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Kolbow M, Quick JD, Powell LE, Wang Q, Nguyen MDT, Barta RJ. A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population. Clin Pediatr (Phila) 2024; 63:680-688. [PMID: 38142360 DOI: 10.1177/00099228231219871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.
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Affiliation(s)
- Madison Kolbow
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Lauren E Powell
- Division of Plastic & Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Minh-Doan T Nguyen
- Department of Plastic & Reconstructive Surgery, Regions Hospital, Saint Paul, MN, USA
| | - Ruth J Barta
- Department of Plastic & Reconstructive Surgery, Gillette Children's Hospital, Saint Paul, MN, USA
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Basnet A, Chug A, Simre S, Vyas A, Shrestha S. Comprehensive Management of Pediatric Orbital Fractures: A Case Series and Review of Literature. Cureus 2024; 16:e57915. [PMID: 38725748 PMCID: PMC11081518 DOI: 10.7759/cureus.57915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents and entrapment of extraocular muscles entrapment with no signs of any soft tissue trauma. A delay in diagnosis can lead to a life-threatening condition known as oculocardiac reflex, characterized by nausea, vomiting, bradycardia, and syncope. Many authors recommend early surgical intervention, but some patients may delay for various reasons. We hereby represent three cases of orbital fracture to prevent long-term persistent diplopia. Depending on the case scenario, two cases were operated on in which an autogenous iliac cortical graft was placed in one patient to prevent postoperative herniation of orbital content, and in one patient, only release of entrapped muscles was done. One patient was managed conservatively with a regular follow-up visit.
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Affiliation(s)
- Abiskar Basnet
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Dehradun, IND
| | - Ashi Chug
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Saurabh Simre
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Akansha Vyas
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, IND
| | - Sudarshan Shrestha
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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3
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Yari A, Fasih P, Bagheri A, Aryanezhad SS, Sani MK. Prevalence and pattern of maxillofacial injuries associated with domestic violence: A retrospective study at a major trauma center. Dent Traumatol 2024; 40 Suppl 2:61-68. [PMID: 37915285 DOI: 10.1111/edt.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM This study aimed to analyze the frequency and pattern of maxillofacial injuries associated with domestic violence. MATERIALS AND METHODS Medical records of victims of domestic violence between May 2016 and May 2023 were scrutinized retrospectively. The following data were analyzed: gender and age, history of previous abuse, hospital admission, pregnancy, type of facial injuries, anatomical location of injuries, side of injuries, concomitant injuries, mechanism of impact, treatment modality, and history of drug and alcohol abuse. RESULTS Seventy-eight patients were included, comprising of 75 (96.2%) women and 3 (3.8%) men. Domestic violence was an etiology of 2.7% of all maxillofacial injuries. The mean age was 27.06 ± 5.5 years. 33.3% of cases had a history of previous domestic violence. The assailant was drug addicted in 47.4% of cases. The attacker was the current partner of the victim in 79.5% of the victims. Soft tissue injuries were found in 96.1% of cases. Maxillofacial fracture was observed in 52.6% of victims among which zygoma was the most common (16.7%) followed by the nose and mandible (15.4%). Isolated fracture was observed in 85.3% of patients and 71.8% of the injuries were observed on the left. Concomitant injuries were present in 51.3% of patients with arms/hands being the most frequent (48.7%). Punch (67.9%) constituted the majority of the mechanism of impact. Based on the statistical analysis, punches resulted in significantly higher soft tissue contusion (p = .046), and injuries that required no intervention were significantly higher in punched victims (p = .002). CONCLUSION Maxillofacial soft tissue injuries with or without isolated fracture on the left side of the zygoma, mandibular angle, or nose in association with arms/hands injuries in young adult women could be clues of domestic violence. Appropriate care such as preventive programs for drug or alcohol abuse should be implemented to reduce domestic violence, thereby reducing these injuries.
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Affiliation(s)
- Amir Yari
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Paniz Fasih
- Department of Prosthodontics, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Abbas Bagheri
- Department of Endodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Mohammad Khosousi Sani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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4
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Spiller LR. Orofacial manifestations of child maltreatment: A review. Dent Traumatol 2024; 40 Suppl 2:10-17. [PMID: 37226580 DOI: 10.1111/edt.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/14/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
The recognition and reporting of child abuse and neglect continues to be a challenge in the healthcare setting. All healthcare providers, including dentists, should be aware of the high prevalence of orofacial injuries and conditions that are concerning for abuse and neglect. Sentinel injuries may appear trivial and do not require medical attention, but are unlikely caused by accidental mechanisms and, if not properly identified, often precede more severe abusive injuries. Concerning orofacial findings can manifest as bruising, eye injuries, intraoral injuries, pharyngeal perforations, facial bone fractures, and sexually transmitted infections. Abusive caregivers are likely to give inadequate explanations or no history at all to explain concerning findings. Medical providers' failure to make mandated reports about their concerns to the appropriate agencies can have significant long-term impacts on the physical and psychological well-being of children.
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Affiliation(s)
- Lora R Spiller
- Division of Child Abuse Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas, USA
- Children's Hospital of San Antonio, San Antonio, Texas, USA
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Voss JO, Ziegenrücker P, Doll C, Maier C, Steffen C, Heiland M, Hofmann E, Koerdt S. Diagnostic pitfalls in pediatric orbital entrapment fractures. J Craniomaxillofac Surg 2024; 52:228-233. [PMID: 38142169 DOI: 10.1016/j.jcms.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023] Open
Abstract
Prompt diagnosis and management of orbital entrapment fractures in the pediatric patient have been advocated. This retrospective study analyzed a cohort of orbital entrapment fractures in pediatric patients with regard to diagnostic pitfalls, treatment and outcomes in a Level I trauma center in Germany. Based on medical records and radiological imaging, patients under the age of 18 years who presented with orbital fractures during 2009-2021 were analyzed. Overall, 125 patients presented with orbital fractures, of whom 29 patients (23.2%) had orbital entrapment fractures. The majority of patients presented with monocle hematoma (n = 23), diplopia (n = 20), and/or restricted extraocular eye movement (n = 14). While all patients with orbital entrapment fractures underwent three-dimensional imaging, 10 radiological reports (34.5%) did not include findings on orbital entrapment fractures. All patients underwent surgical exploration in less than 24 h. In 12 patients, clinical symptoms such as diplopia and restricted ocular elevation were documented upon postoperative evaluation before discharge. Considering the significant proportion of orbital entrapment fractures that are not noted on radiological imaging, prompt clinical examination should be initiated in pediatric patients at risk for orbital fractures. Urgent surgical intervention should be recommended in entrapment fractures.
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Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Paula Ziegenrücker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christoph Maier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany; New York University School of Medicine, Dept. of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), 650 1st Avenue, New York, 10016, NY, USA.
| | - Claudius Steffen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Elena Hofmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
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Kelimu K, Wusiman P, Li W, Huang B, Wu J, Zhan J, Moming A. Epidemiology and Pattern of Pediatric Maxillofacial Trauma: A 5-Year Retrospective Study. J Craniofac Surg 2024; 35:150-153. [PMID: 37754755 DOI: 10.1097/scs.0000000000009723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/02/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE To analyze the epidemiology, pattern, and prevent measurement of pediatric maxillofacial trauma in Xinjiang, China. PATIENTS AND METHODS Clinical records of patients aged 0 to 18 years with maxillofacial trauma over the 5 years were reviewed. Epidemiological features of data were collected for the cause of injury, age and sex distribution, frequency and type of injury, localization and frequency of soft tissue injuries, facial bone fractures, and presence of associated injuries. Statistical analyses performed included descriptive analysis, χ 2 test, and logistic regression analyses. RESULTS Among the 450 patients, 333 were male and 117 were female, with a male-to-female ratio of 3.8:1, the mean age was 9.2±5.4 years; 223 cases were soft tissue injuries and 227 cases were maxillofacial fractures. The 16 to 18-year-old group was the highest, with the prevalence of maxillofacial fractures. The most common cause of pediatric maxillofacial trauma was traffic injuries. CONCLUSION The incidence of maxillofacial trauma in pediatric patients correlates with a number of factors, including age, sex, and etiology of trauma. The 16 to 18-year-old group is the most prevalent group for maxillofacial trauma in pediatric patients, and traffic accidents are the leading cause of maxillofacial trauma in pediatric patients.
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Affiliation(s)
- Keyimu Kelimu
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Patiguli Wusiman
- Orthodontic Department of the First Affiliated Hospital of Xinjiang Medical University (Stomatological Hospital of Xinjiang Medical University), Urumqi, Xinjiang
- Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang
| | - Weidong Li
- Department of Oral & Maxillofacial Surgery, The First Affiliated Hospital Xinjiang Medical University (Stomatological hospital of Xinjiang Medical University), Urumqi, Xinjiang, People's Republic of China
| | - Bi Huang
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Jianming Wu
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Jinliang Zhan
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Adili Moming
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
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Koti AS, Vega S, Johnson KL, Schlatter A, Ayson N, Menashe SJ, Feldman KW. Accidental and Abusive Mandible Fractures in Infants and Toddlers. Pediatr Emerg Care 2023; 39:923-928. [PMID: 36728119 DOI: 10.1097/pec.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident. METHODS Records and imaging were reviewed for children aged 24 months and younger who were diagnosed with mandible fractures at 2 tertiary pediatric care centers. Twenty-one cases were included, 8 of whom had formal child abuse consultations. Cases were reviewed for mechanisms of injury, physical examination findings, and occult injuries identified, as well as the final abuse determination. RESULTS Among children with child abuse consultations, 5 injuries (62.5%) were determined to be accidental, 1 (12.5%) was abusive, and 2 were indeterminate for abuse or accident (25%). In each accidentally injured child, the reported mechanism of injury was a short fall with evidence of facial impact. No accidentally injured child had unexpected occult injuries or noncraniofacial cutaneous injuries. CONCLUSIONS Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.
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8
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Stanbouly D, Koh D, Halsey J, Selvi F, Goudarzi F, Arce K, Chuang SK. Motorcycle Accidents are the Strongest Risk Factor for Panfacial Fractures Among Pediatric Patients. Craniomaxillofac Trauma Reconstr 2023; 16:258-267. [PMID: 38047150 PMCID: PMC10693262 DOI: 10.1177/19433875221116961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design A retrospective cohort study was conducted using the Kids' Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (P < .01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (P < .01) to result in panfacial fractures while car accidents were over two times more likely (P < .01) to result in panfacial fractures. Falls were less likely (OR, .39; P < .01) to result in panfacial fractures. Conclusions Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle.
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Affiliation(s)
- Dani Stanbouly
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Dylan Koh
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Jordan Halsey
- Johns Hopkins All Children’s Hospita Division of Plastic Surgery, St. Petersburg, FL, USA and Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Firat Selvi
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey
| | - Fereshteh Goudarzi
- Department of Oral and Maxillofacial Radiology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Kevin Arce
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, MN, USA
| | - Sung-Kiang Chuang
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA and Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA, USA and Visiting Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
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9
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Bhat A, Lim R, Egbert MA, Susarla SM. Pediatric Le Fort, Zygomatic, and Naso-Orbito-Ethmoid Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:563-575. [PMID: 37302948 DOI: 10.1016/j.coms.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and mandible. With downward and forward growth of the face, there is an increasing frequency of midface injuries seen in children in the mixed and adult dentitions. Midface fracture patterns seen in young children are quite variable; those in children at or near skeletal maturity mimic patterns seen in adults. Non-displaced injuries can typically be managed with observation. Displaced fractures require treatment with appropriate reduction and fixation and longitudinal follow-up to evaluate growth.
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Affiliation(s)
- Aparna Bhat
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA
| | - Rachel Lim
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA
| | - Mark A Egbert
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98015, USA
| | - Srinivas M Susarla
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98015, USA.
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10
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Hassan B, Liang F, Grant MP. Pediatric Orbital Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:585-596. [PMID: 37302946 DOI: 10.1016/j.coms.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA.
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11
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Lee KC, Reynolds R, Recker MJ, Markiewicz MR. Rigid Fixation of the Pediatric Facial Skeleton. Oral Maxillofac Surg Clin North Am 2023; 35:529-541. [PMID: 37537081 DOI: 10.1016/j.coms.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Pediatric facial fractures are uncommon, and fortunately, the majority can be managed with conservative measures. Rigid fixation of the pediatric facial skeleton can potentially be associated with delayed hardware issues and growth inhibition. When appropriate, resorbable fixation is most commonly used for this purpose. Titanium plates and screws are advantageous when rigid fixation is a priority because properly placed hardware that respects natural suture lines is not thought to significantly inhibit growth. Furthermore, titanium fixation may be removed following healing.
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Affiliation(s)
- Kevin C Lee
- Department of Oral and Maxillofacial Surgery, University at Buffalo, 3425 Main Street 112 Squire Hall, Buffalo, NY 14214, USA; Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Renée Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott Street, Buffalo, NY 14203, USA
| | - Matthew J Recker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott Street, Buffalo, NY 14203, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo, 3425 Main Street 112 Squire Hall, Buffalo, NY 14214, USA.
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12
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Taylor JQ, Hopkins E, Yang R, Abramowicz S. Epidemiology and Etiology of Facial Injuries in Children. Oral Maxillofac Surg Clin North Am 2023; 35:515-519. [PMID: 37302950 DOI: 10.1016/j.coms.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.
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Affiliation(s)
- Jeffrey Quinn Taylor
- Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA; Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA.
| | - Elizabeth Hopkins
- Johns Hopkins Children's Center Specialists, 6420 Rockledge Drive, Suite 2300, Bethesda, MD 20817, USA
| | - Robin Yang
- Johns Hopkins Children's Center Specialists, 6420 Rockledge Drive, Suite 2300, Bethesda, MD 20817, USA
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA; Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 2105 Uppergate Drive, Atlanta, GA 30307, USA
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13
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Tolley PD, Massenburg BB, Manning S, Lu GN, Bly RA. Pediatric Nasal and Septal Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:577-584. [PMID: 37302947 DOI: 10.1016/j.coms.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pediatric nasal bone and septal fractures represent a large number of craniofacial injuries in children each year. Due to their differences in anatomy and potential for growth and development, the management of these injuries varies slightly from that of the adult population. As with most pediatric fractures, there is a bias toward less-invasive management to limit disruption to future growth. Often this includes closed reduction and splinting in the acute setting followed by open septorhinoplasty at skeletal maturity as needed. The overall goal of treatment is to restore the nose to its preinjury shape, structure, and function.
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Affiliation(s)
- Philip D Tolley
- Division of Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Seattle Childrens Hospital, Craniofacial Center; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington
| | - Benjamin B Massenburg
- Division of Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Seattle Childrens Hospital, Craniofacial Center; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington
| | - Scott Manning
- Division of Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Seattle Childrens Hospital, Craniofacial Center; Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle Children's Hospital
| | - G Nina Lu
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle Children's Hospital
| | - Randall A Bly
- Division of Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Seattle Childrens Hospital, Craniofacial Center; Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle Children's Hospital.
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14
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Shakir S, Ettinger RE, Susarla SM, Birgfeld CB. Pediatric Panfacial Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:607-617. [PMID: 37280142 DOI: 10.1016/j.coms.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Russell E Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Srinivas M Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Craig B Birgfeld
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
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15
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Mohammadi H, Roochi MM, Heidar H, Garajei A, Dallband M, Sadeghi M, Fatahian R, Tadakamadla SK. A meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies among children and adolescents. Dent Traumatol 2023; 39:403-417. [PMID: 37073864 DOI: 10.1111/edt.12845] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023]
Abstract
AIMS Children and adolescents who are affected by trauma may have complications that are more serious and dangerous. Herein, a meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies according to the geographic regions of the world among children and adolescents was conducted. MATERIALS AND METHODS A comprehensive search was performed in four databases of PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2006 until July 7, 2021. To evaluate the quality of included articles, an adapted version of the Newcastle-Ottawa scale was used. The prevalence of maxillofacial trauma was estimated by event rates and 95% confidence intervals in relation to etiology and geographic region of study population. RESULTS Through search in the databases and the electronic sources, 3071 records were identified, and 58 studies were eligible for inclusion in the meta-analysis. A total of 264,433 maxillofacial trauma cases were reported by all included studies. Globally, the overall prevalence of maxillofacial trauma was highest due to Road Traffic Crashes (RTC) (33.8%) followed by falls (20.7%), violence (9.9%), and sports (8.1%) in children/adolescents. The highest prevalence of maxillofacial trauma were observed in African population (48.3%) while trauma due to falls was most prevalent in Asian population (44.1%). Maxillofacial trauma due to violence (27.6%) and sports (13.3%) were highest in North Americans. CONCLUSION The findings demonstrate that RTC was the most prevalent etiology of maxillofacial trauma in the world. The prevalent causes of maxillofacial trauma differed between the regions of study population.
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Affiliation(s)
- Hady Mohammadi
- Department of Oral and Maxillofacial Surgery, Fellowship in Maxillofacial Trauma, Health Services, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehrnoush Momeni Roochi
- Department of Oral and Maxillofacial Surgery, Fellowship in Maxillofacial Trauma, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Heidar
- Department of Oral and Maxillofacial Surgery, Fellowship in Maxillofacial Trauma, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Garajei
- Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Dallband
- Department of Oral and Maxillofacial Surgery, Dental School, Taleghani Hospital, Shahid Beheshti of Medical Sciences, Tehran, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Fatahian
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Santosh Kumar Tadakamadla
- Dentistry and Oral Health, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Victoria, Bendigo, Australia
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Victoria, Bendigo, Australia
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16
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Glenney AE, Irgebay Z, Cheng LG, Comerci AJ, Mocharnuk JW, Bruce MK, Anstadt EE, Saladino RA, Dvoracek LA, Losee JE, Goldstein JA. Pediatric Nasoorbitoethmoid Fractures: A Single Institution's 15-Year Experience. J Craniofac Surg 2023; 34:1717-1721. [PMID: 37458265 DOI: 10.1097/scs.0000000000009514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study describes characteristics, management, and outcomes of NOE fractures in children seen at a single institution. METHODS A retrospective review of patients under 18 years who presented to our institution from 2006 to 2021 with facial fractures was conducted; patients with NOE fractures were included. Data collected included demographics, mechanism of injury, fracture type, management, and outcomes. RESULTS Fifty-eight patients met inclusion criteria; 77.6% presented with Manson-Marcowitz Type I fractures, 17.2% with Type II, and 5.2% with Type III. The most common cause of injury was motor vehicle accidents (MVAs, 39.7%) and sports (31%). Glasgow Coma Scale and injury mechanism were not predictive of injury severity in the pediatric population ( P =0.353, P =0.493). Orbital fractures were the most common associated fractures (n=55, 94.8%); parietal bone fractures were more likely in Type III fractures ( P =0.047). LeFort III fractures were more likely in type II fractures ( P =0.011). Soft tissue and neurological injuries were the most common associated injuries regardless of NOE fracture type (81% and 58.6%, respectively). There was no significant difference in type of operative management or in the rates of adverse outcomes between types of NOE fractures. CONCLUSIONS These findings suggest that pediatric NOE fractures, although rare, present differently from adult NOE fractures and that revisiting predictive heuristics and treatment strategies is warranted in this population.
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Affiliation(s)
- Anne E Glenney
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | - Zhazira Irgebay
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | | | | | - Joseph W Mocharnuk
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | - Madeleine K Bruce
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | - Erin E Anstadt
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | - Richard A Saladino
- Children's Hospital of Pittsburgh, Department of Emergency Medicine, Pittsburgh, PA
| | - Lucas A Dvoracek
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | - Joseph E Losee
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
| | - Jesse A Goldstein
- Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
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17
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Kirvelä A, Snäll J, Suominen A, Puolakkainen T, Thorén H. Characteristics of Associated Injuries in Children and Teenagers With Craniofacial Fractures. J Craniofac Surg 2023; 34:1625-1628. [PMID: 37202848 PMCID: PMC10445634 DOI: 10.1097/scs.0000000000009343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/08/2023] [Indexed: 05/20/2023] Open
Abstract
The incidence of pediatric craniofacial fractures and heterogeneity of fractures is known to increase with age. This study aimed to determine the occurrence of associated injuries (AIs) to craniofacial fractures and identify differences in patterns of and predictors for AIs in children and teenagers. A 6-year retrospective cross-sectional cohort study was designed and implemented. The study population included 397 patients aged 19 years or less diagnosed with craniofacial fracture at Helsinki University Hospital from 2013 to 2018. Boys (71.0%) and teenagers (64.7%) were predominated. Associated injuries were more common in teenagers than children. Teenagers had more often AI in 2 or more organ systems. Assault and intoxication by alcohol were observed only in teenagers and predominantly boys. A total of 27.0% of all patients sustained AIs. In 18.1%, brain injury was reported. In children, motor vehicle accident (MVA) was an independent predictor for AI. In teenagers, independent predictors for AI were female sex, isolated cranial fracture, combined cranial fracture, and high-energy trauma mechanism. Injury patterns and AI related to craniofacial fractures in the pediatric population are age-specific, requiring multidisciplinary collaboration in the diagnosis, treatment, and follow-up of such trauma. Predictors for AIs increase in complexity with age, and the role of sex as a predictor is evident in teenagers.
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Affiliation(s)
- Aura Kirvelä
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Auli Suominen
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Tero Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Thorén
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
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Rentsch M, Zumbrunn Wojczyńska A, Gallo LM, Colombo V. Prevalence of Temporomandibular Disorders Based on a Shortened Symptom Questionnaire of the Diagnostic Criteria for Temporomandibular Disorders and Its Screening Reliability for Children and Adolescents Aged 7-14 Years. J Clin Med 2023; 12:4109. [PMID: 37373802 DOI: 10.3390/jcm12124109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The prevalence and adequacy of diagnostic approaches for temporomandibular disorders (TMD) in children and adolescents are still matters of debate. This study aimed to determine the prevalence of TMD and oral habits in children and adolescents aged 7-14 years and evaluate the consistency between self-reported TMD symptoms and clinical findings using a shortened Axis I of Diagnostic Criteria for TMD (DC/TMD). Children (aged 7-10) and adolescents (aged 11-14) of both sexes were invited to participate in this study (n = 1468). Descriptive statistics for all observed variables and Mann-Whitney U-Tests for the clinical examination were performed. A total of 239 subjects participated in the study (response rate 16.3%). The self-reported prevalence of TMD was found to be 18.8%. The most frequently reported oral habit was nail biting (37.7%), followed by clenching (32.2%) and grinding (25.5%). Self-reported headache increased with age, while clenching and grinding decreased. Based on the answers to the DC/TMD Symptom Questionnaire, subgroups of asymptomatic and symptomatic participants (n = 59; 24.7%) were established and randomly selected for the clinical examination (f = 30). The shortened Symptom Questionnaire showed a sensitivity of 0.556 and a specificity of 0.719 for pain during the clinical examination. Although the Symptom Questionnaire exhibited high specificity (0.933), its sensitivity (0.286) for temporomandibular joint sounds was low. Disc displacement with reduction (10.2%) and myalgia (6.8%) were the most common diagnoses. In conclusion, the self-reported prevalence of TMD in children and adolescents in this study was comparable to that reported in the literature for adults. However, the accuracy of the shortened Symptom Questionnaire as a screening tool for TMD-related pain and jaw sounds in children and adolescents was found to be low.
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Affiliation(s)
- Mathias Rentsch
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
- Public-School Dental Services of the City of Zurich, 8002 Zurich, Switzerland
| | | | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Vera Colombo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
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19
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Etheridge T, Brintz BJ, Jensen MS, Peralta E, Ayesha A, Jebaraj A, Marx DP. Incidence and severity of asymptomatic ocular injury in adult and pediatric orbital fractures. Orbit 2023; 42:273-278. [PMID: 35801838 PMCID: PMC9943542 DOI: 10.1080/01676830.2022.2095648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures. METHODS We performed a retrospective chart review of all adult and pediatric orbital fractures between 2012-2022 at a level 1 trauma center. Ocular injuries were categorized into severe, moderate, and mild. We evaluated symptoms, mechanism of injury, visual acuity (VA), and severity of injuries using the Cochran-Armitage and linear-by-linear tests. RESULTS Of the 2495 cases, 1534 had ophthalmology evaluation. The mean ± standard deviation age was 40.4 ± 20.4 years. Most patients were male (73.1%) and Caucasian (75.9%). The mean time to evaluation was 0.6 ± 2.5 days. 486 (31.7%) were visually symptomatic, 760 (49.5%) were asymptomatic, and 288 (18.8%) were unknown. Of the symptomatic, 135 (27.8%) had severe injuries, 108 (22.2%) had moderate injuries, 216 (44.4%) had mild injuries, and 27 (5.6%) had no injuries. Of the asymptomatic, 67 (8.8%) had severe injuries, 183 (24.1%) had moderate injuries, 468 (61.6%) had mild injuries, and 42 (5.5%) had no injuries. Symptoms correlated with injury severity (p-value <.001). The most common mechanism of injury were falls (24.0%), assaults (22.2%), and motor vehicle accidents (14.8%). CONCLUSIONS Visually asymptomatic orbital fractures were less likely to have severe ocular injuries; however, many patients were unable to express symptoms. Emergent ophthalmology evaluation should be considered in all patients presenting with orbital fractures, especially patients with visual symptoms or are unable to report symptoms.
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Affiliation(s)
- Tyler Etheridge
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Ben J. Brintz
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Michael S. Jensen
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Esteban Peralta
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Azraa Ayesha
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Abigail Jebaraj
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Douglas P. Marx
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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20
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Hofmann E, Koerdt S, Heiland M, Raguse JD, Voss JO. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent 2023; 16:499-509. [PMID: 37496941 PMCID: PMC10367286 DOI: 10.5005/jp-journals-10005-2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Aim To assess the diagnostic and therapeutic approaches in pediatric mandibular fractures with regards to fracture pattern and localization. Patients and methods This retrospective study included patients under the age of 17 years that presented to the Department of Oral and Maxillofacial Surgery at Charité-Universitätsmedizin Berlin with mandibular fractures over an 11-year long period (2010-2020). Medical records were analyzed for age, gender, injury mechanism, clinical presentation, imaging modalities, fracture pattern, and fracture management. Statistical analyses included descriptive statistics, normality testing, and Mann-Whitney U tests. Results A total of 91 pediatric patients (23 females and 68 males) presented with mandibular fractures. The majority of mandibular fractures occurred in patients aged 13-16 years (67.0%, n = 61). The main causes were activities of daily life (34.1%), followed by assault (25.3%). Malocclusion and pain upon mandibular joint compression were documented in 72.5% and 51.7% of patients, respectively. The most frequently applied radiological diagnostic tool was a panoramic X-ray (49.5%). The main fracture patterns were single (42.9%) and double fractures (48.4%). An age-adapted surgical approach using open reduction and internal fixation (ORIF) was the most frequent management (61.5%). A conservative approach was favored in cases of condylar head fractures. Resorbable plates were used in eight cases of ORIF (8.8%). Conclusion Treatment regimens should be carefully selected based on the unique anatomy of the pediatric patient with regards to centers of growth and dentition phase, to restore stomatognathic function and to maintain adequate skeletal growth and eruption of teeth. Clinical significance This study illustrates the challenges of mandibular fracture management in the pediatric patient. How to cite this article Hofmann E, Koerdt S, Heiland M, et al. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(3):499-509.
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Affiliation(s)
- Elena Hofmann
- Department of Oral and Maxillofacial Surgery, Charité–Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité–Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité–Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, Germany
| | - Jan-Dirk Raguse
- Department of Oral and Maxillofacial Surgery, Fachklinik Hornheide, Dorbaumstraße 300, Münster, Germany
| | - Jan Oliver Voss
- Department of Oral and Maxillofacial Surgery, Charité -Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, Berlin, Germany
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21
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Juncar RI, Moca AE, Juncar M, Moca RT, Țenț PA. Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study. Children (Basel) 2023; 10:children10050800. [PMID: 37238348 DOI: 10.3390/children10050800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13-18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular-86.2%; midface-91.7%; combined-66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy.
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Affiliation(s)
- Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Mihai Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Rahela Tabita Moca
- Doctoral School of Biomedical Sciences, University of Oradea, 1 Universității Street, 410087 Oradea, Romania
| | - Paul Andrei Țenț
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
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22
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Razmara F, Badri A, Mahmoudi X. Maxillofacial Fracture Types and Their Management in 3-to 18-year-old Individuals Referred to Shariati Hospital, Tehran, Iran. Front Dent 2023; 20:5. [PMID: 37312823 PMCID: PMC10258397 DOI: 10.18502/fid.v20i5.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/01/2022] [Indexed: 06/15/2023] Open
Abstract
Objectives: This study was performed to find the most common types of maxillofacial fractures and their management in 3 to 18-year-old individuals referred to the Department of Oral and Maxillofacial Surgery at Shariati Hospital in Tehran, during a 9-year period. Materials and Methods: This retrospective study evaluated the records of 319 patients with maxillofacial fractures between 2012-2020, ranging in age from 3 to 18 years. Data regarding the etiology and location of the fracture, age, gender, and treatment approach were retrieved from the archival records and analyzed. Results: A total of 319 patients were included in the study, out of which, 255 (79.9%) were males and 64 (20.1%) were females. Motor-vehicle accidents were the most common cause of trauma (N=124, 38.9%). We recorded 605 fractures and among them, the parasymphysis (N=131, 21.6%) was the most common site of isolated fractures. Type of treatment varied depending on the fracture type and degree of displacement of the broken segments. It consisted of open reduction and internal fixation, and closed reduction procedures, which included the use of arch bars, ivy loops, lingual splints, and circummandibular wirings. Conclusion: Analysis of the results revealed that the severity of injury increased with age. Older individuals had higher a number of fracture sites and experienced greater displacement of the broken segments.
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Affiliation(s)
- Farnoosh Razmara
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Badri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Xaniar Mahmoudi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Huang W, Hu S, Wang C, Xiao J. Analysis of Pediatric Maxillofacial Fractures: A 10-year Retrospective Study. J Craniofac Surg 2023; 34:448-53. [PMID: 36441830 DOI: 10.1097/SCS.0000000000008846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study is to analyze patterns of maxillofacial fractures in children and adolescent in southeast of China,in a period of 10 years. MATERIAL AND METHODS In this retrospective study, the medical records of 162 hospitalized patients under 18 years old were analyzed in the Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Wenzhou Medical University, China. Age, gender, etiology, site, and type of fracture, monthly distribution, weekly distribution, dental complications, and treatment were evaluated. The cases were divided into 3 age groups: group A: 0 to 6 years, group B: 7 to 12 years, and group C: 13 to 18 years. RESULTS Three hundred thirty-four maxillofacial fractures in 162 patients younger than 18 years were analyzed. The male to female ratio was 2.24:1 and mean age of these patients was 9.85 years old . Falls were the leading cause of maxillofacial fractures.The most frequent fracture site was mandible. Most patients with maxillofacial fractures were treated by open reduction. And it was done more in adolescents than in children. CONCLUSIONS Falls were the main reason for maxillofacial fracutres in childern, and traffic accidents was the leading cause in adolescent. Preventive measures should be applied to reduce occurrences of pediatric facial fractures .Children can not be left at home alone, and monitoring is very necessary when children play in the high place. The government can consider related e-bike driving skills training. Teenagers must pass the relevant electric vehicle test before they can drive. Make the law that the driver of e-bike must wear a safety helmet. Our study shows that open reduction was a good choice for pediatric facial fractures, but usually conservative treatment is a better choice for condylar fractures.
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Kamath AT, Roy S, Pai D. Paediatric condylar trauma - primary management considerations - A review. J Oral Biol Craniofac Res 2023; 13:236-242. [PMID: 36846088 PMCID: PMC9950934 DOI: 10.1016/j.jobcr.2023.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Children are not simply ''small adults'', and the application of adult-type treatment can be inappropriate in many circumstances. Their craniomaxillofacial (CMF) structure changes dramatically as children grow and develop. This anatomical change also changes the location, pattern, and nature of CMF injury. Similarly, condylar architecture and anatomy also differ in children, due to which the management of paediatric condylar fractures is strikingly different from adult condylar fractures. In addition to this physiological, and behavioural differences pose an additional challenge to a surgeon. Paediatric condylar fracture also considers conservative/non-operative treatment as an effective treatment option. However, the decision between operative and non-operative management compromises paediatric facial growth, precise reduction, and rigid fixation. This decision is crucial and is guided by many factors. Improper treatment protocol can have a devastating effect on a child facial growth and development. It can lead to various deforming complications mainly ankylosis. Hence treatment of paediatric condylar fracture should be well planned and executed.
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Affiliation(s)
- Abhay Taranath Kamath
- Department of Oral and Maxillofacial Surgery, Manipal Hospital, Ambedkar Circle, Mangaluru, Dakshina Kannada, 575001, Karnataka, India
| | - Sreea Roy
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, India
| | - Deepika Pai
- Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal, India
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Sobrero F, Roccia F, Galetta G, Strada C, Gerbino G. Pediatric mandibular fractures: Surgical management and outcomes in the deciduous, mixed and permanent dentitions. Dent Traumatol 2023; 39:233-239. [PMID: 36606623 DOI: 10.1111/edt.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIM Mandibular fractures are the most frequent type of pediatric facial traumatic injury, but their treatment remains controversial. The aim of this retrospective study was to analyze the surgical treatment and long-term outcomes of dentate mandibular fractures in children and adolescents. MATERIAL AND METHODS Patients with mandibular fractures in the dentate area who were surgically treated in the period from January 1, 2001, to December 31, 2020, were included. The following data were collected: age, gender, cause and mechanism of injury, fracture site and type, associated maxillofacial fractures, the timing of surgical treatment, Facial Injury Severity Scale (FISS) score, surgical approach, number and thickness of plates, hospitalization stay and outcome. Patients were divided into three groups: deciduous (≤6 years, group A), mixed (7-12 years, group B), and permanent (13-18 years, group C) dentitions. Statistical analyses were performed using SPSS software. RESULTS During the study 91 patients (male: female ratio, 3.8:1), 4 in group A, 12 in group B, and 75 in group C, with 65 single and 52 double fractures were included. An intraoral approach was used in 87% of patients. In group C, 90% of patients were treated with fixation schemes consistent with those suggested in the literature for adults, versus 75% in groups A and B. Median follow-up time was 20 months. No tooth germ injury or facial asymmetry was observed and only six group C patients had post-operative malocclusions. Hardware removal occurred in 22% of the patients. CONCLUSIONS This 20-year retrospective study shows that open reduction and internal fixation of pediatric dentate mandibular fractures caused no tooth germ damage or disturbances of mandibular growth in any dentition stage. Internal fixation schemes were similar to those used for adults, although it was necessary to adapt hardware size and position according to tooth and patient age.
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Affiliation(s)
- Federica Sobrero
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giovanni Galetta
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Carlo Strada
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giovanni Gerbino
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Shah J, Wang F, Ricci JA. Concomitant Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An 11 Year Review of the National Trauma Data Bank. J Oral Maxillofac Surg 2023; 81:413-423. [PMID: 36620992 DOI: 10.1016/j.joms.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Craniofacial trauma with concomitant cervical fractures (CCFs) is responsible for significant morbidity and mortality in the pediatric population. We aim to characterize its incidence, injury patterns, outcomes, and risk factors, along with identifying any association between mandible fractures and cervical injuries via the National Trauma Databank. METHODS A retrospective cohort study was performed using National Trauma Databank records between 2007 and 2017 to identify patients equal or under the age of 18 years hospitalized for maxillofacial trauma and with recorded cervical injury. Variables of interest include age, gender, race/ethnicity, trauma type (blunt vs penetrating), Injury Severity Score, area involved, mechanism of injury, comorbid conditions, inpatient complications, and discharge disposition. Retrospective cohorts were separated by CCF status. Univariate, bivariate, and multivariable regression analysis was utilized, with P-value <.05 considered statistically significant. RESULTS A total of 32,952 patients were included in the study, with the majority being White (60.8%), male (68.2%), and between the ages of 13 and 18 years (65%). Of these, 8.2% experienced CCF. Most common mechanisms of injury were motor vehicle trauma (32.6%), interpersonal violence (18.8%), and falls (13.5%). Univariate analysis revealed patients with CCF were significantly older (15.2 vs 12.9; P < .001), more likely to be motor vehicle occupants (46.6 vs 31.9%; P < .001), and suffer polyfacial fractures (62.6 vs 60.7%; P < .001). Longer length of stay (9.4 vs 3.6 days; P < .001) and significantly higher inpatient complications such as deep vein thrombosis, pulmonary embolism, unplanned intubation, severe sepsis, pressure ulcer, ventilator-associated pneumonia, and unplanned return to operating room were observed in the CCF cohort. Female gender (1.5 [1.37 to 1.64; 95% confidence interval {CI}] P < .001) and higher Injury Severity Score (1.12 [1.11 to 1.11; 95% CI] P < .001) were associated with significantly higher odds on multivariable analysis. The presence of a mandible fracture was not associated with increased CCF on multivariate analysis (1.06 [0.92 to 1.22; 95% CI] P = .36). CONCLUSIONS There are statistically significant differences in demographics, outcomes, and injury patterns in maxillofacial patients with CCF that may help guide treatment. No association between mandible fractures and cervical trauma was identified.
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Affiliation(s)
- Jinesh Shah
- Resident, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Fei Wang
- Research Assistant, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Joseph A Ricci
- Assistant Professor, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
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Dagi AF, Parry GJ, Labow BI, Taghinia AH. Trends in Pediatric Head and Facial Trauma During the COVID-19 Pandemic. J Craniofac Surg 2023; 34:e1-e6. [PMID: 35864579 PMCID: PMC9793995 DOI: 10.1097/scs.0000000000008776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/11/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population. MATERIALS AND METHOD The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children's hospitals across the United States in 2016-2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison). RESULTS A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016-2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at -34.6% (95% confidence interval: -23.6%, -44%; P <0.001) and -27.7% (95% confidence interval: -18.4%, -36%; P <0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant. CONCLUSIONS Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.
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Thorén H, Mäyränpää MK, Mäkitie A, Niemensivu R, Suominen A, Snäll J. Otologic injuries are frequent in pediatric patients with temporal bone fractures. J Craniomaxillofac Surg 2023; 51:24-30. [PMID: 36740516 DOI: 10.1016/j.jcms.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/25/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
This retrospective study aimed to clarify the occurrence and types of otologic injuries in children and adolescents with skull fractures. Files of all patients under 18 years of age who had been diagnosed with skull fractures at a tertiary trauma centre were included. The primary outcome variable was the presence of any otologic symptom or finding. Secondary outcome variables were clinically detected and radiologically detected otologic injuries. The primary predictor variable was a temporal bone fracture. Other study variables were sex, age, mechanism of injury, traumatic brain injury, and mortality. A total of 97 patients were identified for the study. Otologic symptoms and findings were frequent (33.9%). The most common clinical findings were bleeding from the external auditory canal (18.6%) and hemotympanum (13.4%). The prevailing radiological finding was blood and/or cerebrospinal fluid in the middle ear (30.9%). Patients with fractures of temporal bone had a 29-fold risk for otologic symptoms or findings (RR 28.9, 95% CI 4.1-202.9, p < 0.001) relative to those who did not have a temporal bone fracture. Severe otologic complications, such as permanent hearing loss (6.2%), cerebrospinal fluid leak (5.2%), or facial nerve palsy (1%), were infrequent. Within the limitations of the study it seems that there is the necessity of otoscopy in all pediatric patients with blunt head trauma. In case of positive otologic findings, the patient should undergo imaging and ENT consultation.
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Affiliation(s)
- Hanna Thorén
- Department of Oral and Maxillofacial Surgery, University of Turku and Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland.
| | - Mervi K Mäyränpää
- Department of Radiology, HUS Diagnostic Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Riina Niemensivu
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Auli Suominen
- Department of Community Dentistry, University of Turku, Turku, Finland.
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Hebballi NB, Xie L, Kane AA, Brown EL, Mathew MS, Messiah SE. Estimated prevalence of facial injury‐related mortality in the United States pediatric population. Dent Traumatol 2022; 39:223-232. [PMID: 36573910 DOI: 10.1111/edt.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS In pediatric populations, the epidemiology of facial trauma, their injury patterns, distribution, and outcomes are well known, However, little is known about the risk factors and impacts of minor and moderate facial injuries on in-hospital mortality among children in the United States of America (USA). The aim of this study was to determine the prevalence and risk factors for in-hospital mortality among pediatric patients following facial injuries in the USA. MATERIAL AND METHODS A cross-sectional study was conducted with data from the National Trauma Data Bank's pediatric hospitalized patients (<18 years) with facial injuries (International Classification of Diseases, Ninth Revision codes 802.00 to 802.9 and Tenth Revision codes S02.2 to S02.92) between January 01, 2016-December 31, 2019. A multivariable logistic regression model was utilized to identify the risk factors for in-hospital mortality. RESULTS A total of 61,294 pediatric patients (mean age 11.9 years, 69.6% males) were included in the analysis. The estimated prevalence of in-hospital mortality following facial injuries was 2.4% (n = 1480). In terms of mortality, compared to those who sustained minor facial injuries, patients with (1) moderate injuries had 43% higher odds (OR = 1.43; 95% CI: 1.25-1.64, p < .0001), (2) serious injuries had seven times higher odds (OR = 7.81; 95% CI: 6.67-9.14, p < .0001), (3) severe injuries had 16 times higher odds (OR = 16.07; 95% CI: 12.62-20.46, p < .0001), and (4) critical/maximum injury virtually unsurvivable had 145 times higher odds (OR = 145.24; 95% CI: 113.82-185.33, p < .0001) of death after controlling for age, race, insurance status, comorbidities, and hospital complications. CONCLUSIONS The severity of facial injury, age 5-17 years, uninsured status, and those with a mental/personality disorder were risk factors for in-hospital mortality among pediatric patients following facial injuries in this population-level analysis. A better understanding of these risk factors is needed for clinical management of pediatric patients to prevent in-hospital mortality following facial injuries.
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Affiliation(s)
- Nutan B. Hebballi
- School of Public Health University of Texas Health Science Center at Houston, Houston Campus Houston Texas USA
| | - Luyu Xie
- School of Public Health University of Texas Health Science Center at Houston, Dallas Campus Dallas Texas USA
- Center for Pediatric Population Health University of Texas Health Science Center School of Public Health and Children's Health System of Texas Dallas Texas USA
| | - Alex A. Kane
- Department of Plastic Surgery University of Texas Southwestern Medical Center Dallas Texas USA
| | - Eric L. Brown
- School of Public Health University of Texas Health Science Center at Houston, Houston Campus Houston Texas USA
| | - Matthew S. Mathew
- Center for Pediatric Population Health University of Texas Health Science Center School of Public Health and Children's Health System of Texas Dallas Texas USA
| | - Sarah E. Messiah
- School of Public Health University of Texas Health Science Center at Houston, Dallas Campus Dallas Texas USA
- Center for Pediatric Population Health University of Texas Health Science Center School of Public Health and Children's Health System of Texas Dallas Texas USA
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Pontell ME, O'Sick NR, Kalmar CL, Golinko MS. Pediatric Craniomaxillofacial Trauma. Pediatr Rev 2022; 43:665-675. [PMID: 36450635 DOI: 10.1542/pir.2021-005276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Matthew E Pontell
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Nicholas R O'Sick
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher L Kalmar
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S Golinko
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN.,Division of Pediatric Plastic Surgery, Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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Tung KTS, Wong RS, Ho FK, Chan KL, Wong WHS, Leung H, Leung M, Leung GKK, Chow CB, Ip P. Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study. JMIR Public Health Surveill 2022; 8:e36861. [PMID: 35980728 PMCID: PMC9437780 DOI: 10.2196/36861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries. OBJECTIVE This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong. METHODS This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong. RESULTS We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries. CONCLUSIONS This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong.
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Affiliation(s)
- Keith T S Tung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Rosa S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Hugo Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ming Leung
- Accident and Emergency Department, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Gilberto K K Leung
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Bong Chow
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Stanbouly D, Kocaelli H, Arce K, Selvi F. Risk factors for increased length of hospital stay among young pediatric patients who suffer facial fractures. Dent Traumatol 2022; 38:457-465. [PMID: 35877474 DOI: 10.1111/edt.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM It is not known whether the mechanism of facial trauma influences the associated length of hospitalization. The aim of this study was to determine whether the mechanism of injury influenced the length of hospital stay (LOS) among pediatric patients who sustained facial fractures. MATERIALS AND METHODS This retrospective cohort study was completed using the Kids' Inpatient Database (KID). The primary predictor variable was the mechanism of injury. The primary outcome variable was LOS. Linear regression was used to determine independent predictors of increased/decreased length of stay. A p-value of less than .05 was considered statistically significant. RESULTS The final sample consisted of 2865 subjects aged 12 years or younger who had suffered facial fractures. The most common mechanism of injury was motor vehicle accidents (MVA) (58.6%). Facial fractures due to MVA added 1.20 days (95% CI, 0.02, 2.38; p < .05) when compared to those due to a fall. CONCLUSIONS MVA significantly prolonged the LOS among young pediatric patients who sustained facial fractures, reflecting the exceptional amount of force involved. Having a chronic condition was also a significant factor for longer LOS. Four or more fractures also led to a longer LOS.
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Affiliation(s)
- Dani Stanbouly
- College of Dental Medicine, Columbia University, New York, New York, USA
| | - Humeyra Kocaelli
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey
| | - Kevin Arce
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Firat Selvi
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Stanbouly D, Stewart SJ, Harris JA, Chuang SK. Malar and maxillary fractures among pediatric patients and the risk factors for mortality. Dent Traumatol 2022; 38:466-476. [PMID: 35802839 DOI: 10.1111/edt.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS No studies have characterized the morbidity and mortality of maxillary & malar fractures on a national scale. The aim of this study was to examine the risk factors for mortality in pediatric patients who had sustained maxillary and malar fractures by using a national pediatric hospital inpatient care database. MATERIALS AND METHODS This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the cause of injury. The primary outcome variable was mortality rate. Additional predictor variables included age, gender, race, income, payer information, year and place of injury, number of facial fractures, concomitant facial fractures, other fractures of the body, and intracranial/internal organ injury. Univariate and multivariate regression models were performed to assess risk factors for mortality. Statistical significance was set to a p-value <.05. RESULTS A total of 5859 patients met the inclusion criteria. The most common age group was 13-17 years of age (n = 3816, 65.1%). Motor vehicle accidents were the most common mechanism of injury (n = 2172, 37.1%). The presence of cranial vault (OR = 2.81, p = .017), skull base (OR = 2.72, p < .001), and vertebral column fractures (OR = 2.13, p = .016), as well as sub-arachnoid hemorrhage (OR = 4.75, p = .005), traumatic pneumothorax/hemothorax (OR = 2.16, p = .015), and heart/lung injury (OR = 3.37, p < .001) were each independently associated with increased odds of mortality. CONCLUSIONS Patients in their late teens most commonly sustained malar and maxillary fractures, likely due to general trends in craniomaxillofacial development. The presence of other fractures located in close proximity to the mid-face increased the risk of mortality among pediatric patients with malar and maxillary fractures. This may be explained by the anatomical approximation of the mid-face to vital neurovascular structures of the head, which, when damaged, may prove fatal.
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Affiliation(s)
- Dani Stanbouly
- Columbia University College of Dental Medicine, New York City, New York, USA
| | - Sara J Stewart
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jack A Harris
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Sung-Kiang Chuang
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, Massachusetts, USA.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
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Țenț PA, Juncar RI, Moca AE, Moca RT, Juncar M. The Etiology and Epidemiology of Pediatric Facial Fractures in North-Western Romania: A 10-Year Retrospective Study. Children 2022; 9:children9070932. [PMID: 35883916 PMCID: PMC9323587 DOI: 10.3390/children9070932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. This research aimed to identify the main factors involved in the etiology of pediatric facial fractures, as well as the epidemiology of pediatric facial fractures in a sample of children and adolescents from North-Western Romania. This 10-year retrospective study was performed in a tertiary center for oral and maxillofacial surgery in North-Western Romania. Medical files of patients that were admitted between 1 January 2002 and 31 December 2022 were analyzed. Pediatric patients aged 0 to 18 years were included in this study. The final sample consisted of 142 children and adolescents diagnosed with facial fractures, with this number representing 14.1% of all patients affected by facial fractures. Most frequently, fractures were identified in the 13–18 age group (78.9%, n = 112), which were more often associated with fractures caused by interpersonal violence than caused by road traffic accidents, falls or animal attacks. Boys were more affected (88%, n = 125), and were more frequently associated with fractures caused by interpersonal violence. The most frequently identified etiological factors included interpersonal violence (50%, n = 71), falls (18.3%, n = 26) and road traffic accidents (11.3%, n = 16). In terms of location, the mandible was the most affected facial bone structure (66.2%, n = 94), and patients with mandibular fractures were more frequently associated with fractures caused by interpersonal violence. The incidence of pediatric facial fractures should be lowered because they may interfere with the proper development of the facial skeleton. Establishing measures aimed at preventing interpersonal violence, as well as other causes involved in the etiology of facial fractures is imperative.
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Affiliation(s)
- Paul Andrei Țenț
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania; (P.A.Ț.); (R.I.J.); (M.J.)
| | - Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania; (P.A.Ț.); (R.I.J.); (M.J.)
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania; (P.A.Ț.); (R.I.J.); (M.J.)
- Correspondence:
| | - Rahela Tabita Moca
- Doctoral School of Biomedical Sciences, University of Oradea, 1 Universității Street, 410087 Oradea, Romania;
| | - Mihai Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania; (P.A.Ț.); (R.I.J.); (M.J.)
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Nguyen BN, Edwards MJ, Srivatsa S, Wakeman D, Calderon T, Lamoshi A, Wallenstein K, Fabiano T, Cantor B, Bass K, Narayan A, Zohn R, Chess M, Thomas RD. Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study. Trauma Surg Acute Care Open 2022; 7:e000899. [PMID: 35529807 PMCID: PMC9039460 DOI: 10.1136/tsaco-2022-000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
Background Facial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT is a useful screening tool to identify children requiring dedicated facial CT. Methods We conducted a multicenter retrospective review of children aged 18 years and under with blunt facial injury who underwent both CT of the face and head from 2014 through 2018 at five pediatric trauma centers. Penetrating injuries and animal bites were excluded. Imaging and physical examination findings as well as interventions for facial fracture were reviewed. Clinically significant fractures were those requiring an intervention during hospital stay or within 30 days of injury. Results 322 children with facial fractures were identified. Head CT was able to identify a facial fracture in 89% (287 of 322) of children with facial fractures seen on dedicated facial CT. Minimally displaced nasal fractures, mandibular fractures, and dental injuries were the most common facial fractures not identified on head CT. Only 2% of the cohort (7 of 322) had facial injuries missed on head CT and required an intervention. All seven had mandibular or alveolar plate injuries with findings on physical examination suggestive of injury. Discussion In pediatric blunt trauma, head CT is an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT will usually exclude a clinically significant facial fracture. Level of evidence III.
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Affiliation(s)
| | | | - Shachi Srivatsa
- Department of Surgery, Ohio State University Foundation, Columbus, Ohio, USA
| | - Derek Wakeman
- Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Thais Calderon
- Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Abdularouf Lamoshi
- Department of Surgery, Long Island Jewish Medical Center Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Kim Wallenstein
- Department of Surgery, Upstate Golisano Children's Hospital, Syracuse, New York, USA
| | - Tiffany Fabiano
- Trauma Surgery Division, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Brittany Cantor
- Trauma Surgery Division, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Kathryn Bass
- Department of Surgery, University at Buffalo, Buffalo, New York, USA
| | - Ananth Narayan
- Department of Radiology, Albany Medical Center, Albany, New York, USA
| | - Ralph Zohn
- Department of Radiology, Long Island Jewish Medical Center Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Mitchell Chess
- Department of Radiology, University of Rochester, Rochester, New York, USA
| | - Richard D Thomas
- Department of Radiology, University at Buffalo, Buffalo, New York, USA
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Konrad S, Pähler Vor der Holte A, Bertram O, Welkoborsky HJ. [Skull and skull base injuries in children and adolescents : Results of a monocentric analysis]. HNO 2022; 70:352-360. [PMID: 35420311 DOI: 10.1007/s00106-022-01167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study comprises a retrospective analysis of skull, skull base, and midface fractures in children, to provide clinical orientation for their management. To date, only few data are available on these injuries in this patient group. METHODS Data from inpatient cases diagnosed with a midface, skull, or skull base fracture in the Children's Hospital Auf der Bult from 2015 to 2020 were evaluated. Age, gender, fracture mechanism, diagnosis, treatment, and possible complications were analyzed. Data of 224 children were grouped into 107 cases with nose fractures, 104 cases with skull fractures, 9 patients with temporal bone fractures, 4 patients with rhinobasal fractures, and 2 cases with fractures of the orbital floor. RESULTS Among patients with nose fractures, the average age was 10.9 years (64% males), among patients with skull fractures 1.0 year (64% males), and in children with skull base fractures 6.0 years (85% males). Falls were the most frequent genesis (63%), followed by car accidents, collisions (25%), and violence (10%). Patients with skull fractures underwent sonography in 94% of cases; in 87% the fracture was verified. Patients with nose fractures underwent x‑ray in 92% of cases, or sonography only in 8%; 95% of patients with nose fractures underwent operative repositioning. Typical fracture signs (i.e., hemotympanum, ophthalmic symptoms) or signs of central nervous system involvement (i.e., nausea, amnesia) occurred in 12 of 13 children with skull base fractures, and CT was performed in all these cases (none of whom developed a cerebrospinal fluid leak). CONCLUSION The imaging modality should be selected based on the clinically suspected diagnosis and the course. Most fractures can be sufficiently treated without any permanent sequelae, except for nose fractures, which frequently require operative repositioning.
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Affiliation(s)
- Simon Konrad
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland.
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland.
| | - Anja Pähler Vor der Holte
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Oliver Bertram
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Hans-Jürgen Welkoborsky
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland
- Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
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Romeo I, Sobrero F, Roccia F, Dolan S, Laverick S, Carlaw K, Aquilina P, Bojino A, Ramieri G, Duran-Valles F, Bescos C, Segura-Pallerès I, Ganasouli D, Zanakis SN, de Oliveira Gorla LF, Pereira-Filho VA, Gallafassi D, Perez Faverani L, Alalawy H, Kamel M, Samieirad S, Jaisani MR, Rahman SA, Rahman T, Aladelusi T, Hassanein AG, Goetzinger M, Bottini GB. A multicentric, prospective study on oral and maxillofacial trauma in the female population around the world. Dent Traumatol 2022; 38:196-205. [PMID: 35390219 PMCID: PMC9321108 DOI: 10.1111/edt.12750] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1-year period. METHODS The following data were collected: age (0-18, 19-64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization. RESULTS Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20-39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction. CONCLUSION Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19-64 years, and they are related to alcohol use.
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Affiliation(s)
- Irene Romeo
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federica Sobrero
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sean Dolan
- Department Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Sean Laverick
- Department Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Kirsten Carlaw
- Department Plastic, Reconstructive and Maxillofacial Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Peter Aquilina
- Department Plastic, Reconstructive and Maxillofacial Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Alessandro Bojino
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesc Duran-Valles
- Department Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Coro Bescos
- Department Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Ignasi Segura-Pallerès
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Dimitra Ganasouli
- Department Oral and Maxillofacial Surgery, Hippokration General Hospital, Athens, Greece
| | - Stelios N Zanakis
- Department Oral and Maxillofacial Surgery, Hippokration General Hospital, Athens, Greece
| | - Luis Fernando de Oliveira Gorla
- Department Diagnosis and Surgery, Araraquara Dental School, São Paulo State University, UNESP, Araraquara, São Paulo, Brazil
| | - Valfrido Antonio Pereira-Filho
- Department Diagnosis and Surgery, Araraquara Dental School, São Paulo State University, UNESP, Araraquara, São Paulo, Brazil
| | - Daniel Gallafassi
- Division of Oral and Maxillofacial Surgery, Department of Diagnosis and Surgery, São Paulo State University, UNESP, Araçatuba, São Paulo, Brazil
| | - Leonardo Perez Faverani
- Division of Oral and Maxillofacial Surgery, Department of Diagnosis and Surgery, São Paulo State University, UNESP, Araçatuba, São Paulo, Brazil
| | - Haider Alalawy
- Department Oral and Maxillofacial Surgery, Gazi Alhariri Hospital, Medical City, Baghdad, Iraq
| | - Mohammed Kamel
- Department Oral and Maxillofacial Surgery, Gazi Alhariri Hospital, Medical City, Baghdad, Iraq
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sajjad Abdur Rahman
- Department Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Tabishur Rahman
- Department Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Timothy Aladelusi
- Department Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ahmed Gaber Hassanein
- Maxillofacial Surgery Unit, Faculty of Medicine, General Surgery Department, Sohag University, Sohag, Egypt
| | - Maximilian Goetzinger
- Department Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
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Sangalli L, Gibler R, Boggero I. Pediatric Chronic Orofacial Pain: A Narrative Review of Biopsychosocial Associations and Treatment Approaches. Front Pain Res (Lausanne) 2022; 2:790420. [PMID: 35295480 PMCID: PMC8915750 DOI: 10.3389/fpain.2021.790420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Pediatric chronic orofacial pain (OFP) is an umbrella term which refers to pain associated with the hard and soft tissues of the head, face, and neck lasting >3 months in patients younger than 18 years of age. Common chronic pediatric OFP diagnoses include temporomandibular disorder, headaches, and neuropathic pain. Chronic OFP can adversely affect youth's daily functioning and development in many areas of well-being, and may be associated with emotional stress, depression, functional avoidance, and poor sleep, among other negative outcomes. In this mini-review, we will discuss common psychological comorbidities and familial factors that often accompany chronic pediatric OFP conditions. We will also discuss traditional management approaches for pediatric orofacial pain including education, occlusal appliances, and psychological treatments such as relaxation, mindfulness-based interventions, and cognitive-behavioral treatments. Finally, we highlight avenues for future research, as a better understanding of chronic OFP comorbidities in childhood has the potential to prevent long-term pain-related disability in adulthood.
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Affiliation(s)
- Linda Sangalli
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, KY, United States
| | - Robert Gibler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ian Boggero
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, KY, United States
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Segura-Palleres I, Sobrero F, Roccia F, de Oliveira Gorla LF, Pereira-Filho VA, Gallafassi D, Faverani LP, Romeo I, Bojino A, Copelli C, Duran-Valles F, Bescos C, Ganasouli D, Zanakis SN, Hassanein AG, Alalawy H, Kamel M, Samieirad S, Jaisani MR, Rahman SA, Rahman T, Aladelusi T, Carlaw K, Aquilina P, Rae E, Laverick S, Goetzinger M, Bottini GB. Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study. Dent Traumatol 2022; 38:213-222. [PMID: 35146900 PMCID: PMC9305543 DOI: 10.1111/edt.12735] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023]
Abstract
Background/Aims Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1‐year period. Methods The following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. Results Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001). Conclusion The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.
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Affiliation(s)
- Ignasi Segura-Palleres
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federica Sobrero
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | | | - Daniel Gallafassi
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, São Paulo, Brazil
| | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, São Paulo, Brazil
| | - Irene Romeo
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Bojino
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Chiara Copelli
- Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesc Duran-Valles
- Department Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Coro Bescos
- Department Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Dimitra Ganasouli
- Department Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Stelios N Zanakis
- Department Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Ahmed Gaber Hassanein
- Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Haider Alalawy
- Department Oral and Maxillofacial Surgery, Medical City, Gazi Alhariri Hospital, Baghdad, Iraq
| | - Mohammed Kamel
- Department Oral and Maxillofacial Surgery, Medical City, Gazi Alhariri Hospital, Baghdad, Iraq
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sajjad Abdur Rahman
- Department Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Tabishur Rahman
- Department Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Timothy Aladelusi
- Department Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kirsten Carlaw
- Department Plastic, Reconstructive and Maxillofacial Surgery, Nepean Hospital, Sydney, Australia
| | - Peter Aquilina
- Department Plastic, Reconstructive and Maxillofacial Surgery, Nepean Hospital, Sydney, Australia
| | - Euan Rae
- Department Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Sean Laverick
- Department Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Maximilian Goetzinger
- Department Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
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Ulusoy E, Armağan C, Çağlar A, Er A, Akgül F, Çitlenbik H, Yilmaz D, Duman M. Evaluation of Pediatric Maxillofacial Injury: Who Is Critical? Pediatr Emerg Care 2022; 38:e871-e875. [PMID: 34009887 DOI: 10.1097/pec.0000000000002406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Isolated facial injuries are less common among pediatric trauma patients. The literature has focused on, especially, fractures in facial injuries. There is a limited number of studies evaluating all facial injuries in childhood. The study aims to evaluate the clinical characteristics of maxillofacial injuries and to identify patients who require further intervention. METHODS The data from pediatric patients with maxillofacial injury (<18 years) between January 2011 and December 2015 were collected. Demographic characteristics, trauma mechanisms, concomitant injuries, treatments, hospitalization, and follow-up results were recorded. RESULTS The median age of the patients (N = 2926) was 5.0 years (2.0-10.0 years), and 63.1% were boys. Falls and motor vehicle accidents were the leading mechanism of injury. The most common injury types were lacerations (49.3%) and fractures (15.5%). One hundred thirty (0.4%) patients had concomitant injuries. Surgical treatment was performed in only 3.4% of the patients, and the mortality rate was 0.6%. Patients with concomitant injuries had more hospitalization rates, surgical treatment, and organ dysfunction. All patients who underwent cardiopulmonary resuscitation and resulted in mortality were in the concomitant injury group. CONCLUSIONS Isolated facial injuries are unlikely to be life-threatening, and basic interventions are sufficient in most of the maxillofacial injuries. The primary issue in maxillofacial injuries is to recognize and manage concomitant injuries that can lead to organ dysfunction and mortality.
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Affiliation(s)
- Emel Ulusoy
- From the Division of Pediatric Emergency Care, Department of Pediatrics
| | - Coşkun Armağan
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Aykut Çağlar
- From the Division of Pediatric Emergency Care, Department of Pediatrics
| | - Anil Er
- From the Division of Pediatric Emergency Care, Department of Pediatrics
| | - Fatma Akgül
- From the Division of Pediatric Emergency Care, Department of Pediatrics
| | - Hale Çitlenbik
- From the Division of Pediatric Emergency Care, Department of Pediatrics
| | - Durgül Yilmaz
- From the Division of Pediatric Emergency Care, Department of Pediatrics
| | - Murat Duman
- From the Division of Pediatric Emergency Care, Department of Pediatrics
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Yesantharao PS, Jenny HE, Lopez J, Chen J, Lopez CD, Aliu O, Redett RJ, Yang R, Steinberg JP. The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland. Craniomaxillofac Trauma Reconstr 2021; 14:308-316. [PMID: 34707791 PMCID: PMC8543597 DOI: 10.1177/1943387520983634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective, quasi-experimental difference-in-differences investigation. OBJECTIVE Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland's All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures. The APM implemented global hospital budgets to disincentivize low-value care and encourage preventive, community-based efforts. The objective of this study was to investigate how this reform has impacted pediatric craniofacial fracture care in Maryland. METHODS Children (≤18 years) receiving inpatient craniofacial fracture-related care in Maryland between January, 2009 through December, 2016 were investigated. New Jersey was used for comparison. Data were abstracted from the Kid's Inpatient Database (Healthcare Cost and Utilization Project). RESULTS Between 2009-2016, 3,655 pediatric patients received inpatient care for craniofacial fractures in Maryland and New Jersey. Prior to APM implementation, around 20% of Maryland patients received care outside of urban teaching hospitals. After APM implementation, less than 6% of patients received care outside of urban teaching hospitals (p = 0.003). Implementation of the APM in Maryland also resulted in fewer pediatric craniofacial fracture admissions than New Jersey, though this only reached borderline significance (adjusted difference-in-differences estimate: -1.1 fewer admissions, 95% confidence interval: -2.1 to 0.0, p = 0.05). Inpatient costs for pediatric craniofacial care and mean did not change post-APM. CONCLUSIONS Maryland's APM consolidated pediatric craniofacial fracture inpatient care at urban, teaching hospitals. Inpatient costs and lengths of stay did not change after policy implementation, but overall admission rates decreased. Such considerations are important when considering national expansion of global hospital budgeting.
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Affiliation(s)
- Pooja S. Yesantharao
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hillary E. Jenny
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Lopez
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonlin Chen
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher D. Lopez
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluseyi Aliu
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J. Redett
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan P. Steinberg
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lim RB, Hopper RA. Pediatric Facial Fractures. Semin Plast Surg 2021; 35:284-291. [PMID: 34819811 DOI: 10.1055/s-0041-1736484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Facial trauma is common in the pediatric population with most cases involving the soft tissue or dentoalveolar structures. Although facial fractures are relatively rare in children compared with adults, they are often associated with severe injury and can cause significant morbidity and disability. Fractures of the pediatric craniomaxillofacial skeleton must be managed with consideration for psychosocial, anatomical, growth and functional differences compared with the adult population. Although conservative management is more common in children, displaced fractures that will not self-correct with compensatory growth require accurate and stable reduction to prevent fixed abnormalities in form and function.
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Affiliation(s)
- Rachel B Lim
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
| | - Richard A Hopper
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle Washington
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Epstein S, Ettinger RE. Nasal and Naso-orbito-ethmoid Fractures. Semin Plast Surg 2021; 35:263-268. [PMID: 34819808 DOI: 10.1055/s-0041-1735791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Craniofacial fractures are common among trauma patients. Nasal fractures are the most common craniofacial fracture. Understanding how to evaluate and manage craniofacial fractures is important for the craniofacial trauma consultant. This manuscript describes the appropriate workup and management of nasal and naso-orbito-ethmoid fractures.
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Affiliation(s)
- Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Russell E Ettinger
- Division of Plastic and Craniofacial Surgery, Department of Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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Abstract
Objective The aim of this study was to assess patterns of maxillofacial trauma in the pediatric population in Atlanta. This information is important to help guide management and allocate resources for treatment of maxillofacial injuries at Children's Healthcare of Atlanta (CHOA). Methods This study was a retrospective chart review of children who presented from 2006 to 2015. Inclusion criteria were: (1) age 18 years old or younger, (2) presentation to emergency department, (3) diagnosis of maxillofacial fractures, and (4) evaluation by Oral and Maxillofacial Surgery, Otolaryngology, or Plastic Surgery services. Medical records were reviewed to record demographic, mechanism of injury, fracture location, and yearly incidence of injury. Descriptive statistics were computed to summarize findings and overall trends. Results During the study period, 39,833 patients were identified. Of them, 1995 met the inclusion criteria. The majority were male (n = 1359, 68%) with an average age of 9.4 years old (range of 1 month to 18 years old). Mechanisms of injury were motor vehicle collisions (MVC) (n = 597, 29.9%), fall (n = 565, 28.3%), sports injury (n = 317, 15.9%), pedestrian struck (n = 215, 10.8%), assault/abuse (n = 204, 10.2%), other (n = 81, 4.1%), or gunshot wound (n = 16, 0.8%). Fracture sites were mandible (n = 519, 26%), complex (n = 479, 24%), nasal (n = 419, 21%), dentoalveolar (n = 279, 14%), orbital (n = 259, 13%), and maxilla (n = 40, 2%). Males had a higher incidence of assault than females (n = 185, 91% of assaults). The incidence of maxillofacial trauma increased with age with a peak incidence in 13 to 16-year-olds (n = 566, 28.3%). During the years examined, there was an upward trend in MVCs as the etiology with a peak incidence of facial fractures due to MVCs occurring in 2015. All other mechanisms remained constant during this time period. Conclusions There was an increase in pediatric facial fractures secondary to motor vehicle collisions from 2007 to 2015 despite improvements in regulations, traffic safety, and technology.
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Affiliation(s)
- Kevin Hong
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - James Jeong
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
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TABAKAN İ, KOKAÇYA Ö, ESER C, GENCEL E. Epidemiologic analysis of pediatric maxillofacial trauma. Cukurova Medical Journal 2021. [DOI: 10.17826/cumj.920560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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46
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Halsey J, Argüello-Angarita M, Carrasquillo OY, Hoppe IC, Lee ES, Granick MS. Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center. Craniomaxillofac Trauma Reconstr 2021; 14:183-188. [PMID: 34471473 DOI: 10.1177/1943387520933697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Retrospective chart review of pediatric and globe injuries associated with orbital fractures. Objective Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures.
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Affiliation(s)
- Jordan Halsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marvin Argüello-Angarita
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Osward Y Carrasquillo
- Department of Dermatology, University of Puerto Rico School of Medicine, Puerto Rico
| | - Ian C Hoppe
- Department of Plastic Surgery, University of Mississippi College of Medicine, Jackson, MS, USA
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mark S Granick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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47
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Blankson PK, Amanor EM, Dai-Kosi AD, Amoako E, Konadu AB, Boamah MO, Amoah GK, Parkins GE. Paediatric maxillofacial fractures in Ghana: Pattern, household cost, and distress. Int J Paediatr Dent 2021; 31:613-618. [PMID: 33002267 DOI: 10.1111/ipd.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maxillofacial fractures in the paediatric population are peculiar in risks, management, and potential complications. AIM To determine the pattern, psychological distress to parents, and economic cost of paediatric maxillofacial fractures in Ghana. DESIGN This study combined a retrospective evaluation with a cross-sectional cost-of-illness (COI) analysis to describe the pattern and economic cost of paediatric maxillofacial fractures in Ghana. The DASS 21 was used to assess psychological distress to parents. Descriptive summaries were generated, and cross-tabulations done, with consequent tests of associations. RESULTS In all, 253 patients were included in the study, with 68 households responding to the COI evaluation. Consisting of 179 (70.8%) males and 74 (29.2%) females, the ages ranged from 10 months to 17 years (mean age of 9.0 ± 5.0 years). Maxillofacial fractures frequently resulted from falls (56.5%), while traffic injuries accounted for 27.3%. The average household cost for paediatric maxillofacial fractures in Ghana was US$ 148.77, with the direct cost component accounting for 76% of this amount. At least half of the parents had some degree of psychological distress from the injury sustained. CONCLUSION Knowledge of the pattern and disease burden of maxillofacial fractures in children is vital in informing preventive strategies, especially for evolving health systems in sub-Saharan Africa.
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Affiliation(s)
- Paa Kwesi Blankson
- Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana.,University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Efua M Amanor
- University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred D Dai-Kosi
- University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Emmanuella Amoako
- Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Akua B Konadu
- Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana.,University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Matthew Owusu Boamah
- Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana.,University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gyaami K Amoah
- University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Grace E Parkins
- Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana.,University of Ghana Dental School, College of Health Sciences, University of Ghana, Accra, Ghana
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Pandher M, Mukherjee TJ, Halsey JN, Luthringer MM, Povolotskiy R, Hoppe IC, Granick MS. A Single Center Review of Pediatric Nasal Bone Fractures - An Analysis of Concomitant Injuries, Management, and Outcomes. Eplasty 2021; 21:e5. [PMID: 35875510 PMCID: PMC9275413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pediatric nasal bone fractures presenting as isolated fractures or with concomitant facial injuries are rare and not well documented. Analysis of treatment at an urban, level-one trauma center provides insight into their management. METHODS Data were collected for pediatric nasal bone fractures diagnosed between January 2000 and December 2014. Patients were divided into groups based on presence or absence of isolated nasal bone fractures. Groups were compared using Chi-squared analysis, and a Bonferroni correction was used for a more conservative alpha (a = .004). RESULTS Assault was the most common etiology presenting in 46 of 122 pediatric nasal bone fractures. There was no significant difference in surgical versus non-surgical management of isolated and non-isolated nasal bone fractures (P = 0.98). Treatment for both was predominantly watchful waiting in 91% to 95% of the cases followed by closed reduction in 3.2% to 3.3%. In the patients with isolated fractures, 11.5% sustained intracranial hemorrhage, compared to 35.6% of multifracture cases (P = .002); 15.0% of isolated fractures sustained a traumatic brain injury, compared to 55.9% of multifracture cases (P = .000003). No significant difference in fatality existed between groups (P = 0.53). CONCLUSIONS Multi-facial fracture cases were more likely to present with traumatic brain injuries and be admitted to the intensive care unit than isolated nasal bone fractures. Rates of surgical and non-surgical management were not significantly different between the 2 groups. Watchful waiting of pediatric nasal bone fractures was the management approach selected 92% to 95% of the time regardless of the presence or absence of concomitant facial fractures.
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Affiliation(s)
- Meher Pandher
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Thayer J. Mukherjee
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordan N. Halsey
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Margaret M. Luthringer
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roman Povolotskiy
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ian C. Hoppe
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mark S. Granick
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Cepeda A Jr, Konty LA, Moffitt JK, Wainwright D, Booth JH, Nguyen PD, Greives MR. Study of Pediatric Operative Recreational Trauma: A Retrospective Analysis of Pediatric Sports-Related Facial Fractures. J Craniofac Surg 2021; 32:1611-4. [PMID: 33770047 DOI: 10.1097/SCS.0000000000007620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the United States, most school-aged children participate in some form of organized sports. Despite the advantages to social and physical development that organized sports may have, these activities also place a significant number of America's youth at risk for facial injuries. Pediatric facial fractures resulting from sports trauma are well documented within pediatric literature. Despite knowledge of the importance of safety equipment, there is a continued need for increased awareness about fracture patterns resulting from sports injuries to develop better strategies for their prevention. METHODS A retrospective review of all pediatric patients (age <18) who presented to Children's Memorial Hermann Hospital as a level 1 trauma between January 2006 and December 2015 with radiologically confirmed facial fractures was performed. Data regarding patient demographic information, mechanism of injury, facial fracture location, associated injuries, hospital course, and need for surgical intervention was collected. RESULTS Of the 1274 patients reviewed, 135 (10.59%) were found to have facial fractures resulting from sports trauma and were included in our cohort. The median age was 14 with 77.8% of the cohort being male. The most common fractures identified were orbital (n = 75), mandibular (n = 42), nasal (n = 27), maxilla (n = 26). Fractures were more frequently related to involvement in baseball/softball and bicycling n = 46 and n = 31 respectively. Eighty-two (60.74%) patients required admission, 6 requiring ICU level care, 70 (51.85%) were found to require surgery. There were 14 patients who were found to have a concomitant skull fracture and 6 with TBI. There were no fatalities in this cohort of patients. CONCLUSION Pediatric facial fractures occur in the same anatomic locations as adult facial fractures. However, their frequency, severity, and treatment vary because of important anatomical and developmental differences in these populations. Despite available knowledge on this subject and increased use of protective equipment, pediatric facial fractures continue to occur with similar distribution as historically described. While sports participation confers numerous benefits, it is vital that we continue researching pediatric facial trauma and associated fractures to develop protective equipment and protocols to mitigate the risks of these activities.
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Bourdillon A, Salehi PP, Steren B, Pei KY, Lee YH. Characterizing Epidemiology and Associated-Factors of Adolescent Sports-Related Traumas Using Trauma Quality Improvement Program. J Craniofac Surg 2021; 32:1618-21. [PMID: 33741887 DOI: 10.1097/SCS.0000000000007619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Sports-related injuries contribute to a considerable proportion of pediatric and adolescent craniofacial trauma, which can have severe and longstanding consequences on physical and mental health. The growing popularity of sports within this at-risk group warrants further characterization of such injuries in order to enhance management and prevention strategies. In this study, the authors summarized key trends in 1452 sports-related injuries among individuals aged 16 to 19 using the American College of Surgeon's Trauma Quality Improvement Program database from 2014 to 2016. The authors observed a preponderance of injuries associated with skateboarding, snowboarding, and skiing, with significantly higher percentages of traumatic brain injuries among skateboarding-related traumas. Notably, we observed that traumatic brain injurie rates were slightly higher among subjects who wore helmets. Intensive care unit durations and hospital stays appeared to vary by sport and craniofacial fracture. Altogether, this study contributes to the adolescent sports-related injuries and craniofacial trauma literature.
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