Pediatric Facial Fractures

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.

Keywords: NOE; facial fractures; facial trauma.

Fig. 1

Intraoperative image of a “Ping pong” skull fracture in a 1-year-old prior to craniectomy and cranioplasty. The surgery was performed due to underlying intracranial injury.

Fig. 2

Growing skull fracture in a 2-year-old diagnosed and treated 8 months after the initial traumatic event ( left ). CT scan image of the right parietal bone erosion that had developed from progressive intracranial pulsations on an undiagnosed linear fracture with an underlying dural tear ( center ). Dural repair with autograft after the surrounding craniectomy ( right ). Reconstruction of the craniectomy flap using split calvarial grafts and resorbable plate fixation for coverage of the dura repair.

Fig. 3

Orbital roof fracture in a 4-year-old from a lateral horse kick ( left; preoperative ). The displaced orbital roof is impinging on the periorbital contents and is associated with a displaced zygoma fracture and impacted sphenoid fracture ( right; postoperative ). The zygoma and sphenoid have been reduced and fixated and the orbital roof repaired with an autogenous graft through a frontal craniectomy.

Fig. 4

Coronal CT scan view of a pediatric trap door fracture in a 5 year old. The orbital floor has spontaneously reduced itself after the initial displacement, but the inferior rectus muscle is no longer visible in the orbit and is instead trapped within the maxillary sinus.

Fig. 5

Intraoperative peri-cranial shave graft in a 2-year-old patient. The patient had not developed a cranial diploe space and therefore a sharp osteotome was used to harvest a composite pericranium-particulate cortex graft for treatment of an orbital trap door fracture.

Fig. 6

Displaced right zygoma fracture in a 2-year-old patient ( left ). Coronal CT scan view demonstrates tooth follicles in the maxilla with early maxillary sinus formation ( center ). CT scan after reduction and fixation with a single titanium plate across the fronto-zygomatic suture ( right ). CT scan 3 months later prior to plate removal, demonstrating bone healing.

Fig. 7

CT Scan of displaced fractures of the maxilla and mandible in a 2 year old following a dog bite attack ( left ). At presentation ( center ) following open treatment, reduction, and titanium fixation of the inferior border of the mandible fracture, and cranial bone grafting of the maxillary defect with resorbable fixation ( right ). Panorex imaging at age 14 demonstrating healing of maxillary and mandible buttresses and dental compensation despite loss of two teeth in the mandible.

Fig. 8

CT scan of a severely displaced left mandible angle fracture in a 4 year old ( left ). The fracture was fixated with an upper and lower border titanium plate with monocortical screws. Additional stabilization was required using arch bars that were carefully placed around the posterior primary dentition with care to avoid strain on the incisors ( right ). The titanium plates and interdental bars were removed 6 weeks after surgery.

Fig. 9

CT scan of a displaced fracture of the right condylar neck in a 3-year-old ( left ) at presentation, and ( right ) 3 months after conservative treatment with soft diet for 6 weeks demonstrating complete condylar remodeling.