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Pediatric Maxillofacial Trauma and Its Impact On Developing Dentition: A Retrospective Review of 117 Patients
Sanjay Naran, MD, Liliana Camison, MD, Brian Lam, DMD, Osama Basri, BDS, CAGS, M.Ed, Lindsay Schuster, DMD, MS, Brian Martin, DMD, MS, Joseph Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: No study has looked comprehensively at dental sequela following pediatric facial fractures. Our goal was to explore dental complications in the pediatric population following facial trauma, and to identify those at risk.
METHODS: We identified children with fractures of tooth supporting regions from 2000-2014. Data elements included; demographics, treatment mode, and dental outcome measures including dental avulsion, subluxation, crossbite, openbite, occlusal cant, and dysgenesis of developing dentition.
RESULTS: 117 patients met our criteria. Average age at injury was 10.41yrs (range: 1.03-18.68), and average follow-up was 2.9yrs (range: 0.03-13.27). Fractures were grouped as mandibular (62.39%), maxillary (22.22%), or combination (15.39%). Dental development at the time of injury was classified as primary (17.95%), mixed (38.46%), or permanent (43.59%). Conservative management was employed in 41.88%, open reduction internal fixation (ORIF) in 49.57%, and closed reduction external fixation in 8.55% patients. The majority (67.52%) did not experience any dental trauma or sequela. Dental avulsion (10.26%), subluxation (10.26%), crossbite (5.13%), openbite (3.42%), occlusal cant (0.85%), and dysgenesis (5.13%) were observed. Avulsion was more likely in patients requiring ORIF (p<0.05). Development of an openbite, crossbite, or occlusal cant was more likely in patients whose fracture severity required ORIF, or had a combination fracture (p<0.05). Patients in primary or mixed dentition were more likely to require follow-up dental intervention (p<0.05).
CONCLUSIONS: Dentition is an important consideration in pediatric facial fractures. Fracture severity, mode of treatment, and dental age are all strong predictors for adverse dental complications. Surgeons should be cognizant of the increase in risk of complication in these patients.

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