Complications of Pediatric Facial Fractures
S. Alex Rottgers, Gary Decesare, MD, Darren Smith, MD, Joseph Madia, Sanjay Naran, Shao Jiang, MD, Frederick Deleyiannis, MD MPhil, Lisa Vecchione, DMD MDS, Joseph Losee, MD.
Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND: Pediatric facial fractures occur in patterns which differ from adults. Unique qualities of the pediatric craniofacial skeleton dictate not only how it fractures, but how it should be treated. Treatment algorithms favor non-operative management. When approaching pediatric facial fractures, surgeons must balance the need to correct deformity with the potential complications that can result from surgery. A better understanding of complications which arise from these fractures and their treatment will aid in future management.
METHODS: : The database of the Children’s Hospital of Pittsburgh Cleft-Craniofacial center was searched for children treated with facial fractures. Electronic medical records were reviewed for patient demographics, fracture types, length of follow-up, treatment modalities, fracture complications, and surgical complications. Fracture incidences were calculated for all patients identified. Patients who did not return for at least one follow-up visit were excluded from subsequent analysis.
RESULTS: 196 patients were identified. 179 were seen in follow-up. The average age was 9.8 years (range: 0.4-18.7). Fractures with the greatest incidence included: mandible (35.7%), orbital (30.6%), nasal (26.5%), and craniofacial fractures (10.7%). 22% of patients suffered multiple fractures. 40% underwent operative intervention. Average follow-up was 13.4 months (range 0.1-80.4). 59 patients (33.0%) suffered complications. 46 patients (25.7%) suffered complications secondary to their injury, and 19 (10.6%) suffered treatment-related complications. Zygoma fractures had the highest complication rate (70.6%). 5 patients (2.5%) suffered wound healing complications. 12 patients (6.7%) suffered nerve injuries, including lesions of the optic nerve, facial nerve, and trigeminal nerves. 11 (6.1%) patients developed mild, persistent enophthalmos. 10 (6.1%) patients had symptoms related to the TMJ joint. Four (2.2%) patients exhibited evidence of mandible growth disturbance, and 4 (2.2%) patients had developing tooth buds damaged. Serious complications included blindness (0.6%), and CSF leak (1.1%). No deaths were observed.
CONCLUSIONS: One third (33%) of pediatric facial fractures suffer complications, and most as a result of the injury rather than treatment. As this study has modest follow-up, the incidence of fracture related complications will likely increase with continued monitoring for growth and development abnormalities of the pediatric patient.