Pediatric Facial Fractures: Children Are Not Just Small Adults

Abstract

Radiologic imaging is essential for diagnosing pediatric facial fractures and selecting the optimal therapeutic approach. Trauma-induced maxillofacial injuries in children may affect functioning as well as esthetic appearance, and they must be diagnosed promptly and accurately and managed appropriately to avoid disturbances of future growth and development. However, these fractures may be difficult to detect on images, and they are frequently underreported. The interpretation of facial radiographs is particularly challenging, and computed tomography (CT) is necessary in many cases to achieve an accurate diagnosis. To keep the radiation dose as low as reasonably achievable, ultrasonography may be used instead of radiography for the initial imaging evaluation when the clinical suspicion of fracture is low; if evidence of fracture is found, CT then may be performed for a more detailed evaluation. Regardless of the modality used, a familiarity with the characteristic imaging features of pediatric facial fractures is necessary for accurate image interpretation. In addition, knowledge of the epidemiologic and anatomic distribution of pediatric facial fractures is helpful. Particular kinds of fracture (nondisplaced, greenstick, displaced, comminuted) tend to occur at specific anatomic sites in children, with the severity and extent of the fracture varying according to the patient's age and the stage of skeletal development. Midfacial fractures and fractures that are severely displaced and comminuted may be accompanied by neurocranial injuries or other complications and should be evaluated at CT with multiplanar reformatting of image data.

Pediatric Nasoorbitoethmoid Fractures

“…Because of the relative prominence of the skull to face, children younger than 5 years have a much higher chance of sustaining basilar skull fractures with frontal and orbital fractures, whereas children with facial skeletal proportions similar to adults are more likely to sustain midface and mandibular fractures. 3,4 Children younger than 2 years tend to have flexible bones, making greenstick fractures more common. After the age of 2 to 3 years, increased bone mineralization makes greenstick fractures less common.…”

“…There is a high correlation between facial fractures and intracranial trauma in the pediatric population; studies have demonstrated that any suspicion of facial trauma warrants computed tomographic (CT) scan evaluation in the pediatric population. 3,15,16 Interestingly, initial Glasgow coma scale score and loss of consciousness during the accident are poor predictors of intracranial trauma in pediatric patients (though these are commonly used indicators in adults). The mechanism of injury is the most reliable predictor of intracranial trauma in pediatric patients.…”

Closed Reduction of Displaced Mandibular Fracture in a Child - A Case Study

“…Facial growth, paranasal sinus development, dentition and bone structure all affect the pattern of facial structures in children. 3 A green stick fracture is a fracture in which one cortex of the bone is broken and the other cortex is bend. Green stick fracture commonly occur in children due to thin cortices, inherent elasticity of bone, thick surrounding layer of adipose tissue and the relatively larger amount of medullary bone held by a strong periosteal support results in a high incidence of greenstick fractures in children.…”

Splint fixation with circummandibular wires for pediatric mandibular fracture: Two case reports

“…Facial growth, paranasal sinus development, dentition, and bone structure all affect the pattern of facial fractures in children. 5 Management of children with primary or mixed dentition is complicated by several factors. First is the presence of secondary, unerupted teeth in the mandible body until 6 years of age or longer.…”