ORIGINAL RESEARCH PAPER PEDIATRIC FACIAL FRACTURES: ARE KIDS IMPLICITLY A MINIATURE VERSION OF ADULTS? Dr. Roshma Upadhaya* B.D.S, B.P.Koirala Institute Of Health Science. *Corresponding Author Dr. Silky Gabbi B.D.S, Adesh Institute Of Dental Sciences And Research. Dr. Ashritha Reddy Chalamalla B.D.S, M.P.H, University Of Alabama, Birmingham. INTRODUCTION Trauma has been considered as the leading cause of morbidity and mortality in children. Unlike adults the facial skeletal fractures in [1] children are less likely to occur and are minimally displaced. This is due to the relative smaller size of the facial skeleton, the nature of [2] elasticity of bones, shortness of condyles and non-prominent chin [3] region. Facial fractures in young adults comprise less than 15% of all the facial fractures. They are seen rarely below the age of 5 years, having a male dominating predilection, seen as a constant incidence over the years. ETIOLOGY, GENDER The major causes of facial fracture in children incorporates falls, sports injury and RTA.The rate of occurrence solely depends upon the age factor of the child and the types of fractures included (young children may sustain injury from low-velocity forces like falls, while the older once require higher velocity forces such as RTA, sports-related injury). The preponderance of boys over girls can be explained because of frequent involvement in sports related activities, dangerous behavior [4] and activities. DISTINCT FEATURES OF THE PEDIATRIC PATIENT At birth the cranial volume and facial volume ratio is approximately [5] 8:1, which after the growth completion becomes 2.5:1. As a matter of fact, the prominent frontal bone (with the protecting skull) and the retruded facial skeleton is likely to be the cause of higher incidence of [6] cranial injuries in children less than 5 years of age. Facial fractures in children are less likely to occur than adults with minimal displacement, due to the fact that the elastic bones of a child is covered with a thicker layer of adipose tissue with exible suture lines. The presence of tooth buds and lack of pneumatization increases the stability of the fractured [7] bone. Furthermore, the growth potential of the condyle may come in handy to compensate post condylar fracture, while a spontaneous occlusal [8] readjustment during the mixed dentition stage can be accomplished. DIAGNOSIS OF FACIAL FRACTURE IN CHILDREN CT Scan being the gold standard in diagnostic aid is helpful in pediatric patients, especially in midfacial fracture, comprising of underdeveloped sinuses and tooth buds obscuring the skeletal bones. [7] Plain radiographs may not prove to be useful as in the case of adults. RIGID INTERNAL FIXATION AS AN OPTION IN CHILDREN It comes with a package of advantages over the closed reduction technique, such as it promotes primary healing, lesser treatment period, early removal of MMF enhancing postoperative oral hygiene, [7] nutritional intake and respiratory care, However, there are controversies concerning the use of rigid internal xation in growing children, comprising of the high cost, potential artifacts on CT/MRI, visibility of plates through the child's thin skin, pain, early/late infection, trauma to the tooth buds and erupting teeth, risk of dural penetration of plates and screws (potential risk of secondary headacks/ [9] seizure focus), cerebrospinal uid leak, meningitis, brain injury, [83] disturbed growth pattern. Mini plates and screws are known to possess the capacity to migrate in bone and other tissues such as [10] cartilage. Device loosening, skin irritation and device exposure are [9] the causes of potential need for secondary removal surgery. It is suggested to remove the plate and screws as early as possible (within 2-3 months). Furthermore, the plates and screws must not traverse suture lines or the midline of the mandible. With the introduction of absorbable plates and screws these complications will [10] be further minimized. RESORBABLE PLATING SYSTEM With the introduction of resorbable material the need for additional surgery for the removal of hardware is eliminated. Adding to its advantages such as lesser hospital spending, the use of large mesh panels helps to contain the cost with resorbable systems (by placing several small pieces in cost-effective fashion) from a single large panel. Improving patients quality of life. Various authors in their respective studies demonstrated that the larger resorbable plate xation in the tooth bearing regions can be troublesome in a way that the developing tooth buds and the roots of erupting teeth may be damaged, making them a selective choice of treatment in mixed dentition phase. They are also presumed to have lower biomechanical [4] strength. The development and use of bioresorbable material such as polylactic (PLA), polyglycolic (PGA) and polydioxanone acid plates has transformed the way and view point of pediatric fracture treatment, as they are biocompatible in nature with complete degradation within 12-14 months after the completion of bone healing through hydrolysis. MANDIBULAR FRACTURES The management of mandibular fractures in young children offers numerous remarkable challenges for the oral surgeon. The fractures are likely along the line of unerupted teeth, frequently irregular, long [11] and oblique fracture line. Treatment of mandibular fracture depends on the fracture site and the stage of skeletal and mental development. Mostly condylar fractures are treated with supportive care (observation, soft diet, physiotherapy, long span of postoperative follow up). A short period of MMF (<2 weeks) with guiding elastics (<8 weeks) after MMF release is suggested in case of malocclusion. Postoperative physiotherapy [8,9] (passive jaw exercise) is advised for an extended period of time. Furthermore, open reduction avoids MMF, improving the functional outcome.Fractures associated with alveolar process may be treated by open or closed reduction followed by immobilization for 2-3 weeks (via splints and arch bar), rarely indicated for 2 months preventing malocclusion. Displaced mandibular fractures can be alternatively immobilized using splint xed to teeth, to the mandible with circum- [8] mandibular wiring (Gunning splint), or a splint with MMF. ZYGOMATIC COMPLEX FRACTURES The zygomatic complex fracture has the occurrence incidence of 7%- INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Dental Science International Journal of Scientific Research 59 Volume - 10 | Issue - 09 | September - 2021 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr ABSTRACT During the past decades, there have been enormous advances in the management of pediatric facial fractures. Trauma regarded as the sole reason for the cause of morbidity and mortality in children. Diagnosis is more difcult in children than the adults and fractures are easily overlooked. CT imaging is the gold standard for the diagnostic purposes. Operative management must be done while keeping in mind the child’s skeletal and dental age. KEYWORDS Pediatric Facial Trauma, Resorbable Plating System