Assessment Of Panfacial Fractures In The Pediatric Population
Margaret Dalena, Farrah C. Liu, MD, Jordan N. Halsey, MD, Alexa Mae A. Sangalang, BS, Mark S. Granick, MD, Jonathan D. Keith, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
PURPOSE: Panfacial fractures have been traditionally defined as fractures involving the upper, middle, and lower thirds of the face. While management of panfacial fractures is critical and often difficult in adults, there is little to no literature regarding these fractures in the pediatric population. Multiple management approaches have been described within the adult population, however there is no consensus for management of these fractures in pediatric patients. In this study, the authors present their experience in order to provide insight and further investigation regarding prevention and management strategies of panfacial fractures within the pediatric population.
METHODS: A retrospective chart review was performed for all panfacial fractures in the pediatric population between 2002-2014 at an urban, level 1 trauma center, University Hospital in Newark, NJ. Patient demographics were collected, as well as mechanism of injury, location of fractures, concomitant injuries, and surgical management strategies.
RESULTS: During the time period examined, 82 patients were identified as 18 years of age or younger and having sustained a panfacial fracture. Panfacial fractures are defined as involving at least two thirds of the face, including the upper, middle, and lower thirds. The mean age at time of injury was 12.9 (range 1 - 18) years, with a male predominance of 64.9%. A total of 335 fractures were identified on radiologic imaging via CT or X-ray. The most common etiologies were motor vehicle accidents (40.5%), pedestrian struck (20.3%), falls (14.9%) and assault (12.2%). Orbital (79.7%), frontal sinus (59.5%), nasal (45.9%), and zygoma (27%) fractures were the most common. The mean Glasgow Coma Scale on arrival was 12.0 (range 3 - 15). Twenty-nine patients were intubated on, or prior to, arrival to the trauma bay, and surgical airway was required in nine patients. The most common concomitant injuries were traumatic brain injury (64.9%), intracranial hemorrhage (51.4%), and skull fractures (45.9%). Surgical repair was required in 38 patients (48.6%). The cephalic to caudal approach was used in 8 patients (21%), the caudal to cephalic approach in 6 patients (15.8%), the medial to lateral approach in 2 patients (5.3%) and the lateral to medial approach in 1 patient (2.6%). Five patients required maxillomandibular fixation with arch bars. Resorbable plates were implemented in 5 patients, titanium plates in 23 patients, Medpor implants in 1 patient, and Champy plates in 6 patients. Within a year of their initial surgery, 4 patients underwent reoperation for complications (10.5%). The mean hospital length of stay was 10.6 (range 1 - 134) days. Four patients died.
CONCLUSIONS: Pediatric panfacial fractures are rare occurrences, with minimal literature available regarding the management and pattern of injury for these fractures. The impact of these injuries can be devastating with concomitant life-threatening injuries and complications. Additionally, proper management of these fractures is critical in preserving appropriate development of the facial skeleton after injury. Given the lack of literature, and preventable nature of these injuries, the authors hope this study can address primary prevention strategies and provide insight towards management and characteristics of these fractures.
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