Pediatric Facial Fractures: Diagnostic Imaging, Dental Treatment, and Perioperative Nursing
Abstract
Background: Pediatric facial fractures, though less common than in adults, pose significant diagnostic and therapeutic challenges due to the unique anatomical and developmental characteristics of the growing facial skeleton. These injuries often result from age-specific trauma mechanisms and carry risks of long-term functional and aesthetic consequences.
Aim: This study aims to provide a comprehensive overview of the etiology, diagnosis, management, and prognosis of pediatric facial fractures, emphasizing multidisciplinary care and age-appropriate strategies.
Methods: A detailed literature-based review was conducted, integrating current clinical practices in pediatric trauma, radiology, dentistry, and nursing. The article synthesizes anatomical, epidemiological, and procedural data to guide evaluation and treatment.
Results: Facial fractures in children vary by age and mechanism, with nasal and mandibular fractures being most prevalent. Imaging, particularly low-dose CT with 3D reconstruction, is essential for accurate diagnosis. Conservative management is often preferred due to high remodeling potential, while surgical intervention is reserved for displaced, function-threatening, or cosmetically significant fractures. Multidisciplinary coordination—including dental, surgical, ophthalmologic, and nursing teams—is critical for optimal outcomes. Long-term follow-up is necessary to monitor growth disturbances, malocclusion, and psychosocial effects.
Conclusion: Pediatric facial fractures require age-specific assessment and collaborative care. Early diagnosis, appropriate imaging, and tailored treatment strategies improve functional recovery and minimize long-term complications.
Full text article
References
Borse N, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries Among 0- to 19-Year Olds in the United States, 2000-2006. Fam Community Health. 2009 Apr-Jun;32(2):189.
Andrew TW, Morbia R, Lorenz HP. Pediatric Facial Trauma. Clin Plast Surg. 2019 Apr;46(2):239-247.
Rogan DT, Fang A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 25, 2023. Pediatric Facial Trauma.
Joyce T, Gossman W, Huecker MR. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 22, 2023. Pediatric Abusive Head Trauma.
Haydel MJ, Weisbrod LJ, Saeed W. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 16, 2024. Pediatric Head Trauma.
McGrath A, Taylor RS. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 23, 2023. Pediatric Skull Fractures.
Goodmaker C, Hohman MH, De Jesus O. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 23, 2023. Naso-Orbito-Ethmoid Fractures.
Klinginsmith M, Katrib Z. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 26, 2022. Nasal Septal Fracture.
Braun TL, Xue AS, Maricevich RS. Differences in the Management of Pediatric Facial Trauma. Semin Plast Surg. 2017 May;31(2):118-122.
Vasconez HC, Buseman JL, Cunningham LL. Management of facial soft tissue injuries in children. J Craniofac Surg. 2011 Jul;22(4):1320-6.
Patel BC, Wright T, Waseem M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 3, 2023. Le Fort Fractures.
Lofgren DH, McGuire D, Gotlib A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 30, 2023. Frontal Sinus Fractures.
Alcalá-Galiano A, Arribas-García IJ, Martín-Pérez MA, Romance A, Montalvo-Moreno JJ, Juncos JM. Pediatric facial fractures: children are not just small adults. Radiographics. 2008 Mar-Apr;28(2):441-61; quiz 618.
Iida S, Matsuya T. Paediatric maxillofacial fractures: their aetiological characters and fracture patterns. J Craniomaxillofac Surg. 2002 Aug;30(4):237-41.
Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg. 2008 Nov;207(5):710-6.
Woodruff G, Palmer L, Fontane E, Kalynych C, Hendry P, Thomas AC, Crandall M. Nine years of pediatric gunshot wounds: A descriptive analysis. Prev Med Rep. 2022 Aug;28:101890.
Paneitz DC, Ahmad S. Pediatric Trauma Update. Mo Med. 2018 Sep-Oct;115(5):438-442.
Vyas RM, Dickinson BP, Wasson KL, Roostaeian J, Bradley JP. Pediatric facial fractures: current national incidence, distribution, and health care resource use. J Craniofac Surg. 2008 Mar;19(2):339-49; discussion 350.
Zerfowski M, Bremerich A. Facial trauma in children and adolescents. Clin Oral Investig. 1998 Sep;2(3):120-4.
Grunwaldt L, Smith DM, Zuckerbraun NS, Naran S, Rottgers SA, Bykowski M, Kinsella C, Cray J, Vecchione L, Saladino RA, Losee JE. Pediatric facial fractures: demographics, injury patterns, and associated injuries in 772 consecutive patients. Plast Reconstr Surg. 2011 Dec;128(6):1263-1271.
Koller D, Goldman RD. Distraction techniques for children undergoing procedures: a critical review of pediatric research. J Pediatr Nurs. 2012 Dec;27(6):652-81.
Zempsky WT, Cravero JP., American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004 Nov;114(5):1348-56.
Mistry RK, Hohman MH, Al-Sayed AA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 1, 2023. Facial Nerve Trauma.
Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac Trauma Reconstr. 2015 Mar;8(1):1-13.
Saggese NP, Mohammadi E, Cardo VA. The 'White-eyed' Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma. Cureus. 2019 Apr 09;11(4):e4412.
Knuf K, Maani CV. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 28, 2023. Nitrous Oxide.
Del Pizzo J, Callahan JM. Intranasal medications in pediatric emergency medicine. Pediatr Emerg Care. 2014 Jul;30(7):496-501; quiz 502-4.
Singer AJ, Stark MJ. LET versus EMLA for pretreating lacerations: a randomized trial. Acad Emerg Med. 2001 Mar;8(3):223-30.
Malekpour M, Bridgham K, Neuhaus N, Widom K, Rapp M, Leonard D, Baro S, Dove J, Hunsinger M, Blansfield J, Shabahang M, Torres D, Wild J. Utility of Prophylactic Antibiotics in Nonoperative Facial Fractures. J Craniofac Surg. 2016 Oct;27(7):1677-1680.
Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, Rodriguez ED. Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr. 2015 Mar;8(1):64-78.
Burlini D, Conti G, Amadori F, Bardellini E, De Giuli C. Management of paediatric maxillofacial fractures: conventional methods and resorbable materials. Eur J Paediatr Dent. 2015 Mar;16(1):24-8.
Alvi S, Patel BC. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 3, 2023. Nasal Fracture Reduction.
Raflo GT. Blow-in and blow-out fractures of the orbit: clinical correlations and proposed mechanisms. Ophthalmic Surg. 1984 Feb;15(2):114-9.
Dulley B, Fells P. Long-term follow-up of orbital blow-out fractures with and without surgery. Mod Probl Ophthalmol. 1975;14:467-70.
Iizuka T, Thorén H, Annino DJ, Hallikainen D, Lindqvist C. Midfacial fractures in pediatric patients. Frequency, characteristics, and causes. Arch Otolaryngol Head Neck Surg. 1995 Dec;121(12):1366-71.
Cole P, Kaufman Y, Hollier LH. Managing the pediatric facial fracture. Craniomaxillofac Trauma Reconstr. 2009 May;2(2):77-83.
Hegab A. Management of mandibular fractures in children with a split acrylic splint: a case series. Br J Oral Maxillofac Surg. 2012 Sep;50(6):e93-5.
Murphy RX, Birmingham KL, Okunski WJ, Wasser TE. Influence of restraining devices on patterns of pediatric facial trauma in motor vehicle collisions. Plast Reconstr Surg. 2001 Jan;107(1):34-7.
Tyroch AH, Kaups KL, Sue LP, O'Donnell-Nicol S. Pediatric restraint use in motor vehicle collisions: reduction of deaths without contribution to injury. Arch Surg. 2000 Oct;135(10):1173-6.
Hergenroeder AC. Prevention of sports injuries. Pediatrics. 1998 Jun;101(6):1057-63.
Stracciolini A, Sugimoto D, Howell DR. Injury Prevention in Youth Sports. Pediatr Ann. 2017 Mar 01;46(3):e99-e105.
Authors
Copyright (c) 2024 Amal Mohammed Ibn Mandeel, Waad Saad Aldossari, Faris Badullah Saleh Alharbi, Soaad Jadaan Almotery, Zainab Abdullah Saleh Albishi, Majeb Mubark Aldosari, Zahra Ahmed Aysh Alsmaeil, Abdullah Hamood Alazmy, Sawsan Hussain Mohammed Alawad, Ibtesam Ali Alwan, Abdullah Fahad Alntaifat, Amnah Ahmed Alkhateeb
This work is licensed under a Creative Commons Attribution 4.0 International License.