Ali Tawfik, MD., DDS

Prof. of E.N.T. & MF. SurgeryFaculty of Medicine

University of MansouraEgypt

Management of PediatricCranio-Facial Fractures

Trauma Statistics In Us

• The disease of Modern society.

• Trauma is the largest killer of persons.

• 57 million amer. are injured every year – 1 in 4 of these requires medical care.– 150,000 deaths results.

• 25% of an Emergency are trauma cases.

• 33% of Hospital Admission are trauma cases.

• 12.5% of the Hospital beds are occupied by trauma cases.

• US citizens spend 144 million day in bed Annually.

• Trauma is the one of most costly health problems.

• Greater than Health Diseases and cancer combined .

• The direct and indirect Economic loses are estimated.

• To be 200 billion $ Annually.

Trauma Statistics (Cont.)In Us

Management of PediatricCranio-Facial Fractures

In today’s fast speed society, many children sustain Maxillo-facial Fractures that requires surgical reconstruction.

IN US :- The leading cause of death among children each year .

» 100,000 children are permanently disable.

» 15,000 die.» Cost of $15 billion dollars.

(Rowe et al., 1994)

Epidemiology (US)

• Trauma 4th leading cause of death.

• 50% of trauma leads to death = MVA Nonfatal MVA injuries = 4 Million/y.

• Pediatric MF Fractures, 5% of all facial fractures.

• Children > 5 years have lower incidence.

• Male > female.

• Nasal fractures are the most common.

• Mandibular Fractures are the most common cases of hospitalization.

• Associated injuries are common.

Epidemiology

• 2/3 of patients admitted to Trauma Centers have facial trauma.

• > 70% of those in MVA have facial trauma.

• Spectrum of facial injuries from small cuts to complex open fractures.

Epidemiology (US)

A Child’s Face has Protective Anatomic Character:

• Soft and elastic immature bone.

• Covered by thick layer of fat and muscle.

• Unerupted teeth.

In Infancy And early Childhood

• The cranium is relatively large with Prominent forehead leads to a high skull-to-face ratio.

Emergency Management

• Airway.

• Breathing.

• Circulation.

Airway Management

• The First step in management of traumatized patient is to ensure a patient airway.

• Endotracheal intubation is more better than tracheotomy.

Consultation

• Multiple-system trauma.

• Cranial or intracranial trauma.

• Orbital trauma.

• Dental occlusion trauma.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination • Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination • Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Radiologic Examination

• Difficult to document radiographically.

• Panoramic view.

• Towne’s view.

• CT scan has revolutionized the imaging.

• Axial CT.

• Coronal CT.

• Three dimensional CT.

Principles of Treatment by Region

• Cranial vault and supra orbital ridge fractures.

• Naso-Franto-Ethmodial fractures.• Le-Fort fractures.• Zygomatic complex fractures.• Nasal fractures.• Mandibular fractures.• Dento-alveolar fractures.

Fixation

Cranial vault and supra cranial fractures• More common in infant and children 5 years.• Treatment :-

Coronal incision. Reduction. Fixation by wire, miniplates or microplates. Primary bone graft. Neuro surgeon.

Naso-Franto-Ethmoidal fractures• Direct Trauma.• Coronal incision.• Reduction.• Fixation.• Medical canthio- pexies.• Frontal sinus fractures :-

– Ant. w.: Reduction and fixation– Post. w.: Craniolization of the sinus.

Naso-Franto-Ethmoidal fractures

• Direct Trauma.• Coronal incision.• Reduction.• Fixation.• Medical canthio- pexies.• Frontal sinus fractures :-

– Ant. w.: reduction and fixation– Post. w.: Cranialization of the sinus.

Naso-Franto-Ethmoidal fractures

• Direct Trauma.• Coronal incision.• Reduction.• Fixation.• Medical canthio- pexies.• Frontal sinus fractures :-

– Ant. w.: Reduction and fixation– Post. w.: Cranialization of the sinus.

Zygomatic complex Fractures

Nasal Fractures• The growth of the nasal spectrum is considered a

major factor in the midface development.• So sever trauma and improper treatment of nasal

fracture could retard normal growth resulting in a saddle nose and midface deficiency.

• So proper treatment and follow up are essential

Mandibular Fractures

• The mandible is filled with teeth.

• The primary and mixed dentition are obstacles to IMF.

• Interosseous or plate-screw fixation must be located at inferior border.

Treatment of Fractured Mandible Depends on

• Type of fracture (greenstick or complete).

• Location (body or condyle).

• Age of the patient.

• Presence of other facial fractures.

• Presence of associated systematic injuries.

Aim of treatment of fractured mandible

• Normalize occlusion.

• Prevent impairment of the dentition.

• Preserve TMJ mobility.

Conclusion

1. Pediatric cranio-facial fracture is preventable disease.

2. The aim of management is to restore the normal anatomic position of facial skeleton.

3. The difference in the pattern of fractures between children and adult must be recognized.

Conclusion (cont.)4. Fractures in children may go unrecognized due to : -

– Incomplete communication with the child.

– Inadequate radiographic.

– Late presentation.

5. Improper management leads to distortion of the facial growth.

Conclusion (cont.)6. Late squeals are common:-

– Facial growth retardation.

– Facial distortion.

– Treatment rendered.

7. Long-term follow-up is essential to monitoring the facial growth and development.

Conclusion (cont.)

8. So proper diagnosis, management and Long-term follow-up are essential to minimize growth distortion and to maximize functional, psychological, and aesthetic results for both patient, family and community.

Thank Thank YouYou