Kao Richard, Campiti Vincent J, Rabbani Cyrus C, Ting Jon Y, Sim Michael W, Shipchandler Taha Z
Department of Otolaryngology-Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A.
Laryngoscope Investig Otolaryngol. 2019 Nov 6;4(6):597-601. doi: 10.1002/lio2.315. eCollection 2019 Dec.
To analyze management, outcomes, and complications of pediatric midface fractures.
Retrospective cohort study at an urban, single-institution, multispecialty surgical teams, at two level 1 pediatric trauma centers. Query included subjects aged 0-17 diagnosed with midface fractures between 2012 and 2016.
A total of 218 pediatric patients presented with 410 total midface fractures. The most common etiologies included motor vehicle collisions (MVC) (n = 56, 25.7%), sport-related (n = 35, 16.1%), and assault/battery (n = 32, 14.7%). Fracture site distribution included: 125 maxillary (34 with exclusively the nasal/frontal process), 109 nasal, 47 ethmoid, 40 sphenoid, 33 zygoma, 29 frontal sinus, 21 lacrimal, and 6 palatal. Among these, there were 105 orbital, 17 naso-orbito-ethmoid, and 12 Le Fort fractures. One-quarter of patients received at least one midface-related operation during the initial encounter. Operative intervention rates for specific midface fracture subsites were not significantly different ( = 6.827, = .234). One hundred thirty-five patients (63.4%) attended follow-up, thus known complication rate was 14.6% (n = 31). Complication rates between midface fracture subsites were not significantly different ( = 5.629, = .229). Complications included facial deformity (n = 18), nasal airway obstruction (n = 8), diplopia (n = 4), hardware-related pain (n = 3), and paresthesias (n = 3).
The most common sites of pediatric midface fractures involved the maxilla, and nasal bones. Three quarters of pediatric midface fractures were treated conservatively, with low rates of complications. Facial deformity was the most common complication; as such, proper management and follow-up are important to ensure normal growth and development of the pediatric facial skeleton.
分析儿童面中部骨折的治疗、预后及并发症情况。
在两个一级儿童创伤中心的城市单机构多专科手术团队进行回顾性队列研究。查询对象为2012年至2016年间年龄在0至17岁、诊断为面中部骨折的患者。
共有218例儿童患者出现410处面中部骨折。最常见的病因包括机动车碰撞（MVC）（n = 56，25.7%）、与运动相关（n = 35，16.1%）以及袭击/殴打（n = 32，14.7%）。骨折部位分布包括：上颌骨125处（其中仅鼻/额突骨折34处）、鼻骨109处、筛骨47处、蝶骨40处、颧骨33处、额窦29处、泪骨21处以及腭骨6处。其中，眼眶骨折105处、鼻眶筛骨折17处、Le Fort骨折12处。四分之一的患者在初次就诊时接受了至少一次与面中部相关的手术。特定面中部骨折亚部位的手术干预率无显著差异（χ² = 6.827，P = .234）。135例患者（63.4%）进行了随访，已知并发症发生率为14.6%（n = 31）。面中部骨折亚部位之间的并发症发生率无显著差异（χ² = 5.629，P = .229）。并发症包括面部畸形（n = 18）、鼻气道阻塞（n = 8）、复视（n = 4）、内固定相关疼痛（n = 3）以及感觉异常（n = 3）。
儿童面中部骨折最常见的部位累及上颌骨和鼻骨。四分之三的儿童面中部骨折采用保守治疗，并发症发生率较低。面部畸形是最常见的并发症；因此，正确的治疗和随访对于确保儿童面部骨骼的正常生长发育很重要。
4级。
