The Epidemiology and Management of Pediatric Maxillary Fractures.
Journal
The Journal of craniofacial surgery
ISSN: 1536-3732
Titre abrégé: J Craniofac Surg
Pays: United States
ID NLM: 9010410
Informations de publication
Date de publication:
01 May 2021
01 May 2021
Historique:
pubmed:
18
9
2020
medline:
18
11
2021
entrez:
17
9
2020
Statut:
ppublish
Résumé
Most literature regarding traumatic Le Fort or maxillary fractures exists in the adult population, with limited information regarding the epidemiology and management of pediatric fractures. The purpose of this study was to evaluate fracture mechanism, surgical management, and associated injuries in pediatric patients with Le Fort fractures. A retrospective chart analysis of all pediatric patients age ≤18 years diagnosed with facial fractures at a single level 1 trauma center over a 10-year period (January 2006-December 2015) was performed. Demographics, fracture location, mechanism of injury, and hospital course were abstracted as well as associated injuries and need for operative management. A total of 1274 patients met inclusion criteria. Sixty-nine (5.4%) presented with Le Fort fractures. Factors associated with Le Fort fractures included motor vehicle collisions (P < 0.001), increased age (P < 0.001), and traumatic brain injury (P < 0.04). Patients with Le Fort fractures were more likely to need intensive care unit admission (P < 0.001), surgical management (P < 0.001), transfusions (P < 0.001), secondary fixation surgery (P < 0.001), and have a longer length of stay (P < 0.001). Multivariate showed increased odds for increased age (OR 1.1; 95%CI 1.04-1.17) and concomitant orbit fractures (OR 8.33; 95%CI 4.08-19.34). Decreased odds were associated for all mechanisms of injury other than motor vehicle collisions (Other blunt trauma: OR 0.36; 95%CI 0.2-0.6. Penetrating trauma: OR 0.13; 95%CI 0.01-0.6). Maxillary or Le Fort fractures represent a small portion of pediatric facial fractures but require high rates of operative management. The high velocity required to create this fracture type is associated with significant traumatic comorbidities, which can complicate the hospital course.
Sections du résumé
BACKGROUND
BACKGROUND
Most literature regarding traumatic Le Fort or maxillary fractures exists in the adult population, with limited information regarding the epidemiology and management of pediatric fractures. The purpose of this study was to evaluate fracture mechanism, surgical management, and associated injuries in pediatric patients with Le Fort fractures.
METHODS
METHODS
A retrospective chart analysis of all pediatric patients age ≤18 years diagnosed with facial fractures at a single level 1 trauma center over a 10-year period (January 2006-December 2015) was performed. Demographics, fracture location, mechanism of injury, and hospital course were abstracted as well as associated injuries and need for operative management.
RESULTS
RESULTS
A total of 1274 patients met inclusion criteria. Sixty-nine (5.4%) presented with Le Fort fractures. Factors associated with Le Fort fractures included motor vehicle collisions (P < 0.001), increased age (P < 0.001), and traumatic brain injury (P < 0.04). Patients with Le Fort fractures were more likely to need intensive care unit admission (P < 0.001), surgical management (P < 0.001), transfusions (P < 0.001), secondary fixation surgery (P < 0.001), and have a longer length of stay (P < 0.001). Multivariate showed increased odds for increased age (OR 1.1; 95%CI 1.04-1.17) and concomitant orbit fractures (OR 8.33; 95%CI 4.08-19.34). Decreased odds were associated for all mechanisms of injury other than motor vehicle collisions (Other blunt trauma: OR 0.36; 95%CI 0.2-0.6. Penetrating trauma: OR 0.13; 95%CI 0.01-0.6).
CONCLUSION
CONCLUSIONS
Maxillary or Le Fort fractures represent a small portion of pediatric facial fractures but require high rates of operative management. The high velocity required to create this fracture type is associated with significant traumatic comorbidities, which can complicate the hospital course.
Identifiants
pubmed: 32941219
pii: 00001665-202105000-00014
doi: 10.1097/SCS.0000000000007050
doi:
Types de publication
Journal Article
Langues
eng
Pagination
859-862Informations de copyright
Copyright © 2020 by Mutaz B. Habal, MD.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Grunwaldt L, Smith DM, Zuckerbraun NS, et al. Pediatric facial fractures: demographics, injury patterns, and associated injuries in 772 consecutive patients. Plast Reconstr Surg 2011; 128:1263–1271.
Imahara SD, Hopper RA, Wang J, et al. Patterns and outcomes of pediatric facial fractures in the united states: a survey of the national trauma data bank. J Am Coll Surg 2008; 207:710–716.
Kim DB, Sacapano M, Hardesty RA. Facial fractures in children. West J Med 1997; 167:100.
Ferreira PC, Barbosa J, Amarante JM, et al. Associated injuries in pediatric patients with facial fractures in Portugal: analysis of 1416 patients. J Cranio-Maxillo-fac Surg 2015; 43:437–443.
Boyette JR. Facial fractures in children. Otolaryngol Clin N Am 2014; 47:747–761.
Currey JD, Butler G. The mechanical properties of bone tissue in children. J Bone Joint Surg Am 1975; 57:810–814.
Rodríguez-Merchán EC. Pediatric skeletal trauma: a review and historical perspective. Clin Orthop Relat Res 2005; 432:8–13.
Moffitt JK, Wainwright DJ, Bartz-Kurycki M, et al. Factors associated with surgical management for pediatric facial fractures at a level one trauma center. J Craniofac Surg 2019; 30:854–859.
Zimmermann CE, Troulis MJ, Kaban LB. Pediatric facial fractures: recent advances in prevention, diagnosis and management. Int J Oral Maxillofac Surg 2006; 35:2–13.
Ferreira PC, Amarante JM, Natividade Silva P, et al. Retrospective study of 1251 maxillofacial fractures in children and adolescents. Plast Reconstr Surg 2005; 115:1500–1508.
Phillips BJ, Turco LM. Le Fort fractures: a collective review. Bull Emerg Trauma 2017; 5:221–230.
Zhou H, Ongodia D, Liu Q, et al. Incidence and pattern of maxillofacial fractures in children and adolescents: a 10 years retrospective cohort study. Int J Pediatr Otorhinolaryngol 2013; 77:494–498.
Tessier P. The classic reprint: experimental study of fractures of the upper jaw. Parts I and II. Rene Le Fort, M.D., Lille, France. Plast Reconstr Surg 1972; 50:497–506.
Tessier P. The classic reprint: experimental study of fractures of the upper jaw. Parts III. Rene Le Fort, M.D., Lille, France. Plast Reconstr Surg 1972; 50:600–605.
Gassner R, Tuli T, Hächl O, et al. Craniomaxillofacial trauma in children: a review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg 2004; 62:399–407.
Vyas RM, Dickinson BP, Wasson KL, et al. Pediatric facial fractures: current national incidence, distribution, and health care resource use. J Craniofac Surg 2008; 19:339–349.
Macmillan A, Lopez J, Luck JD, et al. How Do Le Fort – type fractures present in a pediatric cohort? J Oral Maxillofac Surg 2017; 76:1044–1054.
Ferreira P, Marques M, Pinho C, et al. Midfacial fractures in children and adolescents: a review of 492 cases. Br J Oral Maxillofac Surg 2004; 42:501–505.
Iizuka T, Thoren H, Annino D Jr, et al. Midfacial fractures in pediatric patients. Arch Otolaryngol Head Neck Surg 1995; 121:1366–1371.
Davidson EH, Cantab MA, Schuster ÃL, et al. Severe pediatric midface trauma: a prospective study of growth and development. J Craniofac Surg 2015; 26:1523–1528.
Mcgraw BL, Cole RR. Pediatric maxillofacial trauma: age-related variations in injury. Arch Otolaryngol Head and Neck Surg 1988; 116:41–45.
Bagheri SC, Holmgren E, Kademani D, et al. Comparison of the severity of bilateral Le Fort injuries in isolated midface. J Oral Maxillofac Surg 2005; 63:1123–1129.
Siy RW, Brown RH, Koshy JC, et al. General management considerations in pediatric facial fractures. J Craniofac Surg 2011; 22:1190–1195.
Viviano SL, Hoppe IC, Halsey JN, et al. Pediatric facial fractures: an assessment of airway management. J Craniofac Surg 2017; 28:2004–2006.
Naran, Sanjay, Keating, et al. The safe and efficacious use of arch bars in patients during primary and mixed dentition: a challenge to conventional teaching. Plast Reconstr Surg 2014; 133:364–366.