Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem

Pediatric cervical spine injuries (CSI) are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children, but may be deemed isolated facial fractures and bypass the standard trauma pathway. The objective of this study is to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center. An analysis was performed of all patients under the age of 18 with maxillofacial trauma admissions to a single level 1 trauma center, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine injury. Data was abstracted to include demographic, mechanism and clinical outcomes data. There were 1274 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.7%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age and penetrating mechanism. Cervical spine injuries were associated with concomitant traumatic brain injuries and skull fractures. Patients with spine injuries were more like to experience a longer length of stay and death. On multivariate analysis, only increased age predicted CSI. Our database demonstrated a 5.7% incidence of pediatric cervical spine injuries in patients with maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out.