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HIGH-YIELD FACTS

  • Maxillofacial trauma in children more often results in soft-tissue injury than facial fractures.

  • Up to half of seriously injured children with facial trauma also have intracranial injury.

  • The most emergent complication of facial trauma is airway compromise.

  • CT scan is the definitive diagnostic test for precise delineation of maxillofacial fractures.

  • Injury patterns vary by age as a result of the unique development of the facial skeleton.

  • Timely referral of nasal fractures is important, as these injuries may have a profound effect on subsequent nasal and maxillofacial development.

Missed or inappropriately treated facial fractures may result in permanent facial deformity in the growing child. 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, provide emergent management of complications and associated injuries, interpret radiographic studies, make appropriate consultations, and ensure safe transitions of care.

INCIDENCE

Pediatric facial fractures are relatively rare but important injuries. Craniofacial trauma accounts for 12.3% of pediatric ED visits but only 1% to 15% of all craniofacial injuries.1 In a study of the National Trauma Data Bank from 2001 to 2005, the most common mechanisms for facial fracture were motor vehicle collisions (55.1%), violence (11.8%), and falls (8.6%);2 facial fractures occurred in 4.6% of admitted patients, and 25% of these fractures required operative intervention.2

The frequency and mechanisms of facial skeletal injury vary with age. Nasal and maxillary fractures occur most commonly in infants and toddlers aged 0 to 1 year, and mandible fractures occur most commonly in adolescents aged 15 to 18 years. Young children demonstrate fractures from falls and low supervision, and older children are associated with sports-related or violent injuries.3 Facial fractures occur in less than 1% of children under the age of 5 years.4 Young children rarely present with severe facial trauma, and nonaccidental injury should be considered if this occurs. Sports-related craniofacial injuries comprise one-third of all pediatric facial fractures.6,7 Sports-related mechanisms peak between ages 13 and 15 years.8 Violent injuries also become more prevalent in adolescence, with estimates ranging from 11.8% to 12.4% of pediatric facial fractures.2,9 Teen violence most commonly results in nasal or mandible fractures.9 Comminuted fractures are rare except with gunshot wounds.10 These patterns of injury help physicians identify patients requiring a more thorough assessment.

The unique developmental features of the growing face create unique injury patterns in children.11 The cranial-to-face volume ratio is only 8:1 at birth, compared to 2.5:1 at adult maturity.11 As a result of the small midface, intracranial injuries are more common and facial fractures are rare.11 The prominent foreheads and small, flat facies of young children lead to fewer facial fractures.12 When fractures do occur, the upper third of the face is most ...

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