Moffitt Joseph K, Wainwright D'Arcy J, Bartz-Kurycki Marisa, Wainwright David J, Demian Nagi, Teichgraeber John F, Greives Matthew R
Division of Pediatric Plastic Surgery.
Department of Pediatric Surgery.
J Craniofac Surg. 2019 May/Jun;30(3):854-859. doi: 10.1097/SCS.0000000000005245.
Pediatric facial fractures present and are managed differently than the adult population. This study describes the pattern and mechanism of facial fractures in children and identifies factors associated with need for surgical management. An IRB-approved retrospective chart analysis of all pediatric patients age ≤ 18 years diagnosed with facial fractures at our level 1 trauma center over a 10-year period (January 2006-December 2015) was performed. Demographics, fracture location, mechanism of injury, concomitant head and neck injuries, and surgical management were reviewed. Statistical analysis was then performed comparing surgical and nonsurgical cohorts using univariate and multivariate analyses. One thousand two hundred seventy-four patients were diagnosed with facial fractures. Five hundred seventeen (40.6%) underwent surgical management. Two thousand one hundred seventy-two total facial fractures were recorded. Orbit fractures (29%) were the most commonly recorded, observed in 49% of patients presenting. Increased age was associated with increased odds of surgical management (OR 1.13; 95% CI 1.09-1.16). Mandible (OR 9.28; 95% CI 6.88-12.51) and Le Fort fractures (OR 19.73; 95% CI 9.78-39.77) had increased odds of surgical management. Patients with traumatic brain injury had reduced odds (OR 0.54; 95% CI 0.35-0.83) of surgical management for their facial fractures. Older pediatric patients may be more likely to require surgical management of their facial fractures, especially those with mandible or Le Fort fractures. Patients with traumatic brain injury are likely to sustain life threatening injuries, deferring repair of their facial fractures. Patient education and counseling, as well as predictive models, can be improved to reflect these data.
小儿面部骨折的表现及处理方式与成人不同。本研究描述了儿童面部骨折的类型和机制，并确定了与手术治疗需求相关的因素。我们对一家一级创伤中心在10年期间（2006年1月至2015年12月）诊断为面部骨折的所有18岁及以下儿科患者进行了一项经机构审查委员会批准的回顾性病历分析。回顾了人口统计学资料、骨折部位、损伤机制、伴发的头颈部损伤以及手术治疗情况。然后使用单因素和多因素分析对手术和非手术队列进行统计学分析。1274例患者被诊断为面部骨折。其中517例（40.6%）接受了手术治疗。共记录了2172处面部骨折。眼眶骨折（29%）是最常见的骨折类型，在49%的就诊患者中观察到。年龄增加与手术治疗的几率增加相关（比值比1.13；95%置信区间1.09 - 1.16）。下颌骨骨折（比值比9.28；95%置信区间6.88 - 12.51）和勒福骨折（比值比19.73；95%置信区间9.78 - 39.77）的手术治疗几率增加。创伤性脑损伤患者面部骨折的手术治疗几率降低（比值比0.54；95%置信区间0.35 - 0.83）。年龄较大的儿科患者面部骨折可能更需要手术治疗，尤其是下颌骨或勒福骨折的患者。创伤性脑损伤患者可能会遭受危及生命的损伤，从而推迟面部骨折的修复。患者教育和咨询以及预测模型可以得到改进以反映这些数据。
