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Outcomes in Pediatric Facial Fractures: Early Follow-Up in 177 Children and Classification Scheme

Rottgers, S. Alex MD*; DeCesare, Gary MD; Chao, Mimi MD; Smith, Darren M. MD*; Cray, James J. PhD*; Naran, Sanjay MD*; Vecchione, Lisa DMD; Grunwaldt, Lorelei MD; Losee, Joseph E. MD, FACS, FAAP

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1260-1265
doi: 10.1097/SCS.0b013e31821c6ab7
Original Articles

A comprehensive study of adverse outcomes after pediatric facial fractures has not been published. This study aimed to determine the incidence and classify adverse outcomes after facial fractures in children while reporting our early results. A retrospective chart review was performed on facial fracture patients identified in the Craniofacial Trauma Database of the Children's Hospital of Pittsburgh and seen in follow-up from 2003 to 2007. An Adverse Outcome Classification Scheme was developed: type 1, outcomes resulting from the fracture; type 2, outcomes resulting from fracture treatment; and type 3, outcomes resulting from the interaction between the fracture, its treatment, and subsequent growth and development. Fisher exact or χ2 analyses were completed. A total of 177 pediatric facial fracture patients were identified with 13.3 months of average follow-up. Mean age was 9.8 years (range, 0.4-18.7 y). Of these patients, 41.8% underwent surgery and 57 patients (32.2%) had adverse outcomes (type 1, 14.1%; type 2, 11.3%; and type 3, 15.8%); 26.3% of these had multiple adverse outcomes. Isolated fractures resulted in fewer adverse outcomes and fewer multiple adverse outcomes compared with combined fractures (26.6% versus 45.3%, P = 0.015; 4% versus 18.9%, P = 0.002). Patients treated operatively exhibited more types 1, 2, and 3 and multiple adverse outcomes compared to those treated conservatively (P < 0.01). In our pediatric cohort, 32.2% of patients had an adverse outcome. With longer follow-up and growth and development studies, we will likely see an increase in the incidence of type 3 adverse outcomes. We recommend, whenever possible, conservative treatment of pediatric facial fractures.

From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Philadelphia; †Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; ‡Children's Hospital of Central California, Madera, California; and §Children's Hospital of Pittsburgh, Pittsburgh, Philadelphia.

Received October 20, 2010.

Accepted for publication December 6, 2010.

Address correspondence and reprint requests to Joseph E. Losee, MD, FACS, FAAP, University of Pittsburgh Medical Center and Division Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Children's Hospital Drive, 45th & Penn, Pittsburgh, PA 15201; E-mail:

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD