Pediatric Facial Trauma

Traumatic facial injury may occur in children. The vast majority of pediatric facial trauma is blunt in nature. The most common cause varies by age, with falls the most common cause of injury in younger childhood and blunt trauma or motor vehicle injury the most common causes of injury in older children. Accidental blunt trauma is the most common etiology, and the most commonly injured bone is the nasal bone. Sports-related injury has a higher incidence of midface and upper midface fracture. This chapter reviews the most common facial injuries in children and discusses important diagnostic and management principles in the care of the acutely injured child.

Indications and Complications Associated with Coronal Approach to Upper Midface Fracture

Background: Coronal approach has been widely used by maxillofacial surgeons around the world for wide exposure and fixation of upper midface fractures. Coronal approach hides the scar in hair and completely avoids any incisions on face thus providing better aesthetic outcome. Our aim was to describe the data on indications and complications associated with coronal approach in our patient population. Methods: Prospective longitudinal study was planned and data was collected from a study population of all patients treated with coronal approach for facial fractures from January 2016 to June 2019. Demographic variables, Type of fracture, hemicoronal or bicoronal approach used and early complications of hematoma, infection and dehiscence were recorded. Delayed complications of neurosensory disturbances, facial nerve weakness, temporal hollowing and alopecia scar in hair bearing area was recorded. Results: Isolated zygomatic arch fracture was most common indication with 14 cases followed by ZMC fractures with 12 cases, NOE fracture with 7 cases, Lefort III with 6 cases and Frontal bone fracture with 2 cases. Hematoma was not observed in any of our cases. Infection was observed in 2 cases (4.8%), Dehiscence was observed in 5 cases (11.9%), Neurosensory disturbance was observed in 12 cases (28.6%). Permanent neurosensory changes beyond 6 months of follow up was not observed. Alopecia scar was seen in 7 cases (16.7%) and Facial nerve weakness was observed in 4 cases (9.5%). Conclusions: Coronal approach is best approach in terms of exposure provided to upper midface fractures and can be safely performed with minimal complications. Keywords: complications; coronal approach; upper midface fractures.

Midface Fracture Simulation and Repair: A Computer-Based Algorithm

We introduce a novel computer-based method to digitally fixate midfacial fractures to facilitate more efficient intraoperative fixation. This article aims to describe a novel computer-based algorithm that can be utilized to model midface fracture reduction and fixation and to evaluate the algorithm's ability to produce images similar to true postoperative images. This is a retrospective review combined with cross-sectional survey from January 1, 2010, to December 31, 2015. This study was performed at a single tertiary care, level-I trauma center. Ten patients presenting with acute midfacial traumatic fractures were evaluated. Thirty-five physicians were surveyed regarding the accuracy of the images obtained using the algorithm. A computer algorithm utilizing AquariusNet (TeraRecon, Inc., Foster City, CA) and Adobe Photoshop (Adobe Systems Inc., San Jose, CA) was developed to model midface fracture repair. Preoperative three-dimensional computed tomographic (CT) images were processed using the algorithm. Fractures were virtually reduced and fixated to generate a virtual postoperative image. A survey comparing the virtual postoperative and the actual postoperative images was produced. A Likert-type scale rating system of 0 to 10 (0 being completely different and 10 being identical) was utilized. Survey participants evaluated the similarity of fracture reduction and fixation plate appearance. The algorithm's capacity for future clinical utility was also assessed. Survey response results from 35 physicians were collected and analyzed to determine the accuracy of the algorithm. Ten patients were evaluated. Fracture types included zygomaticomaxillary complex, LeFort, and naso-orbito-ethmoidal complex. Thirty-four images were assessed by a group of 35 physicians from the fields of otolaryngology, oral and maxillofacial surgery, and radiology. Mean response for fracture reduction similarity was 7.8 ± 2.5 and fixation plate similarity was 8.3 ± 1.9. All respondents reported interest in the tool for clinical use. This computer-based algorithm is able to produce virtual images that resemble actual postoperative images. It has the ability to model midface fracture repair and hardware placement.

The Comprehensive AOCMF Classification System: Midface Fractures - Level 2 Tutorial

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 system for the midface unit that concentrates on the location of the fractures within defined regions in the central (upper, intermediate, and lower) and lateral (zygoma, pterygoid) midface, as well as the internal orbit and palate. The level 2 midface fracture location outlines the topographic boundaries of the anatomical regions. The common nasoorbitoethmoidal and zygoma en bloc fracture patterns, as well as the time-honored Le Fort classification are taken into account. This tutorial is organized in a sequence of sections dealing with the description of the classification system with illustrations of the topographical cranial midface regions along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification. Individual fracture mapping in these regions regarding severity, fragmentation, displacement of the fragment or bone defect is addressed in a more detailed level 3 system in the subsequent articles.