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Cleft & Craniofacial Surgery

OMS and Other Dental Specialists

Session: Oral Abstract Session One

SA1 - Maxillofacial Fractures in Pediatric Patients: Orbital Trauma and the Biomechanical Link to Cervical Spine Injuries

Friday, September 19, 2025
8:30 AM - 8:40 AM EDT
Location: Room 204C, Walter E. Washington Convention Center
Abstract:

Background: Maxillofacial fractures in adults carry a risk for concomitant cervical spine injuries (CSI), but the risk of CSI in pediatric patients with similar fractures remains understudied. This study aims to examine injury mechanisms, treatment approaches, and associated CSI in pediatric maxillofacial fractures over two decades.

Methods: A retrospective review of patients under 18 with maxillofacial fractures treated at a major children’s hospital from 2002 to 2024 was conducted. Inclusion criteria focused on nonsyndromic patients with computed tomography-confirmed fractures secondary to blunt trauma. Data on demographics, fracture types, injury mechanisms, CSI occurrence, and treatment were analyzed using Pearson’s chi-squared and Student T-tests.

Results: Among 2,401 patients, 395 met inclusion criteria; 139 (35.2%) required surgery. The mean age was 11.6 ± 5.2 years, with a male-to-female ratio of 3:1. Orbital fractures were the most common (47.6%), followed by maxillary fractures (25.1%). Falls were the leading cause (27.8%), followed by assault (17.7%). Orbital fractures showed a significantly higher CSI rate compared to other fracture types (3.2% vs 0.57%, P < .05). Patients with orbital fractures were also more likely to need surgical intervention (39.9% vs 28.9%, P < .05).

Conclusions: Our findings indicate that children with orbital fractures face a substantially increased risk of associated CSI compared to those with other maxillofacial fractures. This heightened risk could stem from unique biomechanical characteristics in pediatric anatomy, particularly the relatively higher upper-to-lower face ratio in children than in adults, which may facilitate force transmission from the face to the cervical spine during impact. Moreover, orbital fractures frequently result from high-energy trauma, increasing the likelihood of concurrent cervical damage. These results emphasize the need for careful cervical spine evaluation in pediatric patients with orbital fractures to ensure comprehensive care and prevent unrecognized injuries.