Factors Associated With Surgical Management for Pediatric Facial Fractures at a Level One Trauma Center

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. Address correspondence and reprint requests to Matthew R. Greives, MD, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, McGovern School of Medicine, University of Texas Health Science Center, 6431 Fannin Street MSB 5.281, Houston, TX 77030; E-mail: Matthew.R.Greives@uth.tmc.edu Received 17 October, 2018 Accepted 25 November, 2018 None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. This manuscript is not currently under consideration by any other journals. The abstract has been presented at the American College of Surgeons South Texas Annual Meeting in Houston, TX on February 24, 2018 as well as Plastic Surgery the Meeting in Chicago, IL on September 30, 2018. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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