Facial fractures in children: a historical perspective on treatment techniques

The surgical principles for the treatment of facial fractures in children have evolved progressively over the past 70 years. In 1943 Waldron and colleagues published what is probably the first paper on the subject, thus setting a paradigm for the conservative treatment of pediatric facial fractures. This standard remained viable for about five decades. Therefore, during many years children with facial fractures did not benefit in the same manner as their adult counterparts from the multiple advances made in the management of facial trauma. In the 1990s craniofacial surgeons used plates and screws to correct craniofacial deformities in children with congenital malformations. As a consequence of their findings, pediatric oral and maxillofacial surgeons started to apply such principles to the management of facial fractures in young, growing patients, which eventually paved the way for the open reduction with external fixation paradigm. The aims of this article are to detail Waldron's initial directives, to evaluate the publications that contributed to its consolidation, and to analyze the factors that led to its challenge fifty years later.