Pattern and Treatment of Facial Trauma in Pediatric and Adolescent Patients Jose Luis Mun ˜ ante-Ca ´rdenas, DDS, MS, Sergio Olate, DDS, MS, PhD, Luciana Asprino, DDS, MS, PhD, Jose Ricardo de Albergaria Barbosa, DDS, MS, PhD, Ma ´rcio de Moraes, DDS, MS, PhD, and Roger W. F. Moreira, DDS, JD, MS, PhD Abstract: Pediatric maxillofacial trauma is a challenge for sur- geons. There are no completely defined protocols, and sometimes, the initial management could be complex. The aim of this research was to perform a retrospective study to analyze the pattern and treatment of maxillofacial fractures in pediatric and adolescent patients. We reviewed the clinical records of 2986 patients treated at the Oral and Maxillofacial Surgery Division of Piracicaba Dental School between 1999 and 2008. Seven hundred fifty-seven patients were younger than 18 years and were divided into 3 groups according to age; the age and sex of the patients, etiology, fractures and associated injury, treatment, and complications were evaluated. Five hundred thirty boys (70.01%) and 227 girls (29.99%) were treated for injuries with major prevalence in adolescents. The most common injury causes were bicycle accidents (29.06%) and falls (28.40%). The mandible was the most fractured bone (44.8%); associated injuries were lacerations of the soft tissue and dental trauma. Surgical treatment was performed in 75 cases (30%) with minor complications (10% of surgical patients). We conclude that maxillofacial trauma in child is associated to fall and bicycle acci- dents; the mandible is more affected than other maxillofacial structures, and frequently, nonsurgical treatment is performed. Key Words: Pediatric trauma, pediatric injuries, treatment (J Craniofac Surg 2011;22: 1251Y1255) F acial fractures are uncommon injuries in children. Pediatric maxillofacial fractures are present in 1% to 15% of all facial fractures, 1Y3 showing different clinical features when compared with adult patients. 4 The flexibility of the facial skeleton in children, the relative protection offered by the lack of pneumatization of paranasal sinus, and the protection of the malar region by the prominent buccal fat pad in children contribute to reduce the frequency of these fractures. 3,5 Worldwide, the major causes of fractures in children are vehi- cle accidents, falls, violence, and sports-related accidents 1,3,6 ; their incidence is influenced by social, cultural, and environmental factors 7 because the rates of fractures are different between countries. On the other hand, the treatment has changed in the last years. In Brazil, maxillofacial fractures have been studied in adult patients, 8Y10 with limited information regarding facial trauma in children from 0 to 18 years. The aim of this research was to review and compare the eti- ology, frequency, and distribution of maxillofacial fractures and analyze the changes in the last 10 years in pediatric and adolescent patients treated at the Division of Oral and Maxillofacial Surgery of Piracicaba Dental School, Sao Paulo, Brazil. PATIENTS AND METHODS Data were collected from patients attended at the Division of Oral and Maxillofacial Surgery of State University of Campinas, Brazil, from April 1999 to December 2008. The information was obtained from clinical notes and surgical records using a stan- dardized data collection form. Subjects 18 years or younger were included in the admission and were divided into 3 groups according to ages: group 1 (0Y5 years, infants), group 2 (6Y12 years, school- aged children), and group 3 (13Y18 years, adolescents). The data record included patient’s sex and age, etiology and location of the fracture, associated injury, treatment, and complications. The etiology of trauma was related to bicycle accidents, vehicle accidents (car and motorcycle), pedestrian accidents, sports- related accidents, falls, and violence. The fractures were associated to mandible, maxillae, isolated nasal bone, frontal bone, zygomatic bone, and nasal-orbital-ethmoid complex. The classifications of the fractures were based on conventional radiographic study and computed tomographic examinations, and the segment displacement was evaluated with clinical and imaging techniques. They were classified in nondisplaced and displaced. Sign and symptoms of the patient were evaluated as pain, neurologic dis- turbance of infraorbital nerve, asymmetry with evaluation of osseous fragment displacement, occlusion alteration, and diplopia. The sur- gical and nonsurgical treatments were evaluated, and the patient had to submit to at least 3 months of postoperative follow-up. Exclusion criteria were charts that did not had complete information about the trauma, unacceptable postoperatively reduction of fracture (evaluated with computed tomography), and postsurgical follow-up less than 3 months. RESULTS Etiology, Age, and Sex Distribution In 120-month review, 2986 patients (from 1 to 97 years) were treated for facial injuries at the Division of Oral and Maxillofacial Surgery of Piracicaba Dental School. Seven hundred fifty-seven patients (25.35%) who are 18 years or younger were included (mean ORIGINAL ARTICLE The Journal of Craniofacial Surgery & Volume 22, Number 4, July 2011 1251 From the Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Campinas, Brazil; and the Divi- sion of Oral and Maxillofacial Surgery, School of Medicine, University of La Frontera, Temuco, Chile. Received September 20, 2010. Accepted for publication December 5, 2010. Address correspondence and reprint requests to Prof Dr Roger W. F. Moreira, Division of Oral and Maxillofacial Surgery, State University of Campinas, Av Limeira 901, Caixa Postal 52-CEP 13414-903, Piracicaba-SP, Brazil; E-mail: roger@fop.unicamp.br The authors report no conflicts of interest. Copyright * 2011 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e31821c696c Copyright © 2011 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.