Pediatric Facial Trauma

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October 25, 2012
Edward Smith

Unfortunately, trauma is the most common cause of death in children. Severe injuries in the face primarily lead to disfigurement and only lead to death if also associated with head trauma. Serious trauma to the face is more common in adults than in children. The treatment of facial trauma in children is different from that in adults because the skeleton in children is continually growing and trauma can affect that growth. Doctors want to minimize the manipulation and fixation of fractures in children because it better allows for growth of the face later in life.
Facial fractures account for five percent of all facial injuries in children and many of these occur in the midface. Unfortunately, the midface is the area that doctors can least repair without impacting growth and development of the face later. The good news is that midface fractures are extremely rare in children under the age of 5. These children have greater cranial size when compared to face size and have a more elastic bone structure, so they have less chance of getting a facial fracture.

As a child ages, facial fractures begin to mimic those of adults with nasal fractures. These become the most common facial fractures seen. The most common fracture in kids that requires surgery or hospitalization is the mandible fracture, particularly the condyle fracture. These are high impact injuries such as is seen in car accidents or severe child abuse. As a child ages, sports related fractures are seen more often. Because a child has a great deal of cancellous bone in the facial bones, there are more “greenstick” fractures which do not dislocate. Unerupted teeth also protect the mandible and maxillary bone so that there is less trauma to these areas.

It can be difficult to examine the young child with a facial fracture. Doctors should carefully palpate all the bones, looking for dislocation of fractures. Doctors must also look for misalignment of teeth, which could indicate a maxillary or mandibular fracture. Lacerations should be examined carefully to see if any open fractures exist that would need significant treatment to avoid infection in the bone. The mandible should be evaluated to see that it has a normal range of motion. The cranial nerves should be looked at to make sure they are intact.

Facial soft tissue injuries are also extremely common in children. These must be evaluated to make sure underlying bone is intact and to make sure no nerve damage has been done. These should be carefully repaired to make sure that the facial scar is as minimal as possible. All foreign material should be removed prior to repair and the wound should be irrigated freely. Topical anesthesia needs to be used carefully because it contains cocaine and can be toxic.

In one study, 137 patients were studied who sustained a total of 318 different facial fractures. Some were seen at the time of injury and others were seen for reconstruction after a failed attempt at getting a good anatomic alignment conservatively. Sixty one percent of patients were boys and the rest were girls. Most children were between 6 and 12 years of age. Most injuries came from automobile accidents; however, a group of children sustained falls (23 percent) and sports injuries (15 percent). The most common fractures were mandibular fractures at 34 percent and orbital fractures at 23 percent. Only 7 percent were mid-facial fractures.