Children and Facial Trauma
What is facial trauma?
The term facial trauma means any injury to the face or upper jaw bone.
Facial traumas include injuries to the skin covering, underlying skeleton,
neck, nasal (sinuses), orbital socket, or oral lining, as well as the teeth and
dental structures. Sometimes these types of injuries are called maxillofacial
injury. Facial trauma is often recognized by lacerations (breaks in the
skin); bruising around the eyes, widening of the distance between the eyes
(which may indicate injury to the bones between the eye sockets); movement of
the upper jaw when the head is stabilized (which may indicate a fracture in this
area); and abnormal sensations on the cheek.
In the U.S., about three million people are treated in emergency departments
for facial trauma injuries each year. Of the pediatric patients, five percent
have suffered facial fractures. In children less than three years old, the
primary cause of these fractures is falls. In children more than five years old
the primary cause for facial trauma is motor vehicle accidents.
Our fast paced world of ultra sports and increasing violence puts children at
risk for facial injury. But, children’s facial injuries require special
attention. A child’s future growth plays a big role in treatment for
facial trauma. So, one of the most important issues as a care giver is to follow
a physician’s treatment plan as closely as you can until your child is fully
Why is facial trauma different in children than adults?
Facial trauma can range between minor injury to disfigurement that lasts a
lifetime. The face is critical in communicating with others, so it is important
to get the best treatment possible. Pediatric facial trauma differs from adult
injury because the face is not fully formed and future growth will be a factor
in how the child heals and recovers. Certain types of trauma may cause a delay
in the growth or further complicate recovery. Difficult cases require physicians
with great skill to make a repair that will grow with your child.
Types of facial trauma
New technology, such as CT scans, have improved physicians ability to
evaluate and manage facial trauma. In some cases, immediate surgery is needed to
realign fractures before they heal incorrectly. Other injuries will
have better outcomes if repairs are done after cuts and swelling have improved.
A new study has shown that even when injury does not require surgery, it is
important to a child’s health and welfare to continue to follow up with a
Soft tissue injuries
Injuries such as cuts (lacerations) may occur on the soft tissue of the face.
In combination with suturing the wound, the provider should take care to
inspect and treat any injures to the facial nerves, glands, or ducts.
When a fracture of the bones in the face occurs, the treatment process is
similar to that of a fracture in other parts of the body. Factors that
affect how the fracture should be dealt with are the location of the fracture,
the severity of the fracture, and the age and general health of the patient.
It is important during treatment of facial fractures to be careful that
the patient's facial appearance is minimally affected.
Injuries to the teeth and surrounding dental structures
Isolated injuries to teeth are quite common and may require the expertise of
various dental specialists. Because of the specific needs of the dental
structures, certain actions and precautions should be taken if a child has
received an injury to his or her teeth or surrounding dental structures.
- If a tooth is "knocked out", it should be placed in salt water or milk.
The sooner the tooth is re-inserted into the dental socket, the better chance
it will survive. Therefore, the patient should see a dentist or oral surgeon
as soon as possible.
- Never attempt to "wipe the tooth off" since remnants of the ligament which
hold the tooth in the jaw are attached and are vital to the success of
replanting the tooth.
Stewart MG, Chen AY. Factors predictive of poor compliance with follow-up
after Facial trauma: A prospective study. Otolaryn Head and Neck Surg 1997:
Kim MK, Buchman R, Szeremeta. Penetratin neck trauma in children: an urban hospital's experience. Otolaryn Head and Neck Surg 2000: 123: 439-43
© 2004 AAO-HNS/AAO-HNSF
Please read our disclaimer. Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with Dr. Hector N. Hernandez or other healthcare professional. If you have a medical problem, contact us for diagnosis and treatment.