Fractures of the facial skeleton in children

Fractures of the facial skeleton in children are uncommon. This study presents the results of 139 children who sustained a total of 161 such fractures and were admitted to the Royal Hospital for Sick Children, Edinburgh, between January 1983 and December 1992. The male to female ratio was 3:1 and the highest incidence was at age 10 years. Analysis of fracture patterns showed that despite differences in anatomy, the fracture patterns were similar to those occurring in adults, but the relative proportion of each fracture type was different in children. Nasal fractures occurred most frequently (54 per cent), mandibular fractures constituted 30 per cent, and middle third fractures only 16 per cent. Falls, sporting injuries and road traffic accidents (RTA) were the major causes of these injuries. Injuries sustained in RTA were most likely to have involved cyclists or pedestrians in contrast to earlier series which have identified these injuries mainly among car passengers. No deaths were recorded and most patients made a complete recovery, although a few required secondary surgery for complications. This taken in conjunction with the findings of both high numbers of associated injuries, and increased severity commonly occurring in both mandibular and middle third injuries leads to the suggestion that these should be treated in centres where multidisciplinary management can easily be coordinated.