Paediatric Facial Fractures

Paediatric Facial Fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Paediatric Facial Fractures Ella Starck, Esa Färkkilä, Eeva Kormi, Juho Suojanen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6740992/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Paediatric facial fractures are relatively rare due to the elasticity of children´s bones. This elasticity can also make such fractures more challenging to diagnose. Additionally, anatomical differences between juveniles and adults influence the types of fracture observed. In general, boys are more susceptible to trauma; however, this trend does not seem to differ in cases of facial fractures. Purpose The aim of this study is to investigate the association between sex and trauma mechanisms in paediatric facial fractures. Methods A retrospective cohort study was conducted on paediatric patients diagnosed with facial bone fractures between 2008 and 2018 at Päijät-Häme Central Hospital (Lahti, Finland). Inclusion criteria were one or more fractures in facial bones in patients under 18 years of age. Results Of the 37 study subjects, 19% were female and 81% were male. Among females, the most common trauma mechanisms were bicycle accidents and sports related incidents (both 8.1%), whereas in males, motor vehicle accidents and sports related incidents were equally prevalent (both 24%). Associated injuries were uncommon, occurring only in 16% of cases, and they were particularly linked to motor vehicle accidents. Conclusion Paediatric facial fractures are rare. In cases of facial trauma, thorough clinical examination and targeted imaging are recommended rather than routine full body 3D imaging. facial fracture facial trauma paediatric trauma trauma mechanism children trauma Figures Figure 1 Introduction Facial fractures are less common in paediatric patients than adults due to their more elastic bone and cartilage structure (Rogan et al., 2024 , Rogan and Fang, 2024 , Vyas et al., 2008 ). However, when occurring, facial fractures often tend to be more severe and can result in life-long consequences such as disability or even death (Braun et al., 2017 , Totonchi et al., 2012 ). As in adults, paediatric patients with facial fractures are more often male than female (Kaura et al., 2018 , Rogan et al., 2024 , Vyas et al., 2008 ). Fracture patterns in paediatric patients are age-related and differ from older patients. The most significant factors contributing to this are expanding sinuses and erupting teeth which are characteristic of certain age groups. (Rogan et al., 2024 , Totonchi et al., 2012 ) Incomplete pneumatization signifies thicker bone structure and incomplete dentition strengthens the jawbones. Thus, both stabilize facial structures. (Rogan et al., 2024 ) In children, oblique fractures are the most common fracture pattern, whereas adults more often present with more horizontal Le Fort fractures (Naran et al., 2016 ). Facial fractures can appear in the upper face (frontal bone), the midface (nasal bone, orbit, maxilla, zygoma) and the lower face (mandible, alveolar ridge, teeth). Younger children have a proportionally larger skull than face which is why it is more common to encounter trauma in the cranial part than the midface (Imahara et al., 2008 , Rogan and Fang, 2024 , Vyas et al., 2008 ). In older paediatric patients, fractures in the mandible are more likely (Imahara et al., 2008 ). Due to the elastic cartilage and more pliable structure in immature bones, children’s fractures tend to be less displaced than in adult patients and may often appear as greenstick fractures (Chasm and Swencki, 2010 ). Another characteristic appearance in children is a greenstick type blowout fracture, in which orbital contents, usually the inferior rectus or the inferior oblique muscle, become trapped between broken orbital bones when they snap back into their place after breaking (Phan et al., 2012 ). This type of fracture is called trapdoor, and it is due to elasticity of orbital bones (Egbert et al., 2000 ). Trauma in paediatric patients is most often caused by a blunt force, though penetrating injuries are also possible (Rogan and Fang, 2024 ). Blunt trauma can originate from falls, traffic or sports accidents, and assaults for example. Several studies have shown traffic accidents to be the most common etiological factor (Imahara et al., 2008 , Kirvelä et al., 2024 ). In younger children, assaults often refer to child abuse. Regarding trauma aetiology, accidental self-injurious behaviour in younger paediatric patients, and suicide attempts in older patients should be kept in mind (Rogan and Fang, 2024 ). Fracture prevalence grows with age and is most common in adolescents aged 12–18 years (Braun et al., 2017 , Grunwaldt et al., 2011 , Imahara et al., 2008 ). The fact that children have several factors protecting them from facial fractures denotes that a major force is often associated when occurring. Therefore, it is important to pay attention to concomitant injuries when examining facial fractures, especially noticing the airways, brain, eyes and neck. When suspecting a facial fracture, computed tomography (CT) is commonly used to confirm the diagnosis (Rogan and Fang, 2024 ). What comes to treatment, it is essential to consider the ongoing growth and development of paediatric patients. This is why paediatric fractures are often treated conservatively, even if surgical treatment for similar fractures in adults would be required (Braun et al., 2017 ). However, when mandatory to operate, the growth centres should be preserved untouched (Singh and Bartlett, 2004 ). In addition, resorbable plates and screws should be used when treating a fracture operatively (Burlini et al., 2015 ). Due to continuing growth, children with facial fractures should be followed for a longer time since it may affect growth, and intervention with orthodontics may be needed (Braun et al., 2017 , Naran et al., 2016 , Wheeler and Phillips, 2011 ). Overall, the prognosis for facial fractures in paediatric patients is mostly good due to the outstanding capability of remodelling. As a result, lasting bone harm or surgical approach is infrequent. (Rogan and Fang, 2024 ) Knowledge of how injury patterns affect paediatric maxillofacial fracture patterns is limited. Additional information about this might help reducing and preventing risks for facial fractures. This is a descriptive study of paediatric patients and their characteristic appearances in facial fractures, treatment and coefficient factors. The aim is to investigate if sex associates with trauma mechanisms and if certain trauma mechanisms lead to specific facial fractures. The hypothesis is that sex has an influence on trauma mechanisms and that trauma mechanisms and facial fractures have a connecting pattern. Materials and Methods A retrospective cohort study of paediatric patients with facial fractures treated at Päijät-Häme Central Hospital (PHCH, Lahti, Finland) was conducted. Data was collected for a 10-year period, from 2008 to 2018. The study was approved by the institutional review board of PHCH (D/18/07.01.04.05/2018 and D/2929/07.01.04.05/2020). Patients were identified from PHCH’s patient register using the International Classification of Diseases, Ninth Revision (2007–2014) codes 802, 805.0-805.18, 806.0-806.19 and 847.0 and Tenth Revision (2015–2017) codes S02.2-S02.04 and S02.6-S02.7, which correspond to fractures in the upper face, midface, and mandible. Paediatric patients were defined as individuals under 18 years old. The data was collected using Microsoft Excel, and the figure was created using Microsoft OneNote and Microsoft PowerPoint. The inclusion criteria were one or more fractures in facial bones in minors (< 18 years of age) with complete medical and imaging records who were treated at PHCH. Fractures alone in the alveolar ridge were excluded, as well as patients whose later examination ruled out the diagnosis in demand. The cohort contained patient’s age, sex, examination date, fracture location(s), mechanism of injury, associated injuries (AIs), Glasgow Coma Scale (GCS), and treatment. Fractures in the upper face included frontal fractures, while midfacial fractures included orbital, maxillary, nasal and zygomatic fractures, and lower facial fractures consisted of mandibular fractures. Mandibular fracture sites were further categorized based on radiographic imaging as follows: ramus-condyle unit (RCU), coronoid, angle, body and symphyseal/parasymphyseal region. Trauma mechanisms were divided into motor vehicle accidents (MVA), bicycle accidents, sports related incidents, assaults and falls. AIs were classified into extremity injuries, intracranial haemorrhages, skull fractures, chest injuries, blunt cerebrovascular injuries, cervical spine injuries, diffuse axonal injuries or concussion, and pelvic or lumbar spine injuries. Results During the study period, 481 patients with facial fractures, complete medical records and imaging data were found in the patient register. Of these, 38 subjects were paediatric, one of whom was excluded for having exclusively an alveolar fracture. Thus, 37 subjects met the inclusion criteria and formed our study cohort. Of these subjects, 7 (19%) were female and 30 were male (81%), leading to a male to female ratio of 4.3:1. Subjects’ ages were from 6.0 to 17.9 years, with a mean of 14.3 years. Females´ ages ranged from 6.0 to 16.1 (mean of 12.3 years), whereas males’ ages ranged from 8.0 to 17.9 years (mean 14.7 years). Demographic data is presented in Table 1 . Table 1 Demographic data N (%) Range (years) Mean (years) All 37 (100) 6.0-17.9 14.3 Female 7 (19) 6.0-16.1 12.3 Male 30 (81) 8.0-17.9 14.7 There were 22 subjects with mandibular fractures (60%). Of these, 12 (32%) had a single fracture, 6 (16%) had at least one additional fracture in the mandible, and 4 (11%) had a bilateral fracture in the RCU. Of all subjects, 15 (41%) had fractures in the RCU, 8 (22%) in the symphysis or parasymphysis, 6 (16%) in the angle, 3 in the alveolar ridge (8.1%) and 1 subject (2.7%) had a fracture in the body of the mandible. In total, 15 subjects (41%) had fractures in the midface or upper face. There were 13 subjects (35%) with midfacial fractures of which 10 (27%) had isolated fractures and the rest 3 of them (8.1%) combined midfacial fractures. Midfacial fractures appeared in the orbit in 11 subjects (30%), in the nose in 3 (8.1%), in the zygoma in 2 (5.4%), and in the maxilla in 1 subject (2.7%). Only 2 subjects (5.4%) encountered fractures in the upper face, both of them in the frontal bone. Fracture locations and distributions are illustrated in Fig. 1 . Altogether, 25 (68%) of the facial fractures were unilateral and 12 (32%) bilateral. Of the unilateral fractures, 20 (54%) occurred on the left side and 5 (14%) on the right side of the head. Sports related incidents caused facial fractures in 12 subjects (32%), MVAs in 10 (27%), bicycle accidents in 9 (24%), assaults in 4 (11%) and falls in 2 of the subjects (5.4%). Table 2 presents the division of different trauma mechanisms, fracture types, sex, and AIs. MVAs (14%) and falls (2.7%) caused an equal number of fractures in the midface or upper face as in the mandible, whereas all assaults (11%) and most bicycle accidents (19%) resulted in mandibular fractures. Of 12 sports incidents, 7 (19%) led to midfacial or upper facial fractures and 5 (14%) to mandibular fractures. Among females, the most common trauma mechanisms were bicycle accidents together with sports related incidents (both 8.1%), followed by one (2.7%) MVA-related fracture. Among males, the most common mechanisms were MVAs together with sports incidents (both 24%), followed by bicycle accidents (16%), assaults (11%) and falls (5.4%). AIs were present in 6 subjects (16%). Of these, 4 (11%) appeared in subjects with midfacial fractures and 2 (5.4%) in subjects with mandibular fractures. AIs were caused by MVAs in 4 subjects (11%) and sports incidents in 2 subjects (5.4%). AIs included extremity trauma in 4 subjects (11%), and intracranial haemorrhage (ICH), skull fracture, and thoracic injury in 2 subjects each (5.4%). Table 2 Trauma mechanism distribution by fracture type, sex and AIs Total (%) Midface/ Upper face, n = 15 (41%) Mandible, n = 22 (60%) Female n = 7 (19%) Male n = 30 (81%) AI, n = 6 (16%) Sport 12 (32) 7 (19%) 5 (14%) 3 (8.1%) 9 (24%) 2 (5.4%) MVA 10 (27) 5 (14) 5 (14) 1 (2.7) 9 (24) 4 (11) Bicycle 9 (24) 2 (5.4) 7 (19) 3 (8.1) 6 (16) 0 (0.0) Assault 4 (11) 0 (0.0) 4 (11) 0 (0.0) 4 (11) 0 (0.0) Fall 2 (5.4) 1 (2.7) 1 (2.7) 0 (0.0) 2 (5.4) 0 (0.0) MVA, motor vehicle accident; AI, associated injury Radiographic examination was most often performed using either CT (53%) or PTG (45%), and both in one subject (2.7%). Treatment was operative in 49% of cases, non-operative in another 49%, and combined in one subject (2.7%). All subjects had a normal GCS of 15. With regard to injury timing, 5 (14%) occured in winter, 11 (30%) in spring, 13 (35%) in summer and 8 (22%) in autumn. Discussion The aim of this study was to investigate whether sex is associated with trauma mechanisms and if certain trauma mechanisms lead to specific facial fractures in paediatric patients. The hypothesis was that sex has an influence on trauma mechanisms and that trauma mechanisms and facial fractures have a connecting pattern. We also examined the presence of characteristic patterns in facial fractures, treatment, and contributing factors. To begin with, the difference in incidence between female and male subjects was remarkable, as there were approximately four times more boys than girls. This was expected, since males are generally more likely to experience accidents and facial trauma, which has been stated in various other studies as well (Goswami, 2024 , Kaura et al., 2018 , Khan et al., 2019 , Vyas et al., 2008 , Wusiman et al., 2020 ). Goswami’s study reported a male-to-female ratio in children aged 12 years or less of 1.6:1 (Goswami, 2024 ). The difference compared to our 4.3:1 ratio could be explained by the fact that older boys (> 12 years) are more often involved in contact sports or other higher-risk free time activities, such as motocross, than girls. This also explains the slightly higher mean age in males compared to females. Differing from some other studies of facial fractures in paediatric patients, our subjects were all 6 years or older. This is because facial fractures are very rare in the youngest age group due to their flexible bone and cartilage structure, the relatively dominant skull size, and the protective frontal bone (Alhumsi and Gilardino, 2014 , Rogan et al., 2024 , Rogan and Fang, 2024 , Vyas et al., 2008 ). Moreover, the age distribution was clearly more emphasized in adolescents than in younger children, which aligns with previous studies (Ferreira et al., 2005 , Grunwaldt et al., 2011 ). This is due to progressive independence and greater involvement in contact sports and driving (Braun et al., 2017 , Grunwaldt et al., 2011 ). Over half (60%) of the subjects’ facial fractures emerged in the mandible, making it clearly the most common fracture site. This is in line with other studies about maxillofacial fractures in both paediatric patients and adults (Goswami, 2024 , Khan et al., 2019 , Wusiman et al., 2020 ). The mandible is prone to fractures due to its prominent appearance and low facial position (Wusiman et al., 2020 ). We found that fractures in the RCU were the most common (41%), followed by fractures in the symphysis or parasymphysis area (22%). This is consistent with studies of paediatric mandibular fractures by Smith et al., who found RCU fractures in 56% and symphysis or parasymphysis fractures in 27% of the subjects, and by Steed et al., who also stated that mandibular fractures occur most often in the RCU, followed by symphysis or parasymphysis (Smith et al., 2013 , Steed and Schadel, 2017 ). When comparing our study to those involving the whole population, Gualtieri et al.’s mandibular fracture sites aligned with ours, whereas Wusiman et al. found the symphysis or parasymphysis to be the most commonly fractured in adults, though followed with condyle fractures (Gualtieri et al., 2021 , Wusiman et al., 2020 ). The remaining facial fractures were mostly midfacial, with orbital fractures being distinctly the most common (30%) due to the orbit´s fragile, paper-thin bone structure (Felding, 2018 ). However, only one of our subjects was diagnosed with an orbital trapdoor fracture (2.7%), although other studies report an incidence between 24 to 40% in paediatric patients (Bansagi and Meyer, 2000 , Chi et al., 2010 ). The low percentage could be because trapdoor fractures are acute conditions that require immediate treatment and are therefore directed forward from PHCH if there is not a maxillofacial surgeon on call at that instant. The nasal bone, which is often fractured in adults, was fractured in only 8.1% of subjects. This aligns with Landeen et al., who stated that nasal fractures are less common in paediatric patients than in adults (Landeen et al., 2022 ). The frontal bone was fractured in 2 subjects (5.4%), which corresponds with other studies reporting a frequency of 5 to 15% for frontal fractures (Marinheiro et al., 2014 , Schultz et al., 2017 ). All in all, a study on adult facial fractures from the same region and time period than ours, found that 40% of adult subjects had mandibular fractures and 56% had midfacial fractures (Färkkilä et al., 2024 ). This differs from our findings, where mandibular fractures were the most common (60%) and midfacial fractures occurred in 35% of subjects. However, the divergence is coherent since, as mentioned earlier, children have smaller sinuses and a more protective cranium due to different face-to-skull bone size ratios, which prevent them from fractures in the midface (Imahara et al., 2008 , Rogan et al., 2024 , Rogan and Fang, 2024 , Totonchi et al., 2012 , Vyas et al., 2008 ). When examining unilateral fractures, a notable in side distribution was observed. A significant majority (80%) of fractures occurred on the left side of the head, which could be linked to the fact about 90% of people are right-handed (Levander and Schalling, 1988 , Papadatou-Pastou et al., 2020 ). Consequently, the dominant hand may instinctively protect the same side of the face in accidents, for example, directly covering the face in sports incidents or indirectly in falls or bicycle accidents. However, in MVAs for instance, the handedness does not necessarily influence trauma distribution, which may reduce the proportion of left-sided fractures. In our subjects overall, the most common trauma mechanisms were sports incidents (32%), followed by MVAs (27%) and bicycle accidents (24%). The aetiology varies somewhat between studies. According to Irgebay et al., sports were the leading cause of injury (42%) in patients aged 12 to 18 years, whereas those younger than 6 years were mostly injured in activities of daily living (46%) (Irgebay et al., 2024 ). Ferreira et al. in Portugal and Grunwaldt et al. in the U. S. found MVAs to be the most common trauma mechanism (53% and 25%, respectively), whereas Ghosh et al. found falls to be the most common cause in India (59%) (Ferreira et al., 2005 , Ghosh et al., 2018 , Grunwaldt et al., 2011 ). It is also relevant to note that in our study, motorcross accidents were classified as MVAs, whereas some other studies consider them sport incidents, which affects the distribution of trauma mechanisms (Diab et al., 2021 ). Additionally, it is noteworthy that all our subjects who encountered assault (11%) were over 15 years old, indicating that younger patients who experienced assault did not sustain fractures. There was a clear difference in trauma mechanisms between paediatric patients and adults from the same study period. In adults, falls (37%) and assaults (32%) were the most common causes, whereas in children, sports incidents (32%), MVAs (27%), and bicycle accidents (24%) were the leading trauma mechanisms (Färkkilä et al., 2024 ). This is understandable, as elderly people are more prone to get facial trauma from falls and young and middle-aged adults from assaults, whereas these causes are clearly less frequent in children. When analysing trauma mechanisms in relation to fracture sites, bicycle accidents and assaults appeared to lead to mandibular fractures more frequently than to other facial fractures. This is supported by another study, which described the mandible as an exposed and difficult-to-protect structure (Nogami et al., 2021 ). Following bicycle accidents (19%), MVAs and sports related incidents (both 14%) were the next most common causes of mandibular fractures. Similarly, Smith et al. identified bicycle accidents (29%) as the most common trauma mechanism in paediatric mandibular fractures, followed by MVAs (28%) (Smith et al., 2013 ). In fractures of the midface and upper face, sports incidents (19%) were the leading trauma mechanism, followed by MVAs (14%). In male subjects, the most common trauma mechanisms were sports and MVAs (both 24%) followed by bicycle accidents (16%). In contrast, in females, sports incidents and bicycle accidents were equally common (both 8.1%). This is a notable difference and can be explained by the fact that females are generally less involved in contact sports and traffic accidents than males, except in the youngest age groups (Braun et al., 2017 , Grunwaldt et al., 2011 ). Nevertheless, it is important to keep in mind that the number of female subjects in our study is rather concise, and therefore, cannot be perfectly relied on. Half of our subjects were treated operatively and the other half non-operatively. Only 16% of our subjects experienced AIs, suggesting that paediatric patients often confront relatively simple trauma with fewer serious AIs. The same trend applies to adults, of whom about one in five sustain AIs (Färkkilä et al., 2024 ). However, some studies have reported different results. For example, Grundwaldt et al. found that up to 56% of patients sustained severe concomitant injuries, most commonly soft tissue injuries and neurological trauma, with concussion being the most frequent neurological injury (Grunwaldt et al., 2011 ). The lower AI rate can be explained with that our AIs did not include soft tissue injuries, which are quite common in facial trauma (Mukhopadhyay et al., 2020 ). On the other hand, Kirvelä et al. found that 27% of paediatric patients with facial fractures had AIs and reported that the occurrence of AIs varies with age and, among teenagers, also with sex (Kirvelä et al., 2023 ). All our subjects had a normal GCS score of 15, which may reflect some bias, as the most severe trauma cases with lower GCSs may have been referred forward for treatment. In effect, this could also explain the lower AI percentage in our findings. Notably, 4 of 6 of the subjects with AIs were injured in MVAs. This is in line with other studies, as MVAs often tend to be severe, high-energy injuries (Ferreira et al., 2005 ). AIs most frequently affected the extremities, followed by the head and the thorax, which aligns with other studies as well (Wusiman et al., 2020 ). There were notable seasonal variations in the occurrence of facial fractures. Summer (35%) and spring (30%) were the peak seasons, which can be explained by the Finnish climate that reduces outdoor activities in late autumn (22%) and especially in winter (14%). However, this should be interpreted cautiously, as some of the subjects with facial fractures during holiday periods are directly directed from PHCH to Level 1 trauma centre in Helsinki, Finland due to a lack of maxillofacial surgeon on call. Conclusion Paediatric facial fractures are uncommon. In both sexes, sports related incidents are the most common trauma mechanism, followed by bicycle accidents in girls and MVAs in boys. AIs are infrequent and typically occur in connection with high-energy trauma, such as MVAs. Therefore, in cases of facial trauma, a thorough clinical examination combined with targeted imaging is recommended, rather than routine full-body 3D imaging. Declarations Author Contribution Conceptualization: J.S., E.K.; Methodology: E.F.; Software: E.F.; Formal analysis and investigation: E.S.; Writing - original draft preparation: E.S.; Writing - review and editing: all authors; Funding acquisition and resources: J.S.; Supervision: J.S.. All authors have read and agreed to the manuscript. manuscript. Acknowledgement We would like to thank our research coordinator Marjo Soini for the help in the process. References Alhumsi, T. R. & Gilardino, M. S. 2014. Current Management Of Facial Fractures In The Preadolescent. Curr Opin Otolaryngol Head Neck Surg , 22, 336-41. https://doi.org/10.1097/moo.0000000000000059 Bansagi, Z. C. & Meyer, D. R. 2000. Internal Orbital Fractures In The Pediatric Age Group: Characterization And Management. Ophthalmology , 107, 829-36. https://doi.org/10.1016/s0161-6420(99)90240-6 Braun, T. L., Xue, A. S. & Maricevich, R. S. 2017. Differences In The Management Of Pediatric Facial Trauma. Semin Plast Surg , 31, 118-122. https://doi.org/10.1055/s-0037-1601435 Burlini, D., Conti, G., Amadori, F., Bardellini, E. & De Giuli, C. 2015. Management Of Paediatric Maxillofacial Fractures: Conventional Methods And Resorbable Materials. Eur J Paediatr Dent , 16, 24-8. https://doi.org/10.1179/2014.16.1.024 Chasm, R. M. & Swencki, S. A. 2010. Pediatric Orthopedic Emergencies. Emerg Med Clin North Am , 28, 907-26. https://doi.org/10.1016/j.emc.2010.05.005 Chi, M. J., Ku, M., Shin, K. H. & Baek, S. 2010. An Analysis Of 733 Surgically Treated Blowout Fractures. Ophthalmologica , 224, 167-75. https://doi.org/10.1159/000320067 Diab, J., Flapper, W. J., Grave, B., Anderson, P. J. & Moore, M. H. 2021. Pediatric Facial Fractures In South Australia: Epidemiology, Clinical Characteristics, And Outcomes. J Craniofac Surg , 32, 2317-2321. https://doi.org/10.1097/SCS.0000000000007580 Egbert, J. E., May, K., Kersten, R. C. & Kulwin, D. R. 2000. Pediatric Orbital Floor Fracture : Direct Extraocular Muscle Involvement. Ophthalmology , 107, 1875-9. https://doi.org/10.1016/s0161-6420(00)00374-7 Felding, U. N. A. 2018. Blowout Fractures - Clinic, Imaging And Applied Anatomy Of The Orbit. Dan Med J , 65. Ferreira, P. C., Amarante, J. M., Silva, P. N., Rodrigues, J. M., Choupina, M. P., Silva, A. C., Barbosa, R. F., Cardoso, M. A. & Reis, J. C. 2005. Retrospective Study Of 1251 Maxillofacial Fractures In Children And Adolescents. Plast Reconstr Surg , 115, 1500-8. https://doi.org/10.1097/01.prs.0000151833.27108.3d Färkkilä, E. M., Oksanen, E., Kormi, E. & Suojanen, J. 2024. What Is The Relationship Between Maxillofacial Injury Location And Associated Injuries? J Oral Maxillofac Surg , 82, 800-805. https://doi.org/10.1016/j.joms.2023.11.020 Ghosh, R., Gopalkrishnan, K. & Anand, J. 2018. Pediatric Facial Fractures: A 10-Year Study. J Maxillofac Oral Surg , 17, 158-163. https://doi.org/10.1007/s12663-017-1065-9 Goswami, S. 2024. Pediatric Patients With Facial Fractures: A Retrospective Study. J Inj Violence Res , 16, 71-6. https://doi.org/10.5249/jivr.v16i1.1808 Grunwaldt, L., Smith, D. M., Zuckerbraun, N. S., Naran, S., Rottgers, S. A., Bykowski, M., Kinsella, C., Cray, J., Vecchione, L., Saladino, R. A. & Losee, J. E. 2011. Pediatric Facial Fractures: Demographics, Injury Patterns, And Associated Injuries In 772 Consecutive Patients. Plast Reconstr Surg , 128, 1263-1271. https://doi.org/10.1097/PRS.0b013e31822b8a03 Gualtieri, M., Pisapia, F., Fadda, M. T., Priore, P. & Valentini, V. 2021. Mandibular Fractures Epidemiology And Treatment Plans In The Center Of Italy: A Retrospective Study. J Craniofac Surg , 32, E346-E349. https://doi.org/10.1097/SCS.0000000000007526 Imahara, S. D., Hopper, R. A., Wang, J., Rivara, F. P. & Klein, M. B. 2008. Patterns And Outcomes Of Pediatric Facial Fractures In The United States: A Survey Of The National Trauma Data Bank. J Am Coll Surg , 207, 710-6. https://doi.org/10.1016/j.jamcollsurg.2008.06.357 Irgebay, Z., Glenney, A. E., Beiriger, J. W., Smetona, J., Dixon, A., Kass, N. M., Mocharnuk, J. W., Anstadt, E., Dvoracek, L. A., Saladino, R. A., Losee, J. E. & Goldstein, J. A. 2024. Pediatric Facial Fractures: Demographics, Injury Patterns, And Associated Injuries In 3334 Patients. J Craniofac Surg . https://doi.org/10.1097/SCS.0000000000009373 Kaura, S., Kaur, P., Bahl, R., Bansal, S. & Sangha, P. 2018. Retrospective Study Of Facial Fractures. Ann Maxillofac Surg , 8, 78-82. https://doi.org/10.4103/ams.ams_206_17 Khan, S. R., Khan, Z. A., Hanif, S., Riaz, N. & Warraich, R. A. 2019. Patterns Of Facial Fractures In Children. Br J Oral Maxillofac Surg , 57, 1009-1013. https://doi.org/10.1016/j.bjoms.2019.08.012 Kirvelä, A., Snäll, J., Suominen, A., Puolakkainen, T. & Thorén, H. 2023. Characteristics Of Associated Injuries In Children And Teenagers With Craniofacial Fractures. J Craniofac Surg , 34, 1625-1628. https://doi.org/10.1097/SCS.0000000000008981 Kirvelä, A., Suominen, A. L., Puolakkainen, T., Snäll, J. & Thorén, H. 2024. Paediatric Maxillofacial Fractures Have Increased In Incidence And Their Nature And Aetiology Have Changed During Three Decades. Sci Rep , 14, 20221. https://doi.org/10.1038/s41598-024-57231-0 Landeen, K. C., Kimura, K. & Stephan, S. J. 2022. Nasal Fractures. Facial Plast Surg Clin North Am , 30, 23-30. https://doi.org/10.1016/j.fsc.2021.08.003 Levander, M. & Schalling, D. 1988. Hand Preference In A Population Of Swedish College Students. Cortex , 24, 149-56. https://doi.org/10.1016/S0010-9452(88)80002-7 Marinheiro, B. H., De Medeiros, E. H., Sverzut, C. E. & Trivellato, A. E. 2014. Frontal Bone Fractures. J Craniofac Surg , 25, 2139-43. https://doi.org/10.1097/SCS.0000000000000956 Mukhopadhyay, S., Galui, S., Biswas, R., Saha, S. & Sarkar, S. 2020. Oral And Maxillofacial Injuries In Children: A Retrospective Study. J Korean Assoc Oral Maxillofac Surg , 46, 183-190. https://doi.org/10.5125/jkaoms.2020.46.3.183 Naran, S., Macisaac, Z., Katzel, E., Bykowski, M., Shakir, S., Goldstein, J., Pollack, I. M. & Losee, J. E. 2016. Pediatric Craniofacial Fractures: Trajectories And Ramifications. J Craniofac Surg , 27, 1535-8. https://doi.org/10.1097/SCS.0000000000002856 Nogami, S., Yamauchi, K., Morishima, H., Otake, Y., Kouketsu, A., Higuchi, K., Hirotani, H., Kumagai, M. & Takahashi, T. 2021. Mandible Fractures And Dental Injuries Related To Road Traffic Accidents Over A 12-Year Period-Retrospective Multicentre Study. Dent Traumatol , 37, 223-228. https://doi.org/10.1111/edt.12681 Papadatou-Pastou, M., Ntolka, E., Schmitz, J., Martin, M., Munafò, M. R., Ocklenburg, S. & Paracchini, S. 2020. Human Handedness: A Meta-Analysis. Psychol Bull , 146, 481-524. https://doi.org/10.1037/bul0000229 Phan, L. T., Jordan Piluek, W. & Mcculley, T. J. 2012. Orbital Trapdoor Fractures. Saudi J Ophthalmol , 26, 277-82. https://doi.org/10.1016/j.sjopt.2012.07.006 Rogan, D. T. & Fang, A. 2024. Pediatric Facial Trauma. Statpearls . Treasure Island (Fl): Statpearls Publishing. Copyright © 2024, Statpearls Publishing Llc. Rogan, D. T., Hohman, M. H. & Ahmed, A. 2024. Pediatric Facial Fractures. Statpearls . Treasure Island (Fl): Statpearls Publishing. Copyright © 2024, Statpearls Publishing Llc. Schultz, K., Braun, T. L. & Truong, T. A. 2017. Frontal Sinus Fractures. Semin Plast Surg , 31, 80-84. https://doi.org/10.1055/s-0037-1601471 Singh, D. J. & Bartlett, S. P. 2004. Pediatric Craniofacial Fractures: Long-Term Consequences. Clin Plast Surg , 31, 499-518, Vii. https://doi.org/10.1016/j.cps.2004.04.001 Smith, D. M., Bykowski, M. R., Cray, J. J., Naran, S., Rottgers, S. A., Shakir, S., Vecchione, L., Schuster, L. & Losee, J. E. 2013. 215 Mandible Fractures In 120 Children: Demographics, Treatment, Outcomes, And Early Growth Data. Plast Reconstr Surg , 131, 1348-1358. https://doi.org/10.1097/PRS.0b013e3182855f4e Steed, M. B. & Schadel, C. M. 2017. Management Of Pediatric And Adolescent Condylar Fractures. Atlas Oral Maxillofac Surg Clin North Am , 25, 75-83. https://doi.org/10.1016/j.cxoms.2017.01.001 Totonchi, A., Sweeney, W. M. & Gosain, A. K. 2012. Distinguishing Anatomic Features Of Pediatric Facial Trauma. J Craniofac Surg , 23, 793-8. https://doi.org/10.1097/SCS.0b013e31825b14ff Vyas, R. M., Dickinson, B. P., Wasson, K. L., Roostaeian, J. & Bradley, J. P. 2008. Pediatric Facial Fractures: Current National Incidence, Distribution, And Health Care Resource Use. J Craniofac Surg , 19, 339-49; Discussion 350. https://doi.org/10.1097/SCS.0b013e3181603d7b Wheeler, J. & Phillips, J. 2011. Pediatric Facial Fractures And Potential Long-Term Growth Disturbances. Craniomaxillofac Trauma Reconstr , 4, 43-52. https://doi.org/10.1055/s-0030-1267066 Wusiman, P., Maimaitituerxun, B., Guli, Saimaiti, A. & Moming, A. 2020. Epidemiology And Pattern Of Oral And Maxillofacial Trauma. J Craniofac Surg , 31, E517-E520. https://doi.org/10.1097/SCS.0000000000006558 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 31 Jul, 2025 Reviews received at journal 21 Jul, 2025 Reviewers agreed at journal 06 Jul, 2025 Reviews received at journal 04 Jul, 2025 Reviewers agreed at journal 26 Jun, 2025 Reviewers invited by journal 30 May, 2025 Editor assigned by journal 29 May, 2025 Submission checks completed at journal 29 May, 2025 First submitted to journal 24 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6740992","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":464116788,"identity":"5990c72b-192b-450a-9f15-aff87fd0db18","order_by":0,"name":"Ella Starck","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIie3QPWrDMBTA8fcQyIvdrK+4NFdQ8BAPKbqKTEBdC10KLcXBoFxBQw8jMGjKAQoZewFDlwymVA5ZZdKtg/5CIAQ/9AGQSv3HMtZeVhy/AGrgYTjYUJwwnIiYCKsA6EL0dYSXEwmLMHVcLBjuBhjH5Xrv9evTC8mb0jQOVB0ltx12hEasPg7aH+2BGnPnXSDxi4keW8JWoKXMHAtDitNj6/AUJ7LH7gSjkBN5Ln5InsnsKQxN+CXRWOKeFeFEQ3r+YtSjqRtTbW2ut2Xuw1tIK6dmyGLf9Z/DeP9gM7/6zt82cml1NQzqPUrOqSt2UqlUKvWXfgESX0klzf1RxAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Helsinki, Faculty of Medicine, Clinicum","correspondingAuthor":true,"prefix":"","firstName":"Ella","middleName":"","lastName":"Starck","suffix":""},{"id":464116789,"identity":"2d24149b-ffe7-4a64-be3a-237c9b6ed130","order_by":1,"name":"Esa Färkkilä","email":"","orcid":"","institution":"Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Department of Oral and Maxillofacial Surgery","correspondingAuthor":false,"prefix":"","firstName":"Esa","middleName":"","lastName":"Färkkilä","suffix":""},{"id":464116790,"identity":"8da00117-cea2-45ca-8391-866d0efe5dc9","order_by":2,"name":"Eeva Kormi","email":"","orcid":"","institution":"Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Department of Oral and Maxillofacial Surgery","correspondingAuthor":false,"prefix":"","firstName":"Eeva","middleName":"","lastName":"Kormi","suffix":""},{"id":464116791,"identity":"6ad9b147-1515-44d5-b623-42b86a80bd28","order_by":3,"name":"Juho Suojanen","email":"","orcid":"","institution":"Helsinki University Hospital, Department of Plastic Surgery, Cleft Palate and Craniofacial Centre","correspondingAuthor":false,"prefix":"","firstName":"Juho","middleName":"","lastName":"Suojanen","suffix":""}],"badges":[],"createdAt":"2025-05-24 21:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6740992/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6740992/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83816403,"identity":"7be4ae45-b5e5-414d-ab55-ffbdb7bd128b","added_by":"auto","created_at":"2025-06-03 07:51:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69353,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of different paediatric facial fractures (%), the most common fracture site was the ramus-condyle unit (RCU) in the mandible, followed by the midfacial bony orbit and the mandibular symphysis/parasymphysis area\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6740992/v1/850b67d08170209dbedef330.png"},{"id":83816407,"identity":"b3328a28-326b-4f02-9b88-d5c30768d0aa","added_by":"auto","created_at":"2025-06-03 07:51:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":518955,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6740992/v1/77ce1ed7-f40b-4490-9be9-0e863e72af2a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Paediatric Facial Fractures","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFacial fractures are less common in paediatric patients than adults due to their more elastic bone and cartilage structure (Rogan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Vyas et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). However, when occurring, facial fractures often tend to be more severe and can result in life-long consequences such as disability or even death (Braun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Totonchi et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). As in adults, paediatric patients with facial fractures are more often male than female (Kaura et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Rogan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Vyas et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFracture patterns in paediatric patients are age-related and differ from older patients. The most significant factors contributing to this are expanding sinuses and erupting teeth which are characteristic of certain age groups. (Rogan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Totonchi et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) Incomplete pneumatization signifies thicker bone structure and incomplete dentition strengthens the jawbones. Thus, both stabilize facial structures. (Rogan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) In children, oblique fractures are the most common fracture pattern, whereas adults more often present with more horizontal Le Fort fractures (Naran et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Facial fractures can appear in the upper face (frontal bone), the midface (nasal bone, orbit, maxilla, zygoma) and the lower face (mandible, alveolar ridge, teeth).\u003c/p\u003e \u003cp\u003eYounger children have a proportionally larger skull than face which is why it is more common to encounter trauma in the cranial part than the midface (Imahara et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Vyas et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). In older paediatric patients, fractures in the mandible are more likely (Imahara et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Due to the elastic cartilage and more pliable structure in immature bones, children\u0026rsquo;s fractures tend to be less displaced than in adult patients and may often appear as greenstick fractures (Chasm and Swencki, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Another characteristic appearance in children is a greenstick type blowout fracture, in which orbital contents, usually the inferior rectus or the inferior oblique muscle, become trapped between broken orbital bones when they snap back into their place after breaking (Phan et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). This type of fracture is called trapdoor, and it is due to elasticity of orbital bones (Egbert et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTrauma in paediatric patients is most often caused by a blunt force, though penetrating injuries are also possible (Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Blunt trauma can originate from falls, traffic or sports accidents, and assaults for example. Several studies have shown traffic accidents to be the most common etiological factor (Imahara et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, Kirvel\u0026auml; et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In younger children, assaults often refer to child abuse. Regarding trauma aetiology, accidental self-injurious behaviour in younger paediatric patients, and suicide attempts in older patients should be kept in mind (Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Fracture prevalence grows with age and is most common in adolescents aged 12\u0026ndash;18 years (Braun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Grunwaldt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, Imahara et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The fact that children have several factors protecting them from facial fractures denotes that a major force is often associated when occurring. Therefore, it is important to pay attention to concomitant injuries when examining facial fractures, especially noticing the airways, brain, eyes and neck.\u003c/p\u003e \u003cp\u003eWhen suspecting a facial fracture, computed tomography (CT) is commonly used to confirm the diagnosis (Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). What comes to treatment, it is essential to consider the ongoing growth and development of paediatric patients. This is why paediatric fractures are often treated conservatively, even if surgical treatment for similar fractures in adults would be required (Braun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, when mandatory to operate, the growth centres should be preserved untouched (Singh and Bartlett, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). In addition, resorbable plates and screws should be used when treating a fracture operatively (Burlini et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Due to continuing growth, children with facial fractures should be followed for a longer time since it may affect growth, and intervention with orthodontics may be needed (Braun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Naran et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e, Wheeler and Phillips, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Overall, the prognosis for facial fractures in paediatric patients is mostly good due to the outstanding capability of remodelling. As a result, lasting bone harm or surgical approach is infrequent. (Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eKnowledge of how injury patterns affect paediatric maxillofacial fracture patterns is limited. Additional information about this might help reducing and preventing risks for facial fractures. This is a descriptive study of paediatric patients and their characteristic appearances in facial fractures, treatment and coefficient factors. The aim is to investigate if sex associates with trauma mechanisms and if certain trauma mechanisms lead to specific facial fractures. The hypothesis is that sex has an influence on trauma mechanisms and that trauma mechanisms and facial fractures have a connecting pattern.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA retrospective cohort study of paediatric patients with facial fractures treated at P\u0026auml;ij\u0026auml;t-H\u0026auml;me Central Hospital (PHCH, Lahti, Finland) was conducted. Data was collected for a 10-year period, from 2008 to 2018. The study was approved by the institutional review board of PHCH (D/18/07.01.04.05/2018 and D/2929/07.01.04.05/2020). Patients were identified from PHCH\u0026rsquo;s patient register using the International Classification of Diseases, Ninth Revision (2007\u0026ndash;2014) codes 802, 805.0-805.18, 806.0-806.19 and 847.0 and Tenth Revision (2015\u0026ndash;2017) codes S02.2-S02.04 and S02.6-S02.7, which correspond to fractures in the upper face, midface, and mandible. Paediatric patients were defined as individuals under 18 years old. The data was collected using Microsoft Excel, and the figure was created using Microsoft OneNote and Microsoft PowerPoint.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were one or more fractures in facial bones in minors (\u0026lt;\u0026thinsp;18 years of age) with complete medical and imaging records who were treated at PHCH. Fractures alone in the alveolar ridge were excluded, as well as patients whose later examination ruled out the diagnosis in demand. The cohort contained patient\u0026rsquo;s age, sex, examination date, fracture location(s), mechanism of injury, associated injuries (AIs), Glasgow Coma Scale (GCS), and treatment. Fractures in the upper face included frontal fractures, while midfacial fractures included orbital, maxillary, nasal and zygomatic fractures, and lower facial fractures consisted of mandibular fractures. Mandibular fracture sites were further categorized based on radiographic imaging as follows: ramus-condyle unit (RCU), coronoid, angle, body and symphyseal/parasymphyseal region. Trauma mechanisms were divided into motor vehicle accidents (MVA), bicycle accidents, sports related incidents, assaults and falls. AIs were classified into extremity injuries, intracranial haemorrhages, skull fractures, chest injuries, blunt cerebrovascular injuries, cervical spine injuries, diffuse axonal injuries or concussion, and pelvic or lumbar spine injuries.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 481 patients with facial fractures, complete medical records and imaging data were found in the patient register. Of these, 38 subjects were paediatric, one of whom was excluded for having exclusively an alveolar fracture. Thus, 37 subjects met the inclusion criteria and formed our study cohort.\u003c/p\u003e \u003cp\u003eOf these subjects, 7 (19%) were female and 30 were male (81%), leading to a male to female ratio of 4.3:1. Subjects\u0026rsquo; ages were from 6.0 to 17.9 years, with a mean of 14.3 years. Females\u0026acute; ages ranged from 6.0 to 16.1 (mean of 12.3 years), whereas males\u0026rsquo; ages ranged from 8.0 to 17.9 years (mean 14.7 years). Demographic data is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (years)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e6.0-17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e6.0-16.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e8.0-17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were 22 subjects with mandibular fractures (60%). Of these, 12 (32%) had a single fracture, 6 (16%) had at least one additional fracture in the mandible, and 4 (11%) had a bilateral fracture in the RCU. Of all subjects, 15 (41%) had fractures in the RCU, 8 (22%) in the symphysis or parasymphysis, 6 (16%) in the angle, 3 in the alveolar ridge (8.1%) and 1 subject (2.7%) had a fracture in the body of the mandible.\u003c/p\u003e \u003cp\u003eIn total, 15 subjects (41%) had fractures in the midface or upper face. There were 13 subjects (35%) with midfacial fractures of which 10 (27%) had isolated fractures and the rest 3 of them (8.1%) combined midfacial fractures. Midfacial fractures appeared in the orbit in 11 subjects (30%), in the nose in 3 (8.1%), in the zygoma in 2 (5.4%), and in the maxilla in 1 subject (2.7%). Only 2 subjects (5.4%) encountered fractures in the upper face, both of them in the frontal bone. Fracture locations and distributions are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Altogether, 25 (68%) of the facial fractures were unilateral and 12 (32%) bilateral. Of the unilateral fractures, 20 (54%) occurred on the left side and 5 (14%) on the right side of the head.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSports related incidents caused facial fractures in 12 subjects (32%), MVAs in 10 (27%), bicycle accidents in 9 (24%), assaults in 4 (11%) and falls in 2 of the subjects (5.4%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the division of different trauma mechanisms, fracture types, sex, and AIs. MVAs (14%) and falls (2.7%) caused an equal number of fractures in the midface or upper face as in the mandible, whereas all assaults (11%) and most bicycle accidents (19%) resulted in mandibular fractures. Of 12 sports incidents, 7 (19%) led to midfacial or upper facial fractures and 5 (14%) to mandibular fractures.\u003c/p\u003e \u003cp\u003eAmong females, the most common trauma mechanisms were bicycle accidents together with sports related incidents (both 8.1%), followed by one (2.7%) MVA-related fracture. Among males, the most common mechanisms were MVAs together with sports incidents (both 24%), followed by bicycle accidents (16%), assaults (11%) and falls (5.4%).\u003c/p\u003e \u003cp\u003eAIs were present in 6 subjects (16%). Of these, 4 (11%) appeared in subjects with midfacial fractures and 2 (5.4%) in subjects with mandibular fractures. AIs were caused by MVAs in 4 subjects (11%) and sports incidents in 2 subjects (5.4%). AIs included extremity trauma in 4 subjects (11%), and intracranial haemorrhage (ICH), skull fracture, and thoracic injury in 2 subjects each (5.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTrauma mechanism distribution by fracture type, sex and AIs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMidface/ Upper face, n\u0026thinsp;=\u0026thinsp;15 (41%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMandible, n\u0026thinsp;=\u0026thinsp;22 (60%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale n\u0026thinsp;=\u0026thinsp;7 (19%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMale n\u0026thinsp;=\u0026thinsp;30 (81%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAI, n\u0026thinsp;=\u0026thinsp;6 (16%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSport\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4 (11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBicycle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eMVA, motor vehicle accident; AI, associated injury\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRadiographic examination was most often performed using either CT (53%) or PTG (45%), and both in one subject (2.7%). Treatment was operative in 49% of cases, non-operative in another 49%, and combined in one subject (2.7%). All subjects had a normal GCS of 15. With regard to injury timing, 5 (14%) occured in winter, 11 (30%) in spring, 13 (35%) in summer and 8 (22%) in autumn.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to investigate whether sex is associated with trauma mechanisms and if certain trauma mechanisms lead to specific facial fractures in paediatric patients. The hypothesis was that sex has an influence on trauma mechanisms and that trauma mechanisms and facial fractures have a connecting pattern. We also examined the presence of characteristic patterns in facial fractures, treatment, and contributing factors.\u003c/p\u003e \u003cp\u003eTo begin with, the difference in incidence between female and male subjects was remarkable, as there were approximately four times more boys than girls. This was expected, since males are generally more likely to experience accidents and facial trauma, which has been stated in various other studies as well (Goswami, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Kaura et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Khan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Vyas et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, Wusiman et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Goswami\u0026rsquo;s study reported a male-to-female ratio in children aged 12 years or less of 1.6:1 (Goswami, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The difference compared to our 4.3:1 ratio could be explained by the fact that older boys (\u0026gt;\u0026thinsp;12 years) are more often involved in contact sports or other higher-risk free time activities, such as motocross, than girls.\u003c/p\u003e \u003cp\u003eThis also explains the slightly higher mean age in males compared to females. Differing from some other studies of facial fractures in paediatric patients, our subjects were all 6 years or older. This is because facial fractures are very rare in the youngest age group due to their flexible bone and cartilage structure, the relatively dominant skull size, and the protective frontal bone (Alhumsi and Gilardino, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, Rogan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Vyas et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Moreover, the age distribution was clearly more emphasized in adolescents than in younger children, which aligns with previous studies (Ferreira et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e, Grunwaldt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). This is due to progressive independence and greater involvement in contact sports and driving (Braun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Grunwaldt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOver half (60%) of the subjects\u0026rsquo; facial fractures emerged in the mandible, making it clearly the most common fracture site. This is in line with other studies about maxillofacial fractures in both paediatric patients and adults (Goswami, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Khan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Wusiman et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The mandible is prone to fractures due to its prominent appearance and low facial position (Wusiman et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). We found that fractures in the RCU were the most common (41%), followed by fractures in the symphysis or parasymphysis area (22%). This is consistent with studies of paediatric mandibular fractures by Smith et al., who found RCU fractures in 56% and symphysis or parasymphysis fractures in 27% of the subjects, and by Steed et al., who also stated that mandibular fractures occur most often in the RCU, followed by symphysis or parasymphysis (Smith et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Steed and Schadel, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). When comparing our study to those involving the whole population, Gualtieri et al.\u0026rsquo;s mandibular fracture sites aligned with ours, whereas Wusiman et al. found the symphysis or parasymphysis to be the most commonly fractured in adults, though followed with condyle fractures (Gualtieri et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Wusiman et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe remaining facial fractures were mostly midfacial, with orbital fractures being distinctly the most common (30%) due to the orbit\u0026acute;s fragile, paper-thin bone structure (Felding, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, only one of our subjects was diagnosed with an orbital trapdoor fracture (2.7%), although other studies report an incidence between 24 to 40% in paediatric patients (Bansagi and Meyer, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2000\u003c/span\u003e, Chi et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The low percentage could be because trapdoor fractures are acute conditions that require immediate treatment and are therefore directed forward from PHCH if there is not a maxillofacial surgeon on call at that instant. The nasal bone, which is often fractured in adults, was fractured in only 8.1% of subjects. This aligns with Landeen et al., who stated that nasal fractures are less common in paediatric patients than in adults (Landeen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The frontal bone was fractured in 2 subjects (5.4%), which corresponds with other studies reporting a frequency of 5 to 15% for frontal fractures (Marinheiro et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, Schultz et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll in all, a study on adult facial fractures from the same region and time period than ours, found that 40% of adult subjects had mandibular fractures and 56% had midfacial fractures (F\u0026auml;rkkil\u0026auml; et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This differs from our findings, where mandibular fractures were the most common (60%) and midfacial fractures occurred in 35% of subjects. However, the divergence is coherent since, as mentioned earlier, children have smaller sinuses and a more protective cranium due to different face-to-skull bone size ratios, which prevent them from fractures in the midface (Imahara et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, Rogan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Rogan and Fang, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Totonchi et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Vyas et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen examining unilateral fractures, a notable in side distribution was observed. A significant majority (80%) of fractures occurred on the left side of the head, which could be linked to the fact about 90% of people are right-handed (Levander and Schalling, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1988\u003c/span\u003e, Papadatou-Pastou et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Consequently, the dominant hand may instinctively protect the same side of the face in accidents, for example, directly covering the face in sports incidents or indirectly in falls or bicycle accidents. However, in MVAs for instance, the handedness does not necessarily influence trauma distribution, which may reduce the proportion of left-sided fractures.\u003c/p\u003e \u003cp\u003eIn our subjects overall, the most common trauma mechanisms were sports incidents (32%), followed by MVAs (27%) and bicycle accidents (24%). The aetiology varies somewhat between studies. According to Irgebay et al., sports were the leading cause of injury (42%) in patients aged 12 to 18 years, whereas those younger than 6 years were mostly injured in activities of daily living (46%) (Irgebay et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Ferreira et al. in Portugal and Grunwaldt et al. in the U. S. found MVAs to be the most common trauma mechanism (53% and 25%, respectively), whereas Ghosh et al. found falls to be the most common cause in India (59%) (Ferreira et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e, Ghosh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Grunwaldt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). It is also relevant to note that in our study, motorcross accidents were classified as MVAs, whereas some other studies consider them sport incidents, which affects the distribution of trauma mechanisms (Diab et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Additionally, it is noteworthy that all our subjects who encountered assault (11%) were over 15 years old, indicating that younger patients who experienced assault did not sustain fractures.\u003c/p\u003e \u003cp\u003eThere was a clear difference in trauma mechanisms between paediatric patients and adults from the same study period. In adults, falls (37%) and assaults (32%) were the most common causes, whereas in children, sports incidents (32%), MVAs (27%), and bicycle accidents (24%) were the leading trauma mechanisms (F\u0026auml;rkkil\u0026auml; et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This is understandable, as elderly people are more prone to get facial trauma from falls and young and middle-aged adults from assaults, whereas these causes are clearly less frequent in children.\u003c/p\u003e \u003cp\u003eWhen analysing trauma mechanisms in relation to fracture sites, bicycle accidents and assaults appeared to lead to mandibular fractures more frequently than to other facial fractures. This is supported by another study, which described the mandible as an exposed and difficult-to-protect structure (Nogami et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Following bicycle accidents (19%), MVAs and sports related incidents (both 14%) were the next most common causes of mandibular fractures. Similarly, Smith et al. identified bicycle accidents (29%) as the most common trauma mechanism in paediatric mandibular fractures, followed by MVAs (28%) (Smith et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In fractures of the midface and upper face, sports incidents (19%) were the leading trauma mechanism, followed by MVAs (14%).\u003c/p\u003e \u003cp\u003eIn male subjects, the most common trauma mechanisms were sports and MVAs (both 24%) followed by bicycle accidents (16%). In contrast, in females, sports incidents and bicycle accidents were equally common (both 8.1%). This is a notable difference and can be explained by the fact that females are generally less involved in contact sports and traffic accidents than males, except in the youngest age groups (Braun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Grunwaldt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Nevertheless, it is important to keep in mind that the number of female subjects in our study is rather concise, and therefore, cannot be perfectly relied on.\u003c/p\u003e \u003cp\u003eHalf of our subjects were treated operatively and the other half non-operatively. Only 16% of our subjects experienced AIs, suggesting that paediatric patients often confront relatively simple trauma with fewer serious AIs. The same trend applies to adults, of whom about one in five sustain AIs (F\u0026auml;rkkil\u0026auml; et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, some studies have reported different results. For example, Grundwaldt et al. found that up to 56% of patients sustained severe concomitant injuries, most commonly soft tissue injuries and neurological trauma, with concussion being the most frequent neurological injury (Grunwaldt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The lower AI rate can be explained with that our AIs did not include soft tissue injuries, which are quite common in facial trauma (Mukhopadhyay et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). On the other hand, Kirvel\u0026auml; et al. found that 27% of paediatric patients with facial fractures had AIs and reported that the occurrence of AIs varies with age and, among teenagers, also with sex (Kirvel\u0026auml; et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). All our subjects had a normal GCS score of 15, which may reflect some bias, as the most severe trauma cases with lower GCSs may have been referred forward for treatment. In effect, this could also explain the lower AI percentage in our findings. Notably, 4 of 6 of the subjects with AIs were injured in MVAs. This is in line with other studies, as MVAs often tend to be severe, high-energy injuries (Ferreira et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). AIs most frequently affected the extremities, followed by the head and the thorax, which aligns with other studies as well (Wusiman et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere were notable seasonal variations in the occurrence of facial fractures. Summer (35%) and spring (30%) were the peak seasons, which can be explained by the Finnish climate that reduces outdoor activities in late autumn (22%) and especially in winter (14%). However, this should be interpreted cautiously, as some of the subjects with facial fractures during holiday periods are directly directed from PHCH to Level 1 trauma centre in Helsinki, Finland due to a lack of maxillofacial surgeon on call.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePaediatric facial fractures are uncommon. In both sexes, sports related incidents are the most common trauma mechanism, followed by bicycle accidents in girls and MVAs in boys. AIs are infrequent and typically occur in connection with high-energy trauma, such as MVAs. Therefore, in cases of facial trauma, a thorough clinical examination combined with targeted imaging is recommended, rather than routine full-body 3D imaging.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: J.S., E.K.; Methodology: E.F.; Software: E.F.; Formal analysis and investigation: E.S.; Writing - original draft preparation: E.S.; Writing - review and editing: all authors; Funding acquisition and resources: J.S.; Supervision: J.S.. All authors have read and agreed to the manuscript. manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank our research coordinator Marjo Soini for the help in the process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlhumsi, T. R. \u0026amp; Gilardino, M. S. 2014. Current Management Of Facial Fractures In The Preadolescent. \u003cem\u003eCurr Opin Otolaryngol Head Neck Surg\u003c/em\u003e, 22, 336-41. https://doi.org/10.1097/moo.0000000000000059\u003c/li\u003e\n\u003cli\u003eBansagi, Z. C. \u0026amp; Meyer, D. R. 2000. Internal Orbital Fractures In The Pediatric Age Group: Characterization And Management. \u003cem\u003eOphthalmology\u003c/em\u003e, 107, 829-36. https://doi.org/10.1016/s0161-6420(99)90240-6 \u003c/li\u003e\n\u003cli\u003eBraun, T. L., Xue, A. S. \u0026amp; Maricevich, R. S. 2017. Differences In The Management Of Pediatric Facial Trauma. \u003cem\u003eSemin Plast Surg\u003c/em\u003e, 31, 118-122. https://doi.org/10.1055/s-0037-1601435 \u003c/li\u003e\n\u003cli\u003eBurlini, D., Conti, G., Amadori, F., Bardellini, E. \u0026amp; De Giuli, C. 2015. Management Of Paediatric Maxillofacial Fractures: Conventional Methods And Resorbable Materials. \u003cem\u003eEur J Paediatr Dent\u003c/em\u003e, 16, 24-8. https://doi.org/10.1179/2014.16.1.024 \u003c/li\u003e\n\u003cli\u003eChasm, R. M. \u0026amp; Swencki, S. A. 2010. Pediatric Orthopedic Emergencies. \u003cem\u003eEmerg Med Clin North Am\u003c/em\u003e, 28, 907-26. https://doi.org/10.1016/j.emc.2010.05.005 \u003c/li\u003e\n\u003cli\u003eChi, M. J., Ku, M., Shin, K. H. \u0026amp; Baek, S. 2010. An Analysis Of 733 Surgically Treated Blowout Fractures. \u003cem\u003eOphthalmologica\u003c/em\u003e, 224, 167-75. https://doi.org/10.1159/000320067 \u003c/li\u003e\n\u003cli\u003eDiab, J., Flapper, W. J., Grave, B., Anderson, P. J. \u0026amp; Moore, M. H. 2021. Pediatric Facial Fractures In South Australia: Epidemiology, Clinical Characteristics, And Outcomes. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 32, 2317-2321. https://doi.org/10.1097/SCS.0000000000007580 \u003c/li\u003e\n\u003cli\u003eEgbert, J. E., May, K., Kersten, R. C. \u0026amp; Kulwin, D. R. 2000. Pediatric Orbital Floor Fracture : Direct Extraocular Muscle Involvement. \u003cem\u003eOphthalmology\u003c/em\u003e, 107, 1875-9. https://doi.org/10.1016/s0161-6420(00)00374-7 \u003c/li\u003e\n\u003cli\u003eFelding, U. N. A. 2018. Blowout Fractures - Clinic, Imaging And Applied Anatomy Of The Orbit. \u003cem\u003eDan Med J\u003c/em\u003e, 65.\u003c/li\u003e\n\u003cli\u003eFerreira, P. C., Amarante, J. M., Silva, P. N., Rodrigues, J. M., Choupina, M. P., Silva, A. C., Barbosa, R. F., Cardoso, M. A. \u0026amp; Reis, J. C. 2005. Retrospective Study Of 1251 Maxillofacial Fractures In Children And Adolescents. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e, 115, 1500-8. https://doi.org/10.1097/01.prs.0000151833.27108.3d \u003c/li\u003e\n\u003cli\u003eF\u0026auml;rkkil\u0026auml;, E. M., Oksanen, E., Kormi, E. \u0026amp; Suojanen, J. 2024. What Is The Relationship Between Maxillofacial Injury Location And Associated Injuries? \u003cem\u003eJ Oral Maxillofac Surg\u003c/em\u003e, 82, 800-805. https://doi.org/10.1016/j.joms.2023.11.020 \u003c/li\u003e\n\u003cli\u003eGhosh, R., Gopalkrishnan, K. \u0026amp; Anand, J. 2018. Pediatric Facial Fractures: A 10-Year Study. \u003cem\u003eJ Maxillofac Oral Surg\u003c/em\u003e, 17, 158-163. https://doi.org/10.1007/s12663-017-1065-9 \u003c/li\u003e\n\u003cli\u003eGoswami, S. 2024. Pediatric Patients With Facial Fractures: A Retrospective Study. \u003cem\u003eJ Inj Violence Res\u003c/em\u003e, 16, 71-6. https://doi.org/10.5249/jivr.v16i1.1808 \u003c/li\u003e\n\u003cli\u003eGrunwaldt, L., Smith, D. M., Zuckerbraun, N. S., Naran, S., Rottgers, S. A., Bykowski, M., Kinsella, C., Cray, J., Vecchione, L., Saladino, R. A. \u0026amp; Losee, J. E. 2011. Pediatric Facial Fractures: Demographics, Injury Patterns, And Associated Injuries In 772 Consecutive Patients. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e, 128, 1263-1271. https://doi.org/10.1097/PRS.0b013e31822b8a03 \u003c/li\u003e\n\u003cli\u003eGualtieri, M., Pisapia, F., Fadda, M. T., Priore, P. \u0026amp; Valentini, V. 2021. Mandibular Fractures Epidemiology And Treatment Plans In The Center Of Italy: A Retrospective Study. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 32, E346-E349. https://doi.org/10.1097/SCS.0000000000007526 \u003c/li\u003e\n\u003cli\u003eImahara, S. D., Hopper, R. A., Wang, J., Rivara, F. P. \u0026amp; Klein, M. B. 2008. Patterns And Outcomes Of Pediatric Facial Fractures In The United States: A Survey Of The National Trauma Data Bank. \u003cem\u003eJ Am Coll Surg\u003c/em\u003e, 207, 710-6. https://doi.org/10.1016/j.jamcollsurg.2008.06.357 \u003c/li\u003e\n\u003cli\u003eIrgebay, Z., Glenney, A. E., Beiriger, J. W., Smetona, J., Dixon, A., Kass, N. M., Mocharnuk, J. W., Anstadt, E., Dvoracek, L. A., Saladino, R. A., Losee, J. E. \u0026amp; Goldstein, J. A. 2024. Pediatric Facial Fractures: Demographics, Injury Patterns, And Associated Injuries In 3334 Patients. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e. https://doi.org/10.1097/SCS.0000000000009373 \u003c/li\u003e\n\u003cli\u003eKaura, S., Kaur, P., Bahl, R., Bansal, S. \u0026amp; Sangha, P. 2018. Retrospective Study Of Facial Fractures. \u003cem\u003eAnn Maxillofac Surg\u003c/em\u003e, 8, 78-82. https://doi.org/10.4103/ams.ams_206_17 \u003c/li\u003e\n\u003cli\u003eKhan, S. R., Khan, Z. A., Hanif, S., Riaz, N. \u0026amp; Warraich, R. A. 2019. Patterns Of Facial Fractures In Children. \u003cem\u003eBr J Oral Maxillofac Surg\u003c/em\u003e, 57, 1009-1013. https://doi.org/10.1016/j.bjoms.2019.08.012 \u003c/li\u003e\n\u003cli\u003eKirvel\u0026auml;, A., Sn\u0026auml;ll, J., Suominen, A., Puolakkainen, T. \u0026amp; Thor\u0026eacute;n, H. 2023. Characteristics Of Associated Injuries In Children And Teenagers With Craniofacial Fractures. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 34, 1625-1628. https://doi.org/10.1097/SCS.0000000000008981 \u003c/li\u003e\n\u003cli\u003eKirvel\u0026auml;, A., Suominen, A. L., Puolakkainen, T., Sn\u0026auml;ll, J. \u0026amp; Thor\u0026eacute;n, H. 2024. Paediatric Maxillofacial Fractures Have Increased In Incidence And Their Nature And Aetiology Have Changed During Three Decades. \u003cem\u003eSci Rep\u003c/em\u003e, 14, 20221. https://doi.org/10.1038/s41598-024-57231-0 \u003c/li\u003e\n\u003cli\u003eLandeen, K. C., Kimura, K. \u0026amp; Stephan, S. J. 2022. Nasal Fractures. \u003cem\u003eFacial Plast Surg Clin North Am\u003c/em\u003e, 30, 23-30. https://doi.org/10.1016/j.fsc.2021.08.003 \u003c/li\u003e\n\u003cli\u003eLevander, M. \u0026amp; Schalling, D. 1988. Hand Preference In A Population Of Swedish College Students. \u003cem\u003eCortex\u003c/em\u003e, 24, 149-56. https://doi.org/10.1016/S0010-9452(88)80002-7 \u003c/li\u003e\n\u003cli\u003eMarinheiro, B. H., De Medeiros, E. H., Sverzut, C. E. \u0026amp; Trivellato, A. E. 2014. Frontal Bone Fractures. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 25, 2139-43. https://doi.org/10.1097/SCS.0000000000000956 \u003c/li\u003e\n\u003cli\u003eMukhopadhyay, S., Galui, S., Biswas, R., Saha, S. \u0026amp; Sarkar, S. 2020. Oral And Maxillofacial Injuries In Children: A Retrospective Study. \u003cem\u003eJ Korean Assoc Oral Maxillofac Surg\u003c/em\u003e, 46, 183-190. https://doi.org/10.5125/jkaoms.2020.46.3.183 \u003c/li\u003e\n\u003cli\u003eNaran, S., Macisaac, Z., Katzel, E., Bykowski, M., Shakir, S., Goldstein, J., Pollack, I. M. \u0026amp; Losee, J. E. 2016. Pediatric Craniofacial Fractures: Trajectories And Ramifications. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 27, 1535-8. https://doi.org/10.1097/SCS.0000000000002856 \u003c/li\u003e\n\u003cli\u003eNogami, S., Yamauchi, K., Morishima, H., Otake, Y., Kouketsu, A., Higuchi, K., Hirotani, H., Kumagai, M. \u0026amp; Takahashi, T. 2021. Mandible Fractures And Dental Injuries Related To Road Traffic Accidents Over A 12-Year Period-Retrospective Multicentre Study. \u003cem\u003eDent Traumatol\u003c/em\u003e, 37, 223-228. https://doi.org/10.1111/edt.12681 \u003c/li\u003e\n\u003cli\u003ePapadatou-Pastou, M., Ntolka, E., Schmitz, J., Martin, M., Munaf\u0026ograve;, M. R., Ocklenburg, S. \u0026amp; Paracchini, S. 2020. Human Handedness: A Meta-Analysis. \u003cem\u003ePsychol Bull\u003c/em\u003e, 146, 481-524. https://doi.org/10.1037/bul0000229 \u003c/li\u003e\n\u003cli\u003ePhan, L. T., Jordan Piluek, W. \u0026amp; Mcculley, T. J. 2012. Orbital Trapdoor Fractures. \u003cem\u003eSaudi J Ophthalmol\u003c/em\u003e, 26, 277-82. https://doi.org/10.1016/j.sjopt.2012.07.006 \u003c/li\u003e\n\u003cli\u003eRogan, D. T. \u0026amp; Fang, A. 2024. Pediatric Facial Trauma. \u003cem\u003eStatpearls\u003c/em\u003e. Treasure Island (Fl): Statpearls Publishing. Copyright \u0026copy; 2024, Statpearls Publishing Llc.\u003c/li\u003e\n\u003cli\u003eRogan, D. T., Hohman, M. H. \u0026amp; Ahmed, A. 2024. Pediatric Facial Fractures. \u003cem\u003eStatpearls\u003c/em\u003e. Treasure Island (Fl): Statpearls Publishing. Copyright \u0026copy; 2024, Statpearls Publishing Llc. \u003c/li\u003e\n\u003cli\u003eSchultz, K., Braun, T. L. \u0026amp; Truong, T. A. 2017. Frontal Sinus Fractures. \u003cem\u003eSemin Plast Surg\u003c/em\u003e, 31, 80-84. https://doi.org/10.1055/s-0037-1601471 \u003c/li\u003e\n\u003cli\u003eSingh, D. J. \u0026amp; Bartlett, S. P. 2004. Pediatric Craniofacial Fractures: Long-Term Consequences. \u003cem\u003eClin Plast Surg\u003c/em\u003e, 31, 499-518, Vii. https://doi.org/10.1016/j.cps.2004.04.001 \u003c/li\u003e\n\u003cli\u003eSmith, D. M., Bykowski, M. R., Cray, J. J., Naran, S., Rottgers, S. A., Shakir, S., Vecchione, L., Schuster, L. \u0026amp; Losee, J. E. 2013. 215 Mandible Fractures In 120 Children: Demographics, Treatment, Outcomes, And Early Growth Data. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e, 131, 1348-1358. https://doi.org/10.1097/PRS.0b013e3182855f4e \u003c/li\u003e\n\u003cli\u003eSteed, M. B. \u0026amp; Schadel, C. M. 2017. Management Of Pediatric And Adolescent Condylar Fractures. \u003cem\u003eAtlas Oral Maxillofac Surg Clin North Am\u003c/em\u003e, 25, 75-83. https://doi.org/10.1016/j.cxoms.2017.01.001 \u003c/li\u003e\n\u003cli\u003eTotonchi, A., Sweeney, W. M. \u0026amp; Gosain, A. K. 2012. Distinguishing Anatomic Features Of Pediatric Facial Trauma. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 23, 793-8. https://doi.org/10.1097/SCS.0b013e31825b14ff \u003c/li\u003e\n\u003cli\u003eVyas, R. M., Dickinson, B. P., Wasson, K. L., Roostaeian, J. \u0026amp; Bradley, J. P. 2008. Pediatric Facial Fractures: Current National Incidence, Distribution, And Health Care Resource Use. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 19, 339-49; Discussion 350. https://doi.org/10.1097/SCS.0b013e3181603d7b \u003c/li\u003e\n\u003cli\u003eWheeler, J. \u0026amp; Phillips, J. 2011. Pediatric Facial Fractures And Potential Long-Term Growth Disturbances. \u003cem\u003eCraniomaxillofac Trauma Reconstr\u003c/em\u003e, 4, 43-52. https://doi.org/10.1055/s-0030-1267066 \u003c/li\u003e\n\u003cli\u003eWusiman, P., Maimaitituerxun, B., Guli, Saimaiti, A. \u0026amp; Moming, A. 2020. Epidemiology And Pattern Of Oral And Maxillofacial Trauma. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e, 31, E517-E520. https://doi.org/10.1097/SCS.0000000000006558 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"facial fracture, facial trauma, paediatric trauma, trauma mechanism, children trauma","lastPublishedDoi":"10.21203/rs.3.rs-6740992/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6740992/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePaediatric facial fractures are relatively rare due to the elasticity of children\u0026acute;s bones. This elasticity can also make such fractures more challenging to diagnose. Additionally, anatomical differences between juveniles and adults influence the types of fracture observed. In general, boys are more susceptible to trauma; however, this trend does not seem to differ in cases of facial fractures.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe aim of this study is to investigate the association between sex and trauma mechanisms in paediatric facial fractures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was conducted on paediatric patients diagnosed with facial bone fractures between 2008 and 2018 at P\u0026auml;ij\u0026auml;t-H\u0026auml;me Central Hospital (Lahti, Finland). Inclusion criteria were one or more fractures in facial bones in patients under 18 years of age.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 37 study subjects, 19% were female and 81% were male. Among females, the most common trauma mechanisms were bicycle accidents and sports related incidents (both 8.1%), whereas in males, motor vehicle accidents and sports related incidents were equally prevalent (both 24%). Associated injuries were uncommon, occurring only in 16% of cases, and they were particularly linked to motor vehicle accidents.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePaediatric facial fractures are rare. In cases of facial trauma, thorough clinical examination and targeted imaging are recommended rather than routine full body 3D imaging.\u003c/p\u003e","manuscriptTitle":"Paediatric Facial Fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-03 07:51:26","doi":"10.21203/rs.3.rs-6740992/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-31T13:11:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-21T19:35:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256296629836945419531920460121346967481","date":"2025-07-06T19:01:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-04T19:38:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106514540587117584583671299921893500477","date":"2025-06-26T11:34:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-30T10:29:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-29T13:52:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-29T13:49:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Archives of Paediatric Dentistry","date":"2025-05-24T21:38:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9f6f14be-fe2b-4bbf-8b13-d91d94379060","owner":[],"postedDate":"June 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-22T12:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-03 07:51:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6740992","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6740992","identity":"rs-6740992","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}