- Maxillofacial trauma in children more often results in soft tissue injury than facial fractures.
- Up to 55% of seriously injured children with facial trauma also have intracranial injury, a much higher percentage than occurs with adults.
- The most urgent complication of facial trauma is airway compromise, which is most often associated with mid or lower face injury.
- The CT scan is the definitive diagnostic test for precise delineation of maxillofacial fractures.
- The mandible is the facial bone most frequently involved in posttraumatic developmental deformities.
- Timely referral of nasal fractures is of significant concern, as these injuries may have a profound effect on subsequent nasal and maxillofacial development.
Accurate bony alignment is important in the growing child, and missed fractures or inappropriate treatment may result in permanent facial deformity. A child with severe maxillofacial injury requires a team approach involving emergency physicians, pediatricians, general surgeons, maxillofacial specialists, and radiologists. Emergency specialists must recognize and prioritize injuries, manage the airway, stabilize the patient, read initial radiographs, and make appropriate consultations.
Children have a lower incidence of facial fractures compared with adults. Facial fractures in the pediatric population comprise less than 15% of all facial fractures and they are especially rare below the age of 5. Their incidence peaks as children begin school and during puberty/adolescence with an increase in unsupervised sports, activities, and skeletal changes. Worldwide, the incidence of facial fractures is higher in boys than girls, attributed to more dangerous physical activities in boys.1 This lower incidence of pediatric facial fractures is multifactorial and includes the protected environment of childhood as well as anatomic differences between children and adults. Great structural differences exist between birth and 10 years of age, with marked changes in bone composition and anatomy. Large fat pads in young children cushion impact and lessen forces transmitted to the facial bones that have flexible suture lines. Children have a high ratio of cancellous bone to cortical bone, which provides greater resilience and leads to a higher incidence of incomplete and greenstick fractures.1–3 In addition, the presence of tooth buds within the jaws increases stability.1 This contrasts with the comminuted fracture patterns seen in adults.
Fracture site distribution tends to shift from the upper aspect of the face in younger children to the lower face in older children. In early childhood, the skull is particularly prominent, whereas the face and mandible are small. This results in a high incidence of skull fractures in the younger age group. Development of paranasal sinuses weakens the anterior facial skeleton. LeForte fractures are uncommon in pediatrics and are almost never seen before age 2. For this reason, in children younger than 5 years, orbital and frontal skull fractures predominate, whereas in older children, maxillary and mandibular fractures become more prominent. The most frequently fractured bones are the nose (45%), mandible (32%), orbit (17%), and zygoma/maxilla (5%). The most common facial fractures in injured children requiring hospitalization ...