults or altercations. With any patient who has sustained facial trauma, a thorough history and comprehensive physical examination centering on the head and neck region as well as proper radiological assessment are essential. These elements are fundamental in establishing a diagnosis and developing an appropriate treatment plan for any mandibular fracture.

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Etiology and treatment in craniofacial fractures

ARS Medica Tomitana ◽

10.1515/arsm-2017-0027 ◽

2017 ◽

Vol 23 (3) ◽

pp. 158-162

Author(s):

D. L. Mihail ◽

G. I. Comșa

Keyword(s):

Life Quality ◽

Facial Trauma ◽

Trauma Patients ◽

Secondary Complications ◽

Surgical Interventions ◽

Anatomy And Physiology ◽

Car Accidents ◽

Complex Biological Process ◽

Level Increase ◽

Craniofacial Trauma

Abstract Introduction. Facial trauma remains an important pathology in present days because of its effects. Facial deformities and functional alteration affect patient’s life quality and his society reinsertion. First evaluation has to be thorough to avoid any secondary complications .This type of pathology involves a pluridisciplinary approach: ENT, OMF, neurosurgeon,plastic surgeon,intensive care doctor. Healing implies complex biological process .A healed bone is capable to perform normal duties without titanium plates help. Osteosynthesis allows a faster and correct recovery. Doctors need to possess profound knowledge with regard to anatomy and physiology and to be acquainted with the reconstructive methods used in craniofacial surgery. Material and methods. This study evaluates craniofacial trauma patients who suffered different types of surgical interventions at the ENT Clinic and OMF Department of Constanta County Hospital since January the 1st 2013 until June the 1st 2017. Results. The group involves 133 cases, both genders and all ages. These 2 elements play an important role in this pathology because of the fact that the vast majority of patients are young active males. The sex ratio in the study is 7:1. In most of cases, craniofacial traumas appear after aggressions and car accidents. The nose and mandibular are fractured in a higher percentage in comparison to other parts of facial structures. Discussions. Important and sensitive structures located at this level increase the risk of possible important and definitive damages.

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Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review

Surgical Neurology International ◽

10.25259/sni-11-2019 ◽

2019 ◽

Vol 10 ◽

pp. 86 ◽

Cited By ~ 1

Author(s):

Saúl Solorio-Pineda ◽

Adriana Ailed Nieves-Valerdi ◽

José Alfonso Franco-Jiménez ◽

Guillermo Axayacalt Gutiérrez-Aceves ◽

Luis Manuel Buenrostro-Torres ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Subdural Hematoma ◽

Brain Injuries ◽

Motor Vehicle ◽

Pediatric Population ◽

Traumatic Injury ◽

Vascular Lesions ◽

Vehicle Accidents ◽

Spinal Subdural Hematoma

Background: Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion. Case Description: A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level. Conclusions: Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.

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AUTOMOTIVE RESTRAINT DEVICES FOR THE PEDIATRIC PATIENT

PEDIATRICS ◽

10.1542/peds.45.1.49 ◽

1970 ◽

Vol 45 (1) ◽

pp. 49-53

Author(s):

Frederic D. Burg ◽

John M. Douglass ◽

Eugene Diamond ◽

Arnold W. Siegel

Keyword(s):

Pediatric Patient ◽

Motor Vehicle ◽

Type System ◽

Rear Seat ◽

Motor Vehicle Accidents ◽

Vehicle Accidents ◽

Safety Belts

Last year 6,300 children under 15 years of age died in motor vehicle accidents. This number would have been reduced if all children and infants had been properly restrained. The purpose of this paper is to give information and suggestions to help enable the practicing physician to understand what restraining devices to prescribe. It is recommended that children from birth to the time they are 12 lb in weight be transported in a rear seat bassinet or car bed held in place by front and rear seat safety belts. The bassinet should be parallel to the long axis of the car, with the infant in a feet-forward position. Children from 12 to 24 lb should be placed in a properly constructed rear seat safety harness. Children from 24 to 48 lb should be placed in a rear seat, shield-type system. Children weighing more than 50 lb should use the adult lap belt, and, when their height exceeds 55 in., the adult shoulder harness should also be used. The physician is in a position to be effective in prescribing the proper device.

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Head Trauma in Children

Pediatrics in Review ◽

10.1542/pir.15.6.213 ◽

1994 ◽

Vol 15 (6) ◽

pp. 213-219

Author(s):

Brahm Goldstein ◽

Karen S. Powers

Keyword(s):

Head Injury ◽

Hospital Admissions ◽

Motor Vehicle ◽

Pediatric Population ◽

Head Injuries ◽

Motor Vehicle Accidents ◽

Initial Assessment ◽

Severe Injuries ◽

Vehicle Accidents ◽

Pediatric Head Injury

Head injury, either alone or in association with multiple other injuries, is extremely common. The initial assessment and management of children who have a head injury is an important topic for all pediatricians. Epidemiology Table 1 lists definitions of minor, moderate, and severe head injuries as determined by the initial neurologic presentation. The most common method to assess a child's neurologic status initially is to assign a score based on the Glasgow Coma Scale (GCS). The GCS is determined by eye opening and best verbal and motor responses (Tables 2 and 3). Mild-to-moderate head injuries are far more common than severe injuries in the pediatric population. More than 90% of children requiring admission to a hospital following head injury have a GCS score of 13 to 15; severe head injury (GCS≤ 8) accounts for approximately 5% of admissions. Motor vehicle accidents, bicycle accidents, falls, sporting accidents, assaults, and child abuse are the most common causes of pediatric head injury. Despite a significant reduction in the number of pediatric fatalities due to implementation of the 55 mile/hour speed limit, motor vehicle accidents still result in a large number of hospital admissions and deaths each year. Many of these accidents are associated with drug or alcohol abuse.

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