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Midface Growth Following Severe Pediatric Facial Trauma: A Cephalometric Study
Edward H Davidson MA(Cantab) MBBS, Lindsay Schuster DMD MS, Sanjay Naran MD, Anand Kumar MD, Joseph E. Losee MD
University of Pittsburgh Department of Plastic Surgery
2013-03-15
Presenter: Edward H Davidson MA(Cantab)
Affidavit:
The above is entirely the work of the resident with faculty mentorship/problem solving/guidance
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Background
Disruption of facial growth is a primary concern in the long term sequelae of severe pediatric facial trauma current treatment. We catalogue our experience with cephalometric analysis of midface skeletal growth following injury.
Methods
Patients with multiple orbit and midface fractures were included from a retrospective chart review. Lateral cephalograms at longest-term follow up were traced, digitized, and averaged. Seven 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.
Results
Seven patients met the inclusion criteria with mean age of 8.9 years at time of injury. Mean cephalometric follow up was 4.6 years (range 2-10 years). 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¡Ü0.05) 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.
Conclusions
Severe pediatric facial trauma often results in compromised bone growth and permanent facial deformity. New methodologies of management that better allow for growth are needed.
