Maxillofacial Injuries in Pediatric Patients
Authors: Zhou Hai-Hua , Lv Kun , Rong-TaoYang  , Li Zhi , Li Zu-Bing 
Published: January 2021

Objective:
This study aimed to evaluate and analyse the demographic characteristics and changes in maxillofacial injuries during their development in pediatric patients.

Methods:
A retrospective cohort and case–control study was conducted. The sample was composed of all children (less than 10.5 years) who presented with maxillofacial injuries within a 6.5-year period (from December 2012 to April 2019). Data about age, gender, hospitalization date, mechanism of trauma, location and pattern of injuries, associated general injuries or systemic diseases, admission methods (emergency admission or not), type of anesthesia, treatment methods and hospital costs (¥) were recorded and analyzed. Data analysis included Chi-square test, Fisher exact test, and t test. Univariate and multivariate analyses were also performed. Logistic regression analysis was used to control for confounding variables. Differences at P < 0.05 were considered significant.

Results:
A total of 643 pediatric patients were included in this study, with a boy-to-girl ratio of 1.77:1 (411 boys and 232 girls). The age range was 0.18 to 10.5 years (average of 3.23 ± 1.98 years). The largest age group was patients aged 1 to 2 years (200 patients, 31.1%), followed by 2 to 3 years (139 patients, 21.6%). In the majority of patients, fall at ground level was the most common mechanism of injury (391 patients, 60.8%). In addition, 613 patients (95.3%) sustained at least maxillofacial soft-tissue injuries, while 460 (71.5%) sustained only maxillofacial soft-tissue injuries and 183 (28.5%) sustained maxillofacial fractures. Lip was the most vulnerable soft tissue to be injured (283 patients, 44.0%). Patients who sustained maxillofacial soft-tissue injuries were less prone to maxillofacial fractures than those who did not. Maxillofacial fractures were highly presented in patients with dental injuries (OR = 6.783; 95% confidence interval, 3.147–14.620; P < 0.001). Older children (> 5 years old) were at higher risk of maxillofacial fractures than younger children (≤ 5 years old, P = 0.006). The risk of maxillofacial fractures (except symphysis fractures) increased with age, especially in patients aged between 5 and 10 years. Maxillofacial soft-tissue injuries were highly distributed amongst patients aged 1 to 5 years. The number of patients who sustained only maxillofacial soft-tissue injuries gradually decreased from 2013 to 2018. Patients in emergency admission (OR = 13.375; 95% confidence interval, 1.286–139.121; P = 0.030) and treated under general anesthesia (OR = 27015.375; 95% confidence interval, 1033.046–706484.218; P < 0.001) were more prone to be treated by surgery procedure. Patients with facial fractures were less frequent to be treated by surgery procedure (OR = 0.006; 95% confidence interval, 0.000–0.575; P = 0.028); however, the mandibular symphysis (OR = 18.141; 95% confidence interval, 2.860–115.069; P = 0.002) or body fractures (OR = 71.583; 95% confidence interval, 2.358–2172.879; P = 0.014) were highly treated by surgery procedure.

Conclusions:
Maxillofacial fractures in pediatric patients were significantly related to age, etiology, maxillofacial soft-tissue injury, dental injury and other general injuries. Older pediatric patients were at higher risk of maxillofacial fractures (except symphysis fractures) and lower risk of maxillofacial soft-tissue injuries than younger pediatric patients. Patients in emergency admission, fractures of the symphysis or body, and treated under general anesthesia were the main reasons for surgical management.