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Midface Growth Following Severe Pediatric Facial Trauma: A Cephalometric Study
Edward H. Davidson, MA MBBS, Lindsay Schuster, DMD MS, Sanjay Naran, MD, Anand Kumar, MD, Joseph E. Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
Severe pediatric facial trauma is characterized by multiple, comminuted and impacted unstable fractures, necessitating operative intervention. To date, rigid internal fixation is the mainstay of surgical treatment of pediatric facial fractures. Disruption of facial growth is a primary concern in the long term sequelae of pediatric facial fracture management. We catalogue our experience with severe midface pediatric fractures at a major pediatric teaching hospital with cephalometric analysis of midface skeletal growth following injury.
An institutional review board-approved retrospective chart review was performed on all patients with facial fractures. Patients with multiple orbit and midface fractures were included. Lateral cephalograms at longest-term follow up were traced, digitized, and averaged. Seven cephalometric landmarks of the midface (A point, ANS, orbitale, bridge of nose, distal U6, upper lip, stomion superius) were identified for comparative measurements with age and gender-matched superimposed Bolton norms as controls. Differences in x and y axes between test and control metrics were measured. Clinical significance was defined as a 2mm discrepancy from the norm. Statistical significance for each patient was determined using T-tests of the x and y arrays of patient values versus normal controls.
Seven patients met the inclusion criteria for severe midfacial trauma with mean age of 8.9 years (range 3-14 years) at time of injury. All patients underwent initial open reduction and internal fixation and subsequent revision surgeries. Mean cephalometric follow up was 4.6 years (range 2-10 years). Considering all landmarks for all patients, mean deficiency in growth was 3.7mm (range -4.0mm to 13.7mm) in the x axis (p<0.001) and 2.9mm (range -1.1mm to 8.8mm) in the y axis (p<0.001). Six out of 7 patients (86%) showed clinically significant impairment in growth in either horizontal (29%), vertical (29%) or both planes (29%). T-tests confimed statistical significance (p≤0.05) for all clinically significant differences. Mean deficiency in growth for all landmarks was 3.7mm (range -4.0mm to 13.7mm) in the x axis and 2.9mm (range -1.1mm to 8.8mm) in the y axis.
Current treatment of severe pediatric facial trauma often results in compromised bone growth and permanent facial deformity. New methodologies of pediatric facial fracture management that better allow for growth are needed.
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