Pediatric nasal bone and septal fractures represent a large number of craniofacial injuries in children each year. Due to their differences in anatomy and potential for growth and development, the management of these injuries varies slightly from that of the adult population. As with most pediatric fractures, there is a bias toward less-invasive management to limit disruption to future growth. Often this includes closed reduction and splinting in the acute setting followed by open septorhinoplasty at skeletal maturity as needed. The overall goal of treatment is to restore the nose to its preinjury shape, structure, and function.

Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.

The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.

Head and neck vascular pathology is routinely encountered by the maxillofacial surgeon. Although these anomalies have been traditionally managed by surgical means, adjunctive therapies have been popularized in recent years. The use of laser therapy has gained attention for its ability to better access and to provide more predictable outcomes in the highly intricate and vascular areas of the head and neck. Laser therapy allows for the selective targeting of diseased tissue while maintaining the integrity of surrounding healthy tissue.

Interventional approaches to head and neck vascular anomalies have evolved with our understanding of disease pathologic condition and advances in medical and surgical treatment. Embolization's role in the disease management ranges from stand-alone treatment with curative intent to adjunctive or even palliative, depending on the lesion. This decision is best made through multidisciplinary collaboration among surgeons, interventionalists, and medical specialists. Finally, setting realistic expectations with the patient and family is a crucial step preceding any intervention. This article elaborates on the considerations influencing a given treatment plan and specific interventional strategy.

Vascular anomalies (VAs) can be present in any organ; however, the skin being the largest one, it is there where many of them are evident; some are visible at birth, others develop throughout life. Pediatric dermatologists are specially trained to distinguish VAs from their mimickers, which require different treatments and may harbor distinct prognoses. We resume the diagnostic and therapeutic tasks of pediatric dermatologist at our vascular anomaly clinics, as well as the differential diagnoses of mimickers of VAs.

There continuous to be widespread misuse of nomenclature used to described vascular anomalies, This is even more pronounced in the case of intra-osseous lesions. Bone involvement is more common with vascular malformations and extremely rare in haemangiomas. An accurate diagnosis is mandatory for tailored management and often based on a thorough history, clinical examination, and cross-sectional imaging. Surgery remains the main stay for the management of symptomatic venous malformations. Embolisation with or without surgery is the main stay for arteriovenous malformations. Virtual surgical planning, with surgical guides and patient specific implants help achieve predictably excellent results.

The treatment of hemangiomas and vascular malformations should be individualized, based upon the size of the lesion(s), morphology, location, presence or possibility of complications, the potential for scarring or disfigurement, the age of the patient, and the rate of growth or involution at the time of evaluation. The major challenge is the location in a head and neck can lead to unsightly scars if approached improperly, or with inadequate approaches can lead to intraoperative and postoperative morbidity with neurovascular damage and inadequate lesion excision. Facial, trigeminal, and other cranial nerve branches are of key importance in the functional outcome while accessing and approaching head and neck vascular lesions.

The anatomy of the paranasal sinuses is complex with multiple anatomic variants that can predispose patients to disease. Knowledge of this complex anatomy is important not only for successful treatment but to also avoid complications at the time of surgery. This article will review the anatomy with emphasis on a variety of clinically important anatomic variants.