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Cleft & Craniofacial Surgery

(9) Little Faces, Big Challenges: A Two-Decade Analysis of Pediatric Midface Fractures

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT
Disclosure(s):
Valeria Mejia, BS: No financial relationships to disclose
Asli Pekcan, BS: No financial relationships to disclose
Melanie Bakovic, BS: No financial relationships to disclose
Raina K. Patel, BS: No financial relationships to disclose
Abstract:

Background: Trauma is a major cause of injury and mortality in children, and facial fractures in pediatric patients can lead to significant aesthetic, functional, and psychosocial issues. However, mechanisms and management of pediatric midface fractures, especially maxillary fractures, have not been extensively studied. This study analyzes injury mechanisms and treatment approaches for maxillary fractures in children and adolescents over two decades.

Methods: A retrospective review was conducted on patients with maxillary fractures treated at a major children’s hospital from 2005 to 2024. Inclusion criteria focused on patients with Le Fort, dentoalveolar, or maxillary wall fractures confirmed by CT. Data collected included age, gender, fracture mechanism, type, referral, dental complications, and treatment. Patients were categorized into two age groups: children (0-12 years) and adolescents (13-18 years).

Results: Of 2,401 patients with maxillofacial fractures, 176 had maxillary fractures. The mean age was 7.5 ± 3.5 years in children (89 patients) and 15.9 ± 2.5 years in adolescents (87 patients), with a male-to-female ratio of 2.75:1. Falls were the most common cause, followed by baseball injuries. Adolescents were 9 times more likely to sustain fractures from assault than children (18.4% vs 2.7%, P < .05). Most fractures were managed conservatively, while 24% required open reduction and fixation. Management methods, dentoalveolar fractures, tooth injuries, and referral types did not vary significantly between the age groups.

Conclusions: Falls were the primary cause of maxillary fractures across both age groups, with a higher male incidence. Adolescents were more likely to suffer fractures from assault compared to younger children. While conservative treatment prevailed, open reduction and fixation were effective for severe cases. These findings underscore the need for tailored strategies to prevent and manage midface fractures in pediatric patients, especially in adolescents affected by interpersonal violence.