Pediatric Facial Trauma

Trauma is a leading cause of mortality in children (Lopez et al., Pediatrics 138(2):e20161569, 2016; Imahara et al., J Am Coll Surg 207(5):710–6, 2008). Facial Injury patterns vary with age due to growth and development that impacts bone quality, proportional relationship of structures, dentition, sinuses, and soft tissue (Lopez et al., Pediatrics 138(2):e20161569, 2016; Imahara et al., J Am Coll Surg 207(5):710–6, 2008; Totonchi et al., J Craniofac Surg 23(3):793–8, 2012; Ryan et al., J Craniofac Surg 22(4):1183–9, 2011; Meier and Tollefson, Curr Opin Otolaryngol Head Neck Surg 16(6):555–61, 2008; Kellman and Tatum, Facial Plast Surg Clin North Am 22(4):559–72, 2014). A newborn has a relatively large cranium to face ratio of 8:1, but by adulthood, the ratio is 2:1. Infants, toddlers, and children have softer. thinner bones of the facial skeleton. This bone type is more susceptible to greenstick fractures and faster healing. As children approach adulthood, the bone becomes more calcified, the sinuses enlarge and become aerated and permanent dentition erupts (Table 15.1). In the deciduous dentition phase, the permanent tooth buds fill the maxilla and mandible, and once erupted, the maxillary sinus develops more, and the mandible thickens and enlarges. The bones accomplish the majority of the growth in a top-down fashion with the mandible completing growth by age 18 in females and age 20 in males (Ryan et al., J Craniofac Surg 22(4):1183–9, 2011; Meier and Tollefson, Curr Opin Otolaryngol Head Neck Surg 16(6):555–61, 2008; Kellman and Tatum, Facial Plast Surg Clin North Am 22(4):559–72, 2014). Based on the growth and development, the mechanisms of injuries also vary as do the fracture patterns (Lopez et al., Pediatrics 138(2):e20161569, 2016; Imahara et al., J Am Coll Surg 207(5):710–6, 2008; Ryan et al., J Craniofac Surg 22(4):1183–9, 2011) (Table 15.2). Skull fractures are more common than facial fractures in infants, with mandible and nasal fractures being the most common in teenagers (Lopez et al., Plast Reconstr Surg 145(4):1012–23, 2020; Gordon et al., Pediatr Emerg Care 37(12):e1701–7, 2020; Coon et al., Plast Reconstr Surg 134(3):442e–8, 2014; Ryu et al., Pediatr Emerg Care 36(3):125–9, 2020; Choi et al., Pediatr Emerg Care 36(5):e268–73, 2020; Jenny et al., Plast Reconstr Surg 147(2):432–41, 2021). CT is the most sensitive and specific modality for imaging fractures (Gordon et al., Pediatr Emerg Care 37(12):e1701–7, 2020; Ryu et al., Pediatr Emerg Care 36(3):125–9, 2020; Choi et al., Pediatr Emerg Care 36(5):e268–73, 2020). C-spine fractures are less common in kids than adults with facial fractures (Xun et al., J Oral Maxillofac Surg 77(7):1423–32, 2019). Children have more facial injuries from dog bites that may have associated facial fractures than adults (Tu et al., Plast Reconstr Surg 109(4):1259–65, 2002; Saadi et al., Craniomaxillofac Trauma Reconstr 11(4):249–55, 2018). Non-accidental trauma should be considered for histories and injuries that don't align or for children with patterns of hospitalizations for injuries or injuries in various stages of healing. Although many facial fractures can be treated nonoperatively, it is important to follow a child through their growth and development as long-term sequelae to include soft tissue or bony growth disproportion can result.