Study lends new insights into pediatric facial fractures

Facial fractures in children occur in different patterns in different age groups, but most often occur with other types of severe injuries, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The study lends new insights into trends in the demographics, diagnosis and treatment of pediatric facial fractures—including higher rates of fractures caused by violence among adolescents, low-income and minority youth. The study was led by Dr. Joseph E. Losee of Children's Hospital of Pittsburgh.

In-Depth Analysis of 722 Pediatric Facial Fractures
The researchers analyzed facial fractures in infants, children and adolescents over a five-year period. They focused on differences in patient characteristics, fracture patterns and treatment in three age groups: 0 to 5 years, 6 to 11 years, and 12 to 18 years. The study excluded children who had skull fracture only, without fracture of the facial bones.

The average age was 10.7 years, and 69 percent of the patients were boys. Orbital fractures—fractures in and around the eye socket—were the most common type in all age groups. Rates of jaw, nasal and other types of fractures increased with age. Infants and young children were more likely to need treatment in the intensive care unit, while older children were more likely to need surgery.

Motor vehicle crashes were the most common cause, responsible for 21 percent of facial fractures. However, causes varied by age group:
•Infants and children up to age 5 accounted for 20 percent of facial fractures. They were most likely to be injured in falls— none were injured in violence.
•Children ages 6 to 11 accounted for 33 percent of facial fractures. Motor vehicle crashes were the most common cause, followed by play and bicycle riding.
•Adolescents ages 12 to 18 were the largest group with facial fractures at 47 percent. Violence was the most common cause of facial fractures in teens, followed by sports-related injuries.

Across age groups, 56 percent of children had other types of traumatic injuries, including a 22 percent rate of concussions. Overall, 63 percent of children were hospitalized and 1.4 percent died.

About 12 percent of facial fractures resulted from violence. Violent injuries were more likely for minority children and those living in low-income neighborhoods.

Facial fractures are less common in children than adults; less than 15 percent of facial fractures occur in children. Because the skull and facial bones of children are "anatomically distinct" from those of adults, they are subject to unique injury patterns. Because of these distinct patterns, along with concern for future growth, surgeons must approach facial fractures in children as "fundamentally different" from those in adults.

The study is one of the first to look at the full range of facial fractures in children, from infancy through adolescence. Anatomy explains the higher rate of middle-third facial fractures in older children. Because of the relatively large size of the cranial bones in infants and young children, they are more likely to sustain isolated skull fractures rather than facial fractures.

The results call attention to the high rate of facial fractures caused by violence in boys, especially minorities and those in low-income areas. Dr. Losee and colleagues hope their findings will help plastic and reconstructive surgeons develop new and more effective approaches to diagnosis, treatment and prevention of these unique injuries.