1. Pediatric cranio-facial fractures are increasingly common due to rising trauma rates. 2. Proper emergency management of airway, breathing, and circulation is essential. 3. Diagnosis requires various imaging methods like CT scans to properly evaluate fractures. 4. Treatment aims to restore normal anatomy and minimize growth impacts through approaches specific to different fracture regions like the nasal bones or mandible.

1. Ali Tawfik, MD., DDS
Prof. of E.N.T. & MF. Surgery
Faculty of Medicine
University of Mansoura
Egypt

2. Management of Pediatric
Cranio-Facial Fractures

3. Trauma Statistics
In Us
• The disease of Modern society.
• Trauma is the largest killer of persons.
• 57 million amer. are injured every year
– 1 in 4 of these requires medical care.
– 150,000 deaths results.
• 25% of an Emergency are trauma cases.
• 33% of Hospital Admission are trauma
cases.

4. • 12.5% of the Hospital beds are occupied by trauma cases.
• US citizens spend 144 million day in bed Annually.
• Trauma is the one of most costly health problems.
• Greater than Health Diseases and cancer combined .
• The direct and indirect Economic loses are estimated.
• To be 200 billion $ Annually.
Trauma Statistics (Cont.)
In Us

5. Management of Pediatric
Cranio-Facial Fractures
 In today’s fast speed society, many
children sustain Maxillo-facial Fractures
that requires surgical reconstruction.

6. IN US :- The leading cause of death
among children each year .
»100,000 children are permanently
disable.
»15,000 die.
»Cost of $15 billion dollars.
(Rowe et al., 1994)

7. Epidemiology (US)
• Trauma 4th
leading cause of death.
• 50% of trauma leads to death = MVA
Nonfatal MVA injuries = 4 Million/y.

8. • Pediatric MF Fractures, 5% of all facial
fractures.
• Children > 5 years have lower incidence.
• Male > female.
• Nasal fractures are the most common.
• Mandibular Fractures are the most
common cases of hospitalization.
• Associated injuries are common.
Epidemiology

9. • 2/3 of patients admitted to Trauma Centers
have facial trauma.
• > 70% of those in MVA have facial trauma.
• Spectrum of facial injuries from small cuts
to complex open fractures.
Epidemiology (US)

10. A Child’s Face has Protective
Anatomic Character:
• Soft and elastic immature bone.
• Covered by thick layer of fat and
muscle.
• Unerupted teeth.

11. In Infancy And early Childhood
• The cranium is relatively large with
Prominent forehead leads to a high skull-
to-face ratio.

12. Emergency Management
• Airway.
• Breathing.
• Circulation.

13. Airway Management
• The First step in management of traumatized
patient is to ensure a patient airway.
• Endotracheal intubation is more better than
tracheotomy.

14. Consultation
• Multiple-system trauma.
• Cranial or intracranial trauma.
• Orbital trauma.
• Dental occlusion trauma.

15. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

16. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

17. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

18. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

19. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

20. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

21. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

22. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

23. Radiologic Examination
• Difficult to document radiographically.
• Panoramic view.
• Towne’s view.
• CT scan has revolutionized the imaging.
• Axial CT.
• Coronal CT.
• Three dimensional CT.

24. Principles of Treatment by Region
• Cranial vault and supra orbital ridge
fractures.
• Naso-Franto-Ethmodial fractures.
• Le-Fort fractures.
• Zygomatic complex fractures.
• Nasal fractures.
• Mandibular fractures.
• Dento-alveolar fractures.

25. Fixation

26. Cranial vault and supra cranial fractures
• More common in infant and children 5 years.
• Treatment :-
 Coronal incision.
 Reduction.
 Fixation by wire, miniplates or microplates.
 Primary bone graft.
 Neuro surgeon.

27. Naso-Franto-Ethmoidal fractures
• Direct Trauma.
• Coronal incision.
• Reduction.
• Fixation.
• Medical canthio- pexies.
• Frontal sinus fractures :-
– Ant. w.: Reduction and fixation
– Post. w.: Craniolization of the sinus.

28. Naso-Franto-Ethmoidal fractures
• Direct Trauma.
• Coronal incision.
• Reduction.
• Fixation.
• Medical canthio- pexies.
• Frontal sinus fractures :-
– Ant. w.: reduction and fixation
– Post. w.: Cranialization of the sinus.

29. Naso-Franto-Ethmoidal fractures
• Direct Trauma.
• Coronal incision.
• Reduction.
• Fixation.
• Medical canthio- pexies.
• Frontal sinus fractures :-
– Ant. w.: Reduction and fixation
– Post. w.: Cranialization of the sinus.

30. Zygomatic complex Fractures

31. Nasal Fractures
• The growth of the nasal spectrum is considered a
major factor in the midface development.
• So sever trauma and improper treatment of nasal
fracture could retard normal growth resulting in a
saddle nose and midface deficiency.
• So proper treatment and follow up are essential

32. Mandibular Fractures
• The mandible is filled with teeth.
• The primary and mixed dentition are obstacles to IMF.
• Interosseous or plate-screw fixation must be located at
inferior border.

33. Treatment of Fractured Mandible Depends on
• Type of fracture (greenstick or complete).
• Location (body or condyle).
• Age of the patient.
• Presence of other facial fractures.
• Presence of associated systematic injuries.

34. Aim of treatment of fractured mandible
• Normalize occlusion.
• Prevent impairment of the dentition.
• Preserve TMJ mobility.

35. Conclusion
1. Pediatric cranio-facial fracture is preventable disease.
2. The aim of management is to restore the normal anatomic
position of facial skeleton.
3. The difference in the pattern of fractures between
children and adult must be recognized.

36. Conclusion (cont.)
4. Fractures in children may go unrecognized due to : -
– Incomplete communication with the child.
– Inadequate radiographic.
– Late presentation.
5. Improper management leads to distortion of the facial growth.

37. Conclusion (cont.)
6. Late squeals are common:-
– Facial growth retardation.
– Facial distortion.
– Treatment rendered.
7. Long-term follow-up is essential to monitoring the
facial growth and development.

38. Conclusion (cont.)
8. So proper diagnosis, management and Long-
term follow-up are essential to minimize
growth distortion and to maximize
functional, psychological, and aesthetic
results for both patient, family and
community.

39. ThankYouThankYou