Management of Facial Trauma In Children

Facial trauma in children can have long-term medical, social, and psychologic effects. What sorts of facial trauma can a child be subjected to? How do physicians and oral surgeons manage and treat facial trauma in children?

(PRWEB) November 3, 2003 --The face allows recognition and communication among people. No other part of the body is as aesthetically important as the face. Facial injuries can range from a minor inconvenience to a lifetime disfigurement. For this reason, any injury to this area requires particular care and attention during treatment.

In the United States, approximately 3 million people are treated in a hospital emergency department for traumatic facial injuries each year. Five percent of pediatric trauma patients have facial fractures. Falls are the most common cause of facial fractures in children younger than 3 years of age. After 5 years of age, the leading cause of facial fractures is motor vehicle collisions.

The nasal bones and mandible (jaw) are the two most frequent sites of facial fracture. Mandibular fractures occur in 7.7% of children younger than 16 years of age. An equal incidence of mandibular fractures exists between both sexes. Trauma to the condylar growth center (the neck of the jaw) beneath the articular disk may cause delayed growth of the affected side of the jaw.

EMERGENCY EVALUATION OF FACIAL TRAUMA:
First, perform a primary survey and assess airway, breathing and circulation. Note that mobile fracture segments, edema (swelling), hemorrhage (bleeding), vomitus, bone fragments, and foreign bodies may cause obstruction of the airway. The airway is always the first priority in treatment of the trauma patient. In any trauma patient, be sure to obtain cervical spine x-rays to rule out neck injury. A complete set of vital signs including: temperature, pulse, blood pressure, and pulse oximetry should be obtained on every patient.

Second, perform a thorough trauma physical examination.

Third, inspect the face inspected for symmetry, swelling, or ecchymosis (bruising). The face is palpated bimanually in an orderly fashion -- beginning at the cranial vault, then proceeding to the forehead, orbital rims (bone surrounding the eyes), zygomatic arch (cheek bone), maxillary alveolus (upper jaw bone), and the mandible (lower jaw). Numbness of the infraorbital, supraorbital, and mental nerve distributions may indicate a cut or stretched nerve. Gently palpate the nasal area for crepitus, tenderness, or subcutaneous emphysema (air). Swelling, ecchymosis (bruising), crepitation (fine crackling), and facial asymmetry may indicate an underlying fracture. Look for enopthlalmus (sunken-in eyes), exopthalmus (protruding eyes), periorbital ecchymosis, and postauricular ecchymosis (bruising behind the ears - Battles sign). Note that Battles sign is associated with basilar skull fractures. Examination of the inside of the ear with an otoscope may reveal a hemotympanum (bleeding of the eardrum), which indicates either a basilar skull or temporal bone fracture.

Dr. Ravel is a pediatric and children's dentist with a private practice in Fayetteville, NC. His private practice web site is http://www.wnow.net/kidsdental
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