Original Article

Maxillofacial Fracture Types and their Management in 3- to 18-year-old Individuals Referred to Shariati Hospital, Tehran, Iran

Maxillofacial Fracture Treatment in 3-18-year-olds


Objectives: This study was performed to find the most common types of maxillofacial fractures and their management in 3 to 18-year-old individuals referred to the Department of Oral and Maxillofacial Surgery at Shariati Hospital in Tehran, during a 9-year period.

Materials and Methods: This retrospective study evaluated the records of 319 patients with maxillofacial fractures between 2012-2020, ranging in age from 3 to 18 years. Data regarding the etiology and location of the fracture, age, gender, and treatment approach were retrieved from the archival records and analyzed.

Results: A total of 319 patients were included in the study, out of which, 255 (79.9%) were males and 64 (20.1%) were females. Motor-vehicle accidents were the most common cause of trauma (N=124, 38.9%). We recorded 605 fractures and among them, the parasymphysis (N=131, 21.6%) was the most common site of isolated fractures. Type of treatment varied depending on the fracture type and degree of displacement of the broken segments. It consisted of open reduction and internal fixation, and closed reduction procedures, which included the use of arch bars, ivy loops, lingual splints, and circummandibular wirings.

Conclusion: Analysis of the results revealed that the severity of injury increased with age. Older individuals had higher a number of fracture sites and experienced greater displacement of the broken segments.

1. Department of Health and Human Services, Centers for Disease Control and Prevention. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0–19 year olds in the United States, 2000–2006. Available at: https://www.cdc.gov/safechild/pdf/cdc-childhoodinjury.pdf. Accessed February 8, 2017.
2. Gassner R, Tuli T, Hächl O, Moreira R, Ulmer H. Craniomaxillofacial trauma in children: a review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg. 2004 Apr;62(4):399-407.
3. American College of Surgeons. The National Trauma Databank 2016 Pediatric Annual Report. Available at: https://www.facs.org/media/d3ufvsmy/ntdb-pediatric-annual-report-2016.pdf Accessed February 8, 2017.
4. Hatef DA, Cole PD, Hollier LH Jr. Contemporary management of pediatric facial trauma. Curr Opin Otolaryngol Head Neck Surg. 2009 Aug;17(4):308-14.
5. Ryan ML, Thorson CM, Otero CA, Ogilvie MP, Cheung MC, Saigal GM, Thaller SR. Pediatric facial trauma: a review of guidelines for assessment, evaluation, and management in the emergency department. J Craniofac Surg. 2011 Jul;22(4):1183-9.
6. Vyas RM, Dickinson BP, Wasson KL, Roostaeian J, Bradley JP. Pediatric facial fractures: current national incidence, distribution, and health care resource use. J Craniofac Surg. 2008 Mar;19(2):339-49; discussion 350.
7. Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg. 2008 Nov;207(5):710-6.
8. Andrew TW, Morbia R, Lorenz HP. Pediatric Facial Trauma. Clin Plast Surg. 2019 Apr;46(2):239-247.
9. Grunwaldt L, Smith DM, Zuckerbraun NS, Naran S, Rottgers SA, Bykowski M, Kinsella C, Cray J, Vecchione L, Saladino RA, Losee JE. Pediatric facial fractures: demographics, injury patterns, and associated injuries in 772 consecutive patients. Plast Reconstr Surg. 2011 Dec;128(6):1263-1271.
10. Rottgers SA, Decesare G, Chao M, Smith DM, Cray JJ, Naran S, Vecchione L, Grunwaldt L, Losee JE. Outcomes in pediatric facial fractures: early follow-up in 177 children and classification scheme. J Craniofac Surg. 2011 Jul;22(4):1260-5.
11. Ellis E 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol. 1985 Feb;59(2):120-9.
12. Amarista Rojas FJ, Bordoy Soto MA, Cachazo M, Dopazo JR, Vélez H. The epidemiology of mandibular fractures in Caracas, Venezuela: Incidence and its combination patterns. Dent Traumatol. 2017 Dec;33(6):427-432.
13. Moffitt JK, Wainwright DJ, Bartz-Kurycki M, Wainwright DJ, Demian N, Teichgraeber JF, Greives MR. Factors Associated With Surgical Management for Pediatric Facial Fractures at a Level One Trauma Center. J Craniofac Surg. 2019 May/Jun;30(3):854-859.
14. Oleck NC, Dobitsch AA, Liu FC, Halsey JN, Le TT, Hoppe IC, Lee ES, Granick MS. Traumatic Falls in the Pediatric Population: Facial Fracture Patterns Observed in a Leading Cause of Childhood Injury. Ann Plast Surg. 2019 Apr;82(4S Suppl 3):S195-S198.
15. Liu FC, Le TT, Oleck NC, Halsey JN, Hoppe IC, Lee ES, Granick MS. Pediatric Pedestrian Facial Fracture Patterns and Management Following Motor Vehicle Collisions. J Craniofac Surg. 2020 Jan/Feb;31(1):265-268.
16. Bormann KH, Wild S, Gellrich NC, Kokemüller H, Stühmer C, Schmelzeisen R, Schön R. Five-year retrospective study of mandibular fractures in Freiburg, Germany: incidence, etiology, treatment, and complications. J Oral Maxillofac Surg. 2009 Jun;67(6):1251-5.
17. Ruslin M, Wolff J, Boffano P, Brand HS, Forouzanfar T. Dental trauma in association with maxillofacial fractures: an epidemiological study. Dent Traumatol. 2015 Aug;31(4):318-23.
18. Holland AJ, Broome C, Steinberg A, Cass DT. Facial fractures in children. Pediatr Emerg Care. 2001 Jun;17(3):157-60.
19. Eggensperger Wymann NM, Hölzle A, Zachariou Z, Iizuka T. Pediatric craniofacial trauma. J Oral Maxillofac Surg. 2008 Jan;66(1):58-64.
20. Li Z, Li ZB. Characteristic changes of pediatric maxillofacial fractures in China during the past 20 years. J Oral Maxillofac Surg. 2008 Nov;66(11):2239-42.
21. Qing-Bin Z, Zhao-Qiang Z, Dan C, Yan Z. Epidemiology of maxillofacial injury in children under 15 years of age in southern China. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Apr;115(4):436-41.
22. Bamjee Y, Lownie JF, Cleaton-Jones PE, Lownie MA. Maxillofacial injuries in a group of South Africans under 18 years of age. Br J Oral Maxillofac Surg. 1996 Aug;34(4):298-302.
23. Ashrafullah, Pandey RK, Mishra A. The incidence of facial injuries in children in Indian population: A retrospective study. J Oral Biol Craniofac Res. 2018 May-Aug;8(2):82-85.
24. Alcalá-Galiano A, Arribas-García IJ, Martín-Pérez MA, Romance A, Montalvo-Moreno JJ, Juncos JM. Pediatric facial fractures: children are not just small adults. Radiographics. 2008 Mar-Apr;28(2):441-61; quiz 618.
25. Zimmermann CE, Troulis MJ, Kaban LB. Pediatric facial fractures: recent advances in prevention, diagnosis and management. Int J Oral Maxillofac Surg. 2006 Jan;35(1):2-13.
26. Wheeler J, Phillips J. Pediatric facial fractures and potential long-term growth disturbances. Craniomaxillofac Trauma Reconstr. 2011 Mar;4(1):43-52.
27. Ferreira PC, Barbosa J, Braga JM, Rodrigues A, Silva ÁC, Amarante JM. Pediatric Facial Fractures: A Review of 2071 Fractures. Ann Plast Surg. 2016 Jan;77(1):54-60.
28. Ghazal G, Jaquiéry C, Hammer B. Non-surgical treatment of mandibular fractures--survey of 28 patients. Int J Oral Maxillofac Surg. 2004 Mar;33(2):141-5.
29. Schilli W. Compression osteosynthesis. J Oral Surg. 1977 Oct;35(10):802-8.
30. James F. Kelly. Management of War Injuries to the Jaws and Related Structures. Government Printing Office; 1st ed 1977.
31. Massenburg BB, Sanati-Mehrizy P, Taub PJ. Surgical Treatment of Pediatric Craniofacial Fractures: A National Perspective. J Craniofac Surg. 2015 Nov;26(8):2375-80.
32. Gebran SG, Wasicek PJ, Elegbede A, Ngaage LM, Liang Y, Ottochian M, Morrison JJ, Rasko YM, Liang F, Grant MP, Nam AJ. Characterization of Age-Related Injury Patterns and Surgical Treatment of Pediatric Facial Fractures: Analysis of the National Trauma Data Bank. J Craniofac Surg. 2019 Oct;30(7):2189-93.
33. Eppley BL. Use of resorbable plates and screws in pediatric facial fractures. J Oral Maxillofac Surg. 2005 Mar;63(3):385-91.
IssueVol 20 (Continuously Published Article-Based) QRcode
SectionOriginal Article
DOI https://doi.org/10.18502/fid.v20i5.12359
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Razmara F, Badri A, Mahmoudi X. Maxillofacial Fracture Types and their Management in 3- to 18-year-old Individuals Referred to Shariati Hospital, Tehran, Iran. Front Dent. 2023;20.