Skip to main content
SpringerLink
Log in

Pediatric Maxillary and Zygomatic Fractures

  • Chapter
  • First Online:
Pediatric Maxillofacial Trauma

  • 601 Accesses

Abstract

Pediatric maxillary and zygomatic fractures are rare due to the anatomic protection and increased bone stability. They are typically the result of high-energy trauma resulting from motor vehicle collisions. As such, they are most commonly seen with concomitant injuries. After stabilization of life-threatening injuries, a thorough history of the inciting injury and careful physical exam of the facial skeleton must be completed. Computed tomographic imaging with three-dimensional analysis of the maxilla and zygomaticomaxillary complex is essential to an accurate diagnosis and proper treatment plan. Conservative, nonsurgical management is reserved for non-displaced or minimally displaced midface fractures with no functional or esthetic deficits. When fractures of the maxilla occur and result in a malocclusion, closed reduction utilizing maxillomandibular fixation can be considered. When the maxilla or zygoma are displaced and more significant functional or esthetic deficits result, open reduction with or without fixation may be necessary. The benefit of restoring form and function must always be weighed against the consequences of operating on the pediatric patient. The soft-tissue scarring and bony trauma created during surgical access, reduction, and fixation of the facial skeleton may lead to growth disturbances in the growing child. The use of biodegradable fixation systems avoids the second surgery required to remove hardware when titanium fixation is used. However, more data is needed to assess whether this benefit carries any growth advantage. In general, bone healing is accelerated in pediatric populations and therefore the timing of conservative treatments and closed reduction techniques is shorter in comparison to that in adults. Long-term complications from pediatric maxillary and zygomatic fractures include hypoplasia of the affected bones and bony asymmetry. Close longitudinal follow-up of these patients with early recognition of growth disturbance may allow for growth modification techniques prior to skeletal maturity and alleviate the need for further surgical intervention in the adult years.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg. 2008;208:325.

    Google Scholar 

  2. Kaban LB. Diagnosis and treatment of fractures in the facial bones in children 1943-1993. J Oral Maxillofac Surg. 1993;51:722–9.

    Article  CAS  PubMed  Google Scholar 

  3. Gassner R, Tuli T, Hächl O, Moreira R, Ulmer H. Craniomaxillofacial trauma in children: a review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg. 2004;62:399–407.

    Article  PubMed  Google Scholar 

  4. Zimmermann CE, Troulis MJ, Kaban LB. Pediatric facial fractures: recent advances in prevention, diagnosis and management. Int J Oral Maxillofac Surg. 2006;35:2–13.

    Article  CAS  PubMed  Google Scholar 

  5. Boyette JR. Facial fractures in children. Otolanyngol Clin North Am. 2014;47:747–61.

    Article  Google Scholar 

  6. Alcalá-Galiano A, Arribas-Garciá I, Marítin-Peréz M, et al. Pediatric facial fractures: children are not just small adults. Radiographics. 2008;28:441–61.

    Article  PubMed  Google Scholar 

  7. Koch B. Pediatric considerations in craniofacial trauma. Neuroimaging Clin N Am. 2014;24(3):513–29.

    Article  PubMed  Google Scholar 

  8. Anderson P. Fractures of the facial skeleton in children. Injury. 1995;26(1):47–50.

    Article  CAS  PubMed  Google Scholar 

  9. Allred LJ, Crantford JC, Reynolds MF, David LR. Analysis of pediatric maxillofacial fractures requiring operative treatment: characteristics, management, and outcomes. J Craniofac Surg. 2015;26:2368–74.

    Article  PubMed  Google Scholar 

  10. Haug R, Foss J. Maxillofacial injuries in the pediatric patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(2):126–34.

    Article  CAS  PubMed  Google Scholar 

  11. Ryan M, Thorson C, Otero C, et al. Pediatric facial trauma: a review of guidelines for assessment, evaluation, and management in the emergency department. J Craniofac Surg. 2011;22(4):1183–9.

    Article  PubMed  Google Scholar 

  12. Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children’s hospital. Child Abuse Negl. 2000;24:521–34.

    Article  CAS  PubMed  Google Scholar 

  13. Morris C, Kushner G, Tiwana P. Facial skeletal trauma in the growing patient. Oral Maxillofac Clin North Am. 2012;24(3):351–64.

    Article  Google Scholar 

  14. Rahman R, Rahman N, Hussaini H, et al. Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999-2001 in three hospitals. Int J Pediatr Otorhinolaryngol. 2007;71(6):929–36.

    Article  PubMed  Google Scholar 

  15. Sperber GH. Craniofacial development. London: BC Decker; 2001. p. 67–111.

    Google Scholar 

  16. Singh D, Bartlett S. Pediatric craniofacial fractures: long-term consequences. Clin Plast Surg. 2004;31(3):499–518.

    Article  PubMed  Google Scholar 

  17. Al Shetawi A, Lim C, Sing Y, et al. Pediatric maxillofacial trauma: a review of 156 patients. J Oral Maxillofac Surg. 2016;74(7):1420.e1–4.

    Article  Google Scholar 

  18. Defazio M, Fan K, Avashia Y. Fractures of the pediatric zygoma: a review of the clinical trends, management strategies, and outcomes associated with zygomatic fractures in children. J Craniofac Surg. 2013;24(6):1891–7.

    Article  PubMed  Google Scholar 

  19. Eggensperger Wymann N, Holzle A, Zachariou Z, et al. Pediatric Craniofacial Trauma. J Oral Maxillofac Surg. 2008;66(1):58–64.

    Article  PubMed  Google Scholar 

  20. Reedy B, Bartlett S. Pediatric plastic surgery. Stamford: Appleton & Lange; 1998. p. 463–86.

    Google Scholar 

  21. Moss ML. The functional matrix. In: Kraus B, Reidel R, editors. Vistas in orthodontics. Philadelphia: Lea & Febiger; 1962. p. 85–98.

    Google Scholar 

  22. Maqusi S, Morris D, Patel P, et al. Complications of pediatric facial fractures. J Craniofac Surg. 2012;23(4):1023–7.

    Article  PubMed  Google Scholar 

  23. Koltai P, Rabkin D. Management of facial trauma in children. Pediatr Clin North Am. 1996;43(6):1253–75.

    Article  CAS  PubMed  Google Scholar 

  24. LeFort R. Etude expérimentale sur les fractures de la machoire supéreure [Experimental study of fractures of the upper jaw parts I and II]. Rev Chir Paris. 1901;23:208. Original in French, translation by Tessier P published 1972.

    Google Scholar 

  25. Kellman R, Tatum S. Pediatric craniomaxillofacial trauma. Facial Plast Surg Clin North Am. 2014;22(4):559–72.

    Article  PubMed  Google Scholar 

  26. Farber SJ, Nguyen DC, Harvey AA, Patel KB. Alternative method of intermaxillary fixation for simple pediatric mandible fractures. J Oral Maxillofac Surg. 2016;74:582.e1–8.

    Article  Google Scholar 

  27. Zheng Z, Fang Y, Lin C. Isolated influences of surgery repair on maxillofacial growth in complete unilateral cleft lip and palate. J Oral Maxillofac Surg. 2016;74:1649–57.

    Article  PubMed  Google Scholar 

  28. Shetye P, Evans C. Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients. Angle Orthod. 2006;76(5):810–6.

    PubMed  Google Scholar 

  29. Kloss F, Stigler A, Brandstätter T, et al. Complications related to midfacial fractures: operative vs. non-surgical treatment. Int J Oral Maxillofac Surg. 2011;40:33–7.

    Article  CAS  PubMed  Google Scholar 

  30. Boffano P, Roccia F, Gallesio C, et al. Infraorbital nerve posttraumatic deficit and displaced zygomatic fractures: a double-center study. J Craniofac Surg. 2013;24(6):2044–6.

    Article  PubMed  Google Scholar 

  31. Fonseca R. Oral and maxillofacial trauma. 4th ed. Philadelphia, PA: Saunders; 2013.

    Google Scholar 

  32. Iatrou I. Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years’ experience. J Craniomaxillofac Surg. 2010;38:511–6.

    Article  PubMed  Google Scholar 

  33. Marinho RO, Freire-Maia B. Management of fractures of the zygomaticomaxillary complex. Oral Maxillofac Surg Clin North Am. 2013;25:617–36.

    Article  PubMed  Google Scholar 

  34. Shuenke M, Schulte E, Schumaker U. Head and neck anatomy for dental medicine. New York/Stuttgart: Thieme, cop; 2010.

    Google Scholar 

  35. Markiewicz M, Savannah G. Zygoma reconstruction. Oral Maxillofac Surg Clin North Am. 2013;25:167–201.

    Article  PubMed  Google Scholar 

  36. Knight J, North J. The classification of malar fractures: an analysis of displacement as a guide to treatment. Br J Plast Surg. 1961;13:325–39.

    Article  CAS  PubMed  Google Scholar 

  37. Zingg M, Laedrach K, Chen J, et al. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg. 1992;50:778–90.

    Article  CAS  PubMed  Google Scholar 

  38. Gerbino G, Roccia F, Bianchi FA, Zavattero E. Surgical management of orbital trapdoor fracture in pediatric population. J Oral Maxillofac Surg. 2010;68:1310–6.

    Article  PubMed  Google Scholar 

  39. Holland A, Broome C, Steinberg A. Facial fractures in children. Pediatr Emerg Care. 2001;17(3):157–60.

    Article  CAS  PubMed  Google Scholar 

  40. Siy RW, Brown RH, Koshy JC, et al. General management considerations in pediatric facial fractures. J Craniofac Surg. 2011;22:1190–5.

    Article  PubMed  Google Scholar 

  41. Wittwer G, Adeyemo W, Yerit K, et al. Complications after zygoma fracture fixation: is there a difference between biodegradable materials and how do they compare with titanium osteosynthesis? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(4):419–25.

    Article  PubMed  Google Scholar 

  42. Ellis E, Perez D. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg. 2014;72(10):1975–83.

    Article  PubMed  Google Scholar 

  43. Bos R, Boering G, Rozema F, et al. Resorbable poly(L-lactide) plates and screws for the fixation of zygomatic fractures. J Oral Maxillofac Surg. 1987;45(9):751–3.

    Article  CAS  PubMed  Google Scholar 

  44. Eppley B. Use of resorbable plates and screws in pediatric facial fractures. J Oral Maxillofac Surg. 2005;63(3):385–91.

    Article  PubMed  Google Scholar 

  45. Chao M, Losee J. Complications in pediatric facial fractures. Craniomaxillofac Trauma Reconstr. 2009;2:103–12.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Wheeler J, Phillips J. Pediatric facial fractures and potential long-term growth disturbances. Craniomaxillofac Trauma Reconstr. 2011;4(1):43–52.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ferreira P, et al. Retrospective study of 1251 maxillofacial fractures in children and adolescents. Plast Reconstr Surg. 2005;115(6):1500–8.

    Article  CAS  PubMed  Google Scholar 

  48. Lizuka, et al. Midfacial fractures in pediatric patients: frequency, characteristics, and causes. Arch Otolaryngol Head Neck Surg. 1995;121(12):1366–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA

    Michael A. Gentile

  2. Oral and Maxillofacial Surgery Residency Program, Naval Medical Center Portsmouth, Portsmouth, VA, USA

    Michael A. Gentile, Aidan A. McKinlay & Sara A. Stires

  3. Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA

    Michael A. Gentile

Authors
  1. Michael A. Gentile
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aidan A. McKinlay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara A. Stires
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. School of Dentistry, University of Louisville, Louisville, KY, USA

    George M. Kushner

  2. School of Dentistry, University of Louisville, Louisville, KY, USA

    Lewis C. Jones

Additional information

Disclaimer: The views expressed in this chapter are those of the author and do not reflect the official policy of the Department of Navy, Department of Defense, or the U.S. Government.

Copyright Statement: I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gentile, M.A., McKinlay, A.A., Stires, S.A. (2021). Pediatric Maxillary and Zygomatic Fractures. In: Kushner, G.M., Jones, L.C. (eds) Pediatric Maxillofacial Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-53092-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-53092-1_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53091-4

  • Online ISBN: 978-3-030-53092-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation