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Facial fractures in children
A J Holland1, C Broome, A Steinberg
1Department of Surgical Research, The New Children's Hospital, Royal Alexandra Hospital for Children, The University of Sydney, Westmead, Australia.
Insights
Facial fractures in children are uncommon but linked to major trauma. CT scans are more effective than plain radiography for diagnosing these injuries, while clinical exams can cause delays.
Area of Science:
- Pediatric Traumatology
- Medical Imaging in Pediatrics
- Facial Trauma Analysis
Background:
- Facial fractures in children are relatively uncommon but often associated with significant trauma.
- Understanding injury patterns and diagnostic modalities is crucial for effective management.
Purpose of the Study:
- To investigate the injury patterns of facial fractures in pediatric patients.
- To evaluate the diagnostic utility of plain radiography versus CT scans.
- To identify factors contributing to delayed diagnosis of facial fractures in children.
Main Methods:
- A retrospective review of case notes for all pediatric patients diagnosed with facial fractures.
- Analysis of data from trauma and medical record databases over a 4-year period.
- Comparison of diagnostic accuracy between plain radiography and CT scans.
Main Results:
- Fifty-nine facial fractures were identified in 46 children, with motor vehicle accidents being the most common cause (63%).
- Plain radiography offered limited diagnostic value compared to clinical examination, often failing to detect fractures.
- Facial CT scans accurately diagnosed injuries and revealed additional unsuspected fractures in all cases where performed.
Conclusions:
- Facial fractures in children necessitate major trauma and are best diagnosed with CT scans.
- Plain facial radiographs have limited utility in diagnosing pediatric facial fractures.
- Prompt and accurate diagnosis, often requiring CT, is essential to avoid delayed treatment and manage associated injuries.
Objective:
To determine the pattern of injury of facial fractures in children, the relative contribution of plain radiography and CT scanning in the diagnosis of these injuries, and factors leading to delayed diagnosis.
Design:
Retrospective case note review.
Participants:
All children with facial fractures identified using the trauma and medical record databases at our institution.
Results:
Forty-six children with 59 facial fractures presented over a 4-year, 2-month period from November 1995 to December 1999. The median age was 10 years, with a range from 1 to 14. There was a 2-to-1 male-to-female sex ratio. A motor vehicle accident (MVA) involving a child as passenger, pedestrian, or cyclist accounted for 63% of cases. In seven of these, the child was either a front seat passenger or inappropriately restrained for their age and size. In all but one case, the presence of a fracture was associated with an overlying laceration, abrasion, or significant soft tissue edema. Initial examination and plain radiologic assessment by a pediatric clinician led to diagnostic delay in nine children. Facial CT was performed in 38 children, and all results were positive. Twenty-six patients required operative intervention for their facial fracture. Associated injuries, particularly of the head and limbs, were present in all but six patients.
Conclusions:
Facial fractures were uncommon overall but occurred more frequently in children with major trauma. Plain facial radiographs provided limited additional diagnostic information to careful clinical examination and often fail to detect or clearly define a facial fracture in children. In the correct clinical setting, a facial CT scan allows accurate diagnosis of the injury and can reveal previously unsuspected additional fractures.