1. Pediatric Facial Trauma Ravi Pachigolla, MD May 12, 1999

2. INTRODUCTION n Leading cause of death n Different treatment modalities in children vs. adults

3. EPIDEMIOLOGY n Amount of facial injuries n Nasal Fractures most common n Types of mandibular fractures n Midfacial fractures rare n Associated injuries common

4. FACIAL GROWTH n Facial development slower than cranial development n Development of face and paranasal sinuses affects patterns of injuries n Vulnerable growth centers of the face

5. EXAMINATION OF THE INJURED CHILD n Sedation often necessary n Calm reassurance n Thorough examination of lacerations and orderly palpation n Mandibular range of motion n Opthalmologic exam

6. SOFT TISSUE INJURIES n Scars more noticeable n FN and parotid duct injuries n Prevention of traumatic tattooing n Topical and buffered infiltrative anesthesia n Auricular hematoma n Bite wounds

7. RIGID FIXATION n Standard of care for adult trauma patients n Controversial use in children n Studies focused on infant animals with rapid facial growth compared to humans n Use of absorbable plates may provide answer n Mandible may resist growth disturbance more than midface

8. RADIOLOGIC EXAMINATION n CT imaging mandatory for most injuries except for the most trivial n Coronal imaging important n Panorex plus Towne’s views n Nasal fractures usually a clinical diagnosis and even moreso in children

9. NASAL FRACTURES n Children have soft, compliant cartilages n Fractures rare n Septal injuries more common with septal hematoma n Long term growth disturbance n Conservative reduction n Newborn nasal trauma

10. MANDIBULAR FRACTURES n Dentoalveolar injuries n Cautious use of intermaxillary fixation n Pattern of injuries with condyle most frequently injured n Possible growth disturbance n High osteogenic potential n Rare complications

11. MANDIBULAR FRACTURES CONT. n Physical Exam n Observance of mandibular range of motion and malocclusion n Radiographic assessment n Greenstick common n Types of condylar fractures

12. ORBITAL AND NASOETHMOID INJURIES n Severe cosmetic and functional consequences if not adequately treated n ZMC fractures rare in children less than 5 because of lack of pneumatization of sinuses n Orbital roof injuries more common in children less than 7 because of lack of pneumatization of frontal sinus and cranium more exposed

13. ORBITAL INJURIES CONTINUED n Craniofacial ratio n Orbital roof injuries associated with neurocranial injuries commonly n Orbital roof injuries rarely require repair n Supraorbital rim fractures rare

14. NASOETHMOID FRACTURES n Central fragment n Adequate exposure n Reconstruction of appropriate intercanthal distance and medial canthal ligaments

15. MAXILLARY FRACTURES n Type 1 injuries n Type 2 injuries n Type 3 injuries n Increased forced needed for these fractures n Comminution uncommon n Goals of therapy n Avoidance of excessive undermining

16. MAXILLARY FRACTURES CONT. n Restore three dimensional facial symmetry, occlusion and proportions n Sequencing of repair of multiple injuries

17. CONCLUSION