MAXILLO-

FACIAL
INJURIES IN
CHILDREN

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INTRODUCTION
PREVALANCE
ETIOLOGY
PREDISPOSING FACTOR
CLASSIFICATION
SOFT TISSUE INJURIES
HARD TISSUE INJURIES

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 INTRODUCTION

Children with maxillo-facial injuries present a

challenge for the dentist because:

o Treatment is largely depend on the co-

operation of child.

o Situation become complicated with

the parents feeling guilty.

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 PREVALANCE

Head Injury: 40%

Facial
Fracture: 1.5-8%
Injuries To
Anterior teeth: 40-46%
Primary Dentition: 11-
30%
Permanent Dentition:
Maxillary 6-29%
Central Incisor: 37%
Maxillary
Lateral Incisor: 3%
Mandibular central Incisor: 18%
Mandibular Lateral
Incisor: 6% www.FourthMolar.com
 Below 6 Yr. of child – Skeletal Body Ratio :: 8:1

Child learn to toddle and is

relatively uncoordinated.

So, skull and frontal bone are more prone to injury

At the age of 6-12 Yrs. – More outdoor

games Maxilla assume more
protrusive condition

So, Mid-face and Anterior teeth more

prone to injury.
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 ETIOLOGY

1. Fall

2.
Accident

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PRE-DISPOSING FACTORS

1.Facial profile:-
Angle class II type 1 Malocclusion
Angle class I type 2
Malocclusion
Increased Overjet with protrusion
of upper Incisors.
2. Children with cerebral
palsy 3.
Epileptic Patient
4.
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 CLASSIFICATION
Acc. To Andreasen
A. Injuries
(1981) :- of hard Dental
1. Crown &
tissues Infraction-
Pulp: Fracture of Enamel
2.
Uncomplicated Fracture- Fracture
involving Enamel
& Dentin
3.
Complicated Crown fracture- Fracture
involving Enamel,
Dentin &
Exposing Pulp
4.
Uncomplicated Crown Root Fracture-
Fracture involving Enamel,
Dentin & Cementum
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 B. Injuries of Periodontal
Tissues:
1. Subluxation

2. Lateral luxation

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3. Extrusive luxation

4. Intrusive luxation

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C. Injuries of
Supporting Bone:
1. Comminution of Alveolar

socket 2.

Fracture of Alveolar Socket

Wall 3.

Fracture of Alveolar Process

4. Fracture
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 D. Injuries to Gingiva or
Oral Mucosa:
1.Laceration

2.Contussion

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3.Abrasion

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Treatment of Soft Tissue
Injuries:
1. Debridement
Removal of Dead Tissue and Foreign-bodie

Make the Tissue Environment Favourable f

healing.
2. Haemostasis

Important for maintaining

systemic circulation & Tissue
perfusion www.FourthMolar.com
3.Contaminated Wound

Wound is thoroughly cleaned.

Tetanus Prophylaxis &
Antibiotic Prophylaxis Should be Given.

4. Closure of Wound

To restore the tissue anatomy.

2 Types : A. Primary Closure

B. Secondary Closure

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5. Drains

Should be placed when significant oozing

is present.

6. Post-Operative Wound Care

Application of a thin film of ointment to

kept the wound moist.

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Treatment of Hard Tissue
Fracture:
Types of Hard Tissue Fractures:

1.Cranial Vault & Supra-orbital Ridge

Fracture 2.
Naso-Fronto-Ethmoid Fracture
3. Le-Forte
I,II & III Fractures
4. Zygomatic
Complex Fracture
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 Principles to be Followed

1. Reduction: To Restore the

Anatomical Continuity of Fractured
Fragments.

2 Types A. Open Reduction

B.
Closed Reduction

2. Fixation: For Immobilization of

Fractured Fragments

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 1. Cranial Vault & Supra-Orbital Ridge Fracture:

Mostly seen in children less then 5 Yrs.

Of Age.
Investigations
:: X-Ray
CT Scan

Neurosurgical Assessment

Ophthalmologic Consultation

Reduction: By Inter-Osseous Wiring, Microplates, Bone

Grafting
 Rx-Plan must be combined with Neurosurgery.
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 2. Naso-Fronto-Ethmoid Fracture (NOE):

Mostly in Adults. Due to direct trauma at the

level of Fronto-Nasal Suture.

Investigations:
X-Ray

CT Scan

Reduction: By Microplates Screws,

Neurosurgical Bone-
Assessment
Grafting.
Ophthalmologic
Complication: Nasal & Naso-Pharyngeal Bleeding
Consultation
may cause Upper Airway Obstruction.
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3. Zygomatic Complex Fracture (ZMC):

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 Fronto-zygomatic Suture
Fracture through:
Zygomat
Buttress
Infra-Orbital Rim

Investigations:
CT Scan
Zygomatic Arch.
Ophthalmologic Consultation

Clinical Findings: Peri-Orbital Ecchymosis

Sub-
Conjunctival Ecchymosis
Anesthesia
Parasthesia in Infra-
Orbital Nerve
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 4.Nasal Fracture:

Most Commonly Found

Fractured Retarded Normal Growth of

Mid-Face

Complications: Airway Obstruction

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5.Le-Fort I,II & III Fractures:

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Mostly seen in Adolescents

Fracture Treated with Open

Reduction and Internal Fixation.

Closed Reduction may be

Preferred in young Child to
avoid Injury of Un erupted
Teeth.

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6.Mandibular Fracture:

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Clinical Signs:
Pain & Swelling Trismus
Occlusal Discrepancies
Sub-lingual Ecchymosis
Chin Assymmetry
Parasthesia of Mental
Nerve
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Management:
Reduction

Fixation

Splinting

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 Reference:--

Text book of Pedodontics — Shobha Tandon

tion :- 2001.
ition Pg:-490-515.

Text book of Pedodontics -- Satish Chandra

tion :- 2002
ition Shaleen Chandra
R K Bali

Oral & Dental Trauma -- Graham Roberts

Children & Adolescents Peter Longhurst
tion :- 1996
ition

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