Contemporary management of pediatric facial trauma

Abstract

Facial fracture management is often complex and demanding, particularly within the pediatric population. Although facial fractures in this group are uncommon relative to their adult counterparts, a thorough understanding of issues relevant to pediatric facial fracture management is critical to optimal long-term success. Children are not 'small adults', and the management of facial fractures in this population is unique. Injuries tend to be less severe, and can often be managed with soft diet and restriction of activity. Maxillomandibular fixation should be used only when indicated, as it can result in temporomandibular joint (TMJ) disturbances; to minimize this risk, it should be in place no longer than 7 days. Open reduction and internal fixation is indicated in severe injuries, and the surgeon must be cognizant of developing teeth. Small plates and screws are useful in this patient population. In this review of modern management of the pediatric facial trauma patient, several issues germane to pediatric facial fractures are discussed. Thorough ophthalmologic and dental/occlusive examinations must be undertaken. Conservative management is optimal for many injuries, as the pediatric fracture is typically not as severe as those seen in the adult facial skeleton. When wiring the jaw to allow for noninvasive fixation, treatment time must be short in order to avoid TMJ ankylosis. Rigid fixation is indicated in the rare comminuted, displaced fracture; when employed, the surgeon must use small plates and screws, and avoid injury to developing teeth. These are challenging cases, but with appropriate knowledge and understanding, they can be appropriately managed.