Contemporary management of pediatric facial trauma

Abstract

In this review of modern management of the pediatric facial trauma patient, several issues germane to pediatric facial fractures are discussed. Thorough ophthalmologic and dental/occlusive examinations must be undertaken. Conservative management is optimal for many injuries, as the pediatric fracture is typically not as severe as those seen in the adult facial skeleton. When wiring the jaw to allow for noninvasive fixation, treatment time must be short in order to avoid TMJ ankylosis. Rigid fixation is indicated in the rare comminuted, displaced fracture; when employed, the surgeon must use small plates and screws, and avoid injury to developing teeth. These are challenging cases, but with appropriate knowledge and understanding, they can be appropriately managed.

Clinical and Radiological Evaluation of Deviated Nasal Septum in Classifying and Surgical Management of the Deviated Septums

“…If one outer most layer is breached as in a traumatic bend of the septum, the inner most tension is lost and the septum remains deviated. Subsequent scarring and fibrosis ensure this deviation remains 13 . Usually, the junction of the bony and cartilaginous septum is the area of greatest deviation due to trauma.…”

Management of Pediatric Maxillary Fractures

“…14 In fact, they are the least commonly reported midfacial injuries in children. 8,15 In a recent retrospective review 16 of 291 pediatric patients with maxillofacial and skull fractures presenting to a level 1 trauma center over a 3-year span, only 3% of the reported fractures corresponded to Le Fort fracture classification. Another 3% were classified to the maxillary sinus specific fractures.…”

“…Specifically, it is calculated to be approximately an 8:1 ratio at birth (in comparison to the adult, it approaches a ratio of 2.5:1.37). 16 Essential absence of pneumatization in the pediatric maxilla, the superior elasticity, and the flexibility of the suture lines define the parameters on why these fractures present as less displaced and comminuted than in the adult trauma population. 1,8,22Y24 Conversely, 2 other authors describe their experience as half of the pediatric Le Fort fractures were being comminuted.…”

A Case of Successful Conservative Management of Multiple Facial Bone Fractures in an Infant

“…The management of facial fractures in children remains controversial [10][11][12][13][14][15][16][17][18]. The published literature provides little in regard to standard treatment protocols for pediatric facial fractures, but…”

“…Even if resorbable plates and screws are used, there is the risk that screws will traumatize tooth buds or erupting teeth. On the other hand, it is generally accepted that stable, undisplaced and asymptomatic fractures are indications for conservative, non-surgical treatment [3,13,18].…”