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Pediatric Maxillary Fractures

Yu, Jack MD, DMD, MS Ed, FACS*; Dinsmore, Robert MD, FACS*; Mar, Philip PharmD; Bhatt, Kirit MD*

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1247-1250
doi: 10.1097/SCS.0b013e31821c6955
Original Articles

Pediatric craniofacial structures differ from those of adults in many ways. Because of these differences, management of pediatric craniofacial fractures is not the same as those in adults. The most important differences that have clinical relevance are the mechanical properties, craniofacial anatomy, healing capacity, and dental morphology. This article will review these key differences and the management of pediatric maxillary fractures. From the mechanical properties' perspective, pediatric bones are much more resilient than adult bones; as such, they undergo plastic deformation and ductile failure. From the gross anatomic perspective, the relative proportion of the cranial to facial structures is much larger for the pediatric patients and the sinuses are not yet developed. The differences related to dentition and dental development are more conical crowns, larger interdental spaces, and presence of permanent tooth buds in the pediatric population. The fracture pattern, as a result of all the above, does not follow the classic Le Fort types. The maxillomandibular fixation may require circum-mandibular wires, drop wires, or Ivy loops. Interfragmentary ligatures using absorbable sutures play a much greater role in these patients. The use of plates and screws should take into consideration the future development with respect to growth centers and the location of the permanent tooth buds. Pediatric maxillary fractures are not common, require different treatments, and enjoy better long-term outcomes.

From the *Section of Plastic Surgery and †School of Medicine, Medical College of Georgia, Augusta, Georgia.

Received September 13, 2010.

Accepted for publication December 6, 2010.

Address correspondence and reprint requests to Jack Yu, MD, DMD, MS Ed, FACS, Section of Plastic Surgery, Medical College of Georgia, Augusta, GA; E-mail:

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD