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How do different specialties care for pediatric facial fractures? Patterns of management of pediatric facial fractures
Zhazira Irgebay, BA; Casey Zhang, BA; Jesse A. Goldstein, MD; Joseph E. Losee, MD
University of Pittsburgh Medical Center
2022-01-26
Presenter: Zhazira Irgebay
Affidavit:
This student was responsible for over half of the conception, design, data collection, analysis of data, and abstract drafting for this project.
Director Name: Vu T Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Pediatric facial fractures are managed by multiple subspecialty teams. This study evaluates the difference in characteristics and management across subspecialty groups.
Methods: We performed a retrospective review of patients under 18 years of age who were evaluated at a pediatric level I trauma center from 2005 to 2021 for facial fractures. Patients were subdivided by specialty: plastic surgery, ENT, OMFS, and ophthalmology. We evaluated the mechanisms of injury, facial fracture types, and treatment across the subspecialties.
Results: Out of 3136 patients, 41.3% were treated by a plastic surgery, 20.0% by ENT, 33.8% by OMFS, and 4.9% by ophthalmology. Most fractures from violence (n = 168, 47.1%) and MVA (n = 260, 60.6%) were treated by plastics, while fractures due to sports (n = 472, 45.3%) and play (n = 181, 46.9%) were treated by ENT (p = 0.001). All facial fractures except nasal were more commonly treated by the plastics team, while most nasal fractures were treated by ENT. Nasal fractures were more likely to be surgically treated by ENT (n = 912, 87.1%%) compared to other specialties (p < 0.001). Patients with orbital fractures were less likely to be surgically treated by ophthalmology (n = 22, 15.8%) than other subspecialties (p < 0.001). Mandibular fractures were more likely to be surgically treated by OMFS (n = 99, 52.9%) than by plastics (n = 116, 36.5%; p = 0.004).
Conclusions: This study demonstrates the differences in management of fractures across specialties and the need for a standardized approach.
