Introduction: Maxillofacial injuries are common among polytraumatized patients, and in Nigeria, the incidence seems to be on the increase. This probably is related to the drive of industrialization and the increase in the number of road traffic accidents. Delays in attending to severe maxillofacial injuries can be grave because of concomitant injuries that can be life threatening. Methods: This is a prospective review of maxillofacial injuries in patients <16 years of age who were seen at the Accident and Emergency Department between October 2002 and December 2006. In all the patients, the accident and emergency physicians carried out initial resuscitation, and thereafter, they were referred to the maxillofacial unit on call. Results: A total of 611 patients with maxillofacial injuries were seen during the study period and of this, 134 (22%) were <16 years old. The male:female ratio was 1.1:1.0. Road traffic accident (RTA) was the most common etiological factor in 73 (54.5%) cases, while gunshot injuries accounted for 6 (4.4%) cases. Soft tissue lacerations were the most common maxillofacial injuries occurring in 90 (55.9%) cases; mandibular fractures were the most common bony injury in 17 (13.4%). Conclusions:The upsurge in maxillofacial gunshot injuries in the pediatric age group is alarming and this may be a reflection of the global changes (westernization and drug-related offenses like armed robberies) and the harsh economic conditions in this community. Okoje VN, Alonge TO, Oluteye OA, Denloye OO: Changing pattern of pediatric maxillofacial injuries at the Accident and Emergency Department of the University Teaching Hospital, Ibadan-A four-year experience. Prehosp Disaster Med 2010;25(l):68-71.