The epidemiology and management of traumatic facial fractures in children under the age of 15 years recorded in a Johannesburg General hospital over a period of 5 years

A research report submitted to the Department of Maxillofacial and Oral Surgery, Faculty of Oral Health Science, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Dentistry (Witwatersrand) performed partly in the Department of Maxillofacial and Oral Surgery 18 May 2017.Aim: This study aim was to determine the prevalence of traumatic facial fractures in children under the age of 15 years who presented at the Charlotte Maxeke Johannesburg Academic Hospital (Department of Maxillofacial and Oral surgery, Wits Oral Health Centre and Department of General Surgery) over a period of 5 years from 2011 to 2015. Objective: This study objective was to determine the prevalence of facial bone fractures, the age and gender mostly affected, the place and cause of facial fracture, the type and distribution of facial fractures, the prevalence of associated injuries as well as the management of facial fractures. Materials and methods: This is a retrospective study based on data retrieved from patient records. Four thousand and forty-four files were used for the analysis of this study. Data collected from existing patient records included: department of admission; date of admission; age; gender; who accompanied the patient to hospital; ethnicity; medical history; number of days between date of injury and date of arrival; place of injury; cause of fracture; site of fracture; type of fracture; teeth affected; associated facial injuries; ophthalmic or globe involvement; associated bodily injuries; specialized consultation; radiographs; management and treatment of injuries. The results: Cases numbering 171 children under the age of 15 years with facial bone fractures were retrieved from patient records. Majority of the patients were males. Mean age of patients was 6.45 ± 3.47 years. Most common places of injury included the home, school and other places which refer to any other environment, surrounding area or public place in the home or school. Most common causes of paediatric facial fracture injury are pedestrianvehicle accidents (PVAs), motor vehicle accidents (MVAs) and falls, with a significant association between the cause of fracture and the age of the patients. Two hundred and forty seven facial bone fractures were detected. Most common site of facial fracture was the frontal bone followed by the orbital bone. Fifty six paediatric patients had multiple facial bone fractures. Forty nine children had an associated tooth injury. Of the 435 facial soft tissue injuries (STIs) detected, 91.0% were extra orally. Most common STIs were lacerations, abrasions and soft tissue swellings. Seventy four of the 117 paediatric patients with associated bodily injuries, had multiple bodily injuries. Twelve patients with facial bone fractures showed results of ophthalmic or globe involvement. One hundred and nine (63.7%) patients with facial bone fractures were managed conservatively, whilst management of 58 (34.0%) patients included surgical intervention. Four (2.3%) patient records did not indicate any treatment. Conclusion: Most facial bone fractures were recorded in children under the age of 10 years and male gender was most affected. Aetiology of facial fractures seems to be more similar in male and female children at a younger age, whereas more variation in aetiology occurs in gender during adolescence. This study suggests that the school is the safest place for children. The seasonal variance in terms of paediatric facial fracture prevalence is most likely related to an increased outdoor activity during the months of summer. Possible reasons that contribute to home and other places as high-risk areas for facial fractures in children could either be lack of parental supervision and responsibility, or the absence of safety measures. More children were involved in PVAs than MVAs. The negligence of drivers, lack of road safety awareness, insufficient pedestrian safety measures or inadequate parental control is potential factors to contribute to the high prevalence of MVAs and PVAs as a major aetiological factor amongst children in these affected communities. From this study, it seems that the mechanism of injury and stage of facial development shows a noticeable influence on the type and site of the bone fracture and that the frequency of aetiological factors changes with age. Management and treatment of paediatric facial fractures should be with a good understanding of the patterns of anatomical growth and stages of skeletal development.LG201