Pediatric Maxillofacial Injuries Etiology, Diagnosis and Management
Abstract
Factures in the facial region is one of the most
common during the maxillofacial injuries which
involves facial bones and the cranial bones. These
fractures cause psychological disturbances and daily
routine is hampered. Patients will have to face
mental harassment and they think they are socially
discarded. Pattern of facture’s nature is similar to
children and adult but the incidence is low in case of
children [1-3].
Fractures in children are minimally displaced this is
because elastic bone is covered by thicker layer of
adipose tissue which acts as protective layer and suture
lines are flexible. Within last 30 years there is
tremendous development in the field of treatment
of pediatric traumas due to development in radiological
aspect and different surgical materials. With
the development of Cone Beam Computerized Technique
(CBCT) in radiograph field it has made quite
easy for diagnosis of fractures in children. It has not
only made easy to do diagnosis but also has helped
to choose the type of treatment what we are going
to do.
Similarly, it has replaced all the plain films. Treatment
is mostly done at the earliest time. Non-displaced
fractures are managed just by closed reduction or
just observation and soft diet may be more than sufficient.
Displaced fractures are treated by open reduction
internal fixation. Primary bone grafting is the
first choice, if not then only we can think of secondary
grafting which may have complications. Pediatric
patients are kept under regular follow up as they are
growing and there may be potential disturbances in
growth abnormalities [4,5].
Due to strict rules of traffic in some countries and
less alcohol use in some countries has decreased
road traffic accidents (RTA). In country like Nepal
there is total restriction in alcohol use by the person
who is driving any kind of vehicles which has significantly
reduced the RTAs. CBCT is one of the most
advance technique with three dimensional imaging
system will provide accurate and precise anatomic
landmarks which guides surgeons for accurate
placements of mini plates and screws without hampering
developing tooth buds in pediatric patients.
With the development of internal rigid fixation the
pattern of treatment in the field of pediatric trauma
has revolutionized by allowing the perfect reduction
and fixation of the fractures part of bones making
them more stable to the accurate site. Recent development
in the field of anesthesia has helped a lot
during surgeries.
Swelling of the airway or the obstruction of the airway
due to mechanical problem in child patients can
quickly compromises the airway. Because of these
reasons airway and breathing management, hemorrhage
control and prior resuscitation are more critical
and time dependent in pediatric patients with
maxillofacial trauma than in adult patients.
Depending on the social, cultural and environmental
values of different countries the etiology varies in
maxillofacial injuries. Age related activities also affect
the nature of injuries and pattern of trauma. Falls,
sports and RTA is considered the frequent cases for
maxillofacial injuries in children. School going children
become victims of falls and with increasing age
sports cases injuries. Etiology, direction of force and
velocity of forces determine the nature, pattern and
location of fractures. The unique anatomic nature of pediatric bone is the other factor which changes the
fracture pattern and nature. Mostly the green stick
fracture can be seen in pediatric patients [6].
Age plays important role in the fractures in case of
children. Below 2 years of age frontal bone is more
prone for fractures and older once are more prone
for chin and lip regions. Below 3 years of children are
more prone for isolated and no displaced fractures
due to low velocity forces. Mandibular fractures are
common in comparison to midface fractures. Most
common fractures in children with maxillofacial injuries
are dentoalveolar and nasal fractures.
Condylar fracture is another common fracture in
children and if left untreated will result in ankylosis
of temporomandibular joint in future. Zygomatic
complex fracture is more common than Le fort fractures.
Nasal fractures alone make almost 50% of total
maxillofacial trauma in children. With the recent advancements
in the field of radiology and internal rigid
fixation techniques the managements of pediatric
patients have revolutionized a lot.
These all developments have reduced postoperative
infections, malunion or nonunion. Due to greater osteogenic
potential and faster healing capacity in children,
it minimizes the requirement of open reduction
and internal fixation. Mostly the nature of facture in
pediatric patients is non-displaced in nature. Preventive
measures are most important to reduce the maxillofacial
injuries. We have to take care of children.
School teachers, sport teachers and parents must be
more aware so that we can reduce the injuries.
Preventive measures if followed strictly and regularly
we can definitely reduce the pediatric trauma and severity
of any kind of injuries. RTA and any kind of road
accidents and its severity nature of injuries can be
reduced by proper use of seat belts and save drive.
Hence education to the society about the accidents
and preventing them is most important in reducing
the maxillofacial injuries in pediatric patients.
