Incidence Of Facial Fractures Research Articles

The role of restraint and seat position in pediatric facial fractures.

Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture. A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998-2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury. Ninety-two children suffered a fracture of the facial bones (0.07% of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2-2.1; p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described. The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.

The effect on facial growth of pediatric mandibular fractures.

The incidence of facial fractures in the pediatric population is between 1.4% and 15% of all maxillofacial traumas. Forty-one percent of pediatric facial fractures involve the mandible. No study has commented on the incidence of mandibular fractures that go on to develop growth disturbances leading to asymmetry and malocclusion. A retrospective chart review was carried out that identified and followed 88 children who sustained mandibular fractures and presented to The Hospital for Sick Children in Toronto during the 13-year period from 1980 to 1993. Patient follow-up ranged from 2 to 15 years, and was performed via phone survey and medical/orthodontic chart review. Patients who required orthodontics and orthognathic surgery were identified. Results indicated that a pediatric mandibular fracture does not lead to a higher incidence of orthodontic intervention. Furthermore, children younger than 4 years or older than 12 years rarely require orthognathic surgery to correct facial growth disturbances following mandibular fractures. In contrast, 22% of children age 4 to 7 years, and 17% of children age 8 to 11 years required orthognathic surgery to correct facial growth disturbances following mandibular fractures. Condylar fractures were the most common site of mandibular fracture, and led to facial asymmetry most frequently.

Aetiology and incidence of facial fractures in adults

The incidence, aetiology and trends in fractures of the facial bones occurring in the years 1965, 1970, 1975 and 1980 in the Grampian Region of Scotland are reported. A 2.7 fold increase in incidence occurred during this period. Males are seen to be most at risk and an increase in assault and sports-related trauma is seen. Offshore oil exploration developed during this period and its effects are discussed. Attention is drawn to the differences in the aetiology of right and left malar fractures.

Dental and Maxillofacial Injuries

Examination of the injured child for maxillary fracture and damage to the teeth is outlined, and the treatment of dental fractures, injuries to the facial soft tissues, and fractures of the facial bones is discussed. The incidence of facial fractures in children is low because, in comparison to the adult, the child’s facial bones constitute a relatively small area in relation to the cranium. Also emphasized is the prevention of injuries through the use of mouth protectors.