![]() However, there are anatomical differences that influence the approach to treatment.įactors to consider in the paediatric maxillofacial skeleton: The principles of managing paediatric facial trauma are the same as for adults. The evaluation of patients with facial injuries. Consultation with a Maxillo-facial Service should be arranged early in Paediatric mortality in trauma is usually secondary to airway compromise or associated neurological injuries. While facial injuries in children are rarely fatal, they may have significant functional and cosmetic sequelae. Open wounds should be covered with moist, clean dressings and tetanus prophylaxis administered if required. ![]() Secondary surveyĪ detailed craniomaxillofacial examination should be performed during the secondary survey, after initial stabilization of the patient. Fiberoptic intubation may be necessary to control the airway of the pediatric trauma patient.Ī chest x-ray to exclude aspiration of dental fragments or foreign bodies may be indicated.Ie., the proper sized tube for a 4 year old child would be (16+4)/4 =5mm (internal diameter) A quick method for determining the proper size endotracheal tube includes adding 16 to the child's age in years, and dividing by 4.Concurrently, the cervical spine must be stabilized and protected until further assessment for cervical spinal injury is undertaken.Control of bleeding by local pressure and, if required, scalp sutures or staples as well as temporary reduction of fractures may be indicated immediately.Bleeding may be profuse (and occult) from scalp lacerations and fractures of the mid-face.Tongue-displacement secondary to comminuted anterior mandibular fractures may also compromise the airway.A softer and floppier epiglottis may complicate pediatric endotracheal intubation.Relative macroglossia, with the tongue positioned higher in the oral cavity.Lymphoid hypertrophy/ enlargement of the tonsils and adenoids between the ages of 4 and 10.Pediatric Oral and Maxillofacial Surgery, Saunders, 2004, pg. Special anatomic considerations of the pediatric airway that can contribute to airway obstruction include: (From Kaban, Troulis.Blood, vomitus, tooth fragments and foreign bodies may obstruct the airway, and clearance of the upper aerodigestive tract of all debris is a priority.(From Advanced Paediatric Life Support, The Practical Approach, 3rd edition, BMJ Books, 2001, pg. In cases in which cervical spine injury is suspected, the jaw thrust manoeuvre is preferred.Avoid overextension of the airway by placing the patient in the neutral position for infants or sniffing position for children. If no cervical spine injury is suspected, attempts to open the airway may be made carefully with the head tilt/ chin lift manoeuvre.Importance in evaluating facial injuries. Testing (even in the presence of marked periorbitalĪdequate exposure is imperative to facilitate a thorough examination. ![]() The secondary survey should include visual acuity Circulation assessment and management (.The primary survey is the first priority Primary survey In general, facial injuries rarely require emergency management. Emergency evaluation of a facial trauma patient should always begin with attention to the ABCs.Maxillofacial injuries are commonly associated with cervical spine and intracranial injury.Patterns of injury that may lead one to suspect child abuse include multiple bruises in various stages of healing.Non-accidental trauma may also need to be considered. Falls are the most common cause of facial trauma in the paediatric group, followed by blunt trauma from sports activities, motor vehicle accidents and assaults.Soft tissue injury patterns include burn injury, electrical injury, and lacerations.However, soft tissue injuries are common. The relative prominence of the child's cranium, compared to mid-face and mandible, together with the elasticity of the immature facial skeleton, account for the low incidence of facial fractures inĬhildren. Differences in the proportions of a child's head and skeleton affect outcome in paediatric "maxfax" injury.Table of contents will be automatically generated here.
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