Clinical Epidemiology, Patterns and Treatment of Maxillofacial Fractures in children and adolescents: A 15- Year Retrospective Study

Clinical Epidemiology, Patterns and Treatment of Maxillofacial Fractures in children and adolescents: A 15- Year Retrospective Study | 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 Clinical Epidemiology, Patterns and Treatment of Maxillofacial Fractures in children and adolescents: A 15- Year Retrospective Study Canyang Jiang, Yan Jiang, Xiaojing Zhang, Yali Wen, Lisong Lin, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7201314/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Dec, 2025 Read the published version in BMC Oral Health → Version 1 posted 15 You are reading this latest preprint version Abstract Background Although pediatric maxillofacial fractures are uncommon relative to the adult counterparts, a comprehensive understanding of this trauma type is critical to the short- and long-term prevention and treatment for minors. The objective of this study was to describe the main clinical epidemiology, characteristics and treatment of pediatric maxillofacial fractures in different age groups. Methods This research was a retrospective study that was conducted for 15 years in a tertiary hospital for oral and maxillofacial surgery from southeast China. Age, sex, etiology, type of fracture, treatment and concomitant injury were collected from the data of the enrolled patients. The patients were categorized into three groups according to age: ≤6 years old, 7–12 years old, and 13–18 years old. Statistical analysis was conducted mainly using Chi-Square test (p ≤ 0.05). Results A total of 341 patients with maxillofacial fractures were followed up for at least 6 months, then most patients achieved good treatment outcomes in this study. The mean age was 12.04±5.16 years and the male-to-female ratio was 2.13∶1. Fall from a height (FAH) was the primary cause of maxillofacial fractures in 0-6 age group, whereas Fall at ground level (FAG) predominated in both 7–12 age group and 13–18 age group. There were a total of 263 mandibular fractures, 139 midfacial fractures, and 12 suprafacial fractures. Among the mandibular fractures, patients with unilateral condylar fractures were more likely to have isolated fractures than those with bilateral fractures ( C = 0.402, p < 0.001), whereas bilateral condylar fractures, compared to unilateral ones, showed a weak positive correlation with symphyseal fractures ( C = 0.284, p < 0.001). Conclusions There are different clinical epidemiological features and characteristics of pediatric maxillofacial fractures in different age groups. Appropriate treatment strategies are crucial for achieving better therapeutic outcomes. Trial registration Clinical trial number: not applicable. maxillofacial fractures epidemiology treatment children and adolescents Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Background With the rapid development of society and changes in lifestyle, maxillofacial fractures are occurring with increasing frequency. But several factors contribute to the lower incidence of facial fractures in children and adolescents compared to adults. These include the relatively lower mineralization degree of the facial skeleton, thicker fat pads, reduced pneumatization of the paranasal sinuses, and greater flexibility of the sutures[ 1 ]. Besides, from infancy through the mixed dentition, the cranium is proportionally larger than the face providing relative protection against facial injuries[ 2 – 4 ]. However, maxillofacial fractures not only affect the normal function of the oral and maxillofacial region, but also have profound impacts on pediatric appearance, leading to long-term psychological burdens[ 5 ]. On the one hand, facial fractures in children and adolescents differ from those in adults in terms of the causes, anatomical structures, and treatment responses[ 6 ]. On the other hand, the facial bones of pediatric patients remain in a dynamic developmental phase, conferring them with a significantly stronger regenerative capacity compared to adults [ 7 ]. The treatment of pediatric facial fractures varies based on the confirmed diagnosis and must account for children’s and adolescents’ active growth. However, There are different clinical characteristics among different age groups in children. Moreover, there are different treatment strategies for different types of maxillofacial fractures, then improper treatment can lead to deformities or functional impairments, significantly affecting their future quality of life[ 3 , 8 ]. Therefore, research on maxillofacial fractures in children and adolescents holds significantly practical importance for improving treatment outcomes, reducing complications and protecting the mental health. The aim of this study is to delve into the epidemiology, etiology, clinical characteristics, and treatment strategies of maxillofacial fractures in children and adolescents, as well as to explore effective interventional methods and rehabilitation guidance to provide scientific evidence for clinical diagnosis and treatment. By summarizing and combining the existing research findings with new clinical data, this paper aims to offer a comprehensive analysis of the current status and trends of maxillofacial fractures in children and adolescents, providing theoretical support and practical guidance for related medical work. 2. Methods 2.1 Object of study To complete this retrospective study, medical records and imaging data of patients with maxillofacial fractures admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Fujian Medical University between January 2010 and December 2024 were analyzed, and some patients were followed up by phone. The following criteria were required for patients to be included in the study: patients aged 18 years or less; patients who had confirmed diagnosis of maxillofacial fractures by the imaging examination; patients who were followed-up for at least 6 months after intervention or treatment. Patients who lacked complete medical records or imaging data, had a history of prior or pathological maxillofacial fractures, or were lost to follow-up were excluded from the study. 2.2 Data collection Age, sex, etiology, fracture type, treatment, and concomitant injuries were collected from the data of the enrolled patients. Patients were divided into three age groups: ≤6 years, 7–12 years, and 13–18 years. Injury etiology was classified as: fall at ground level(FAG), traffic accidents(TA), fall from a height(FAH), and unspecified trauma(UT). Fractures in the maxillofacial region can be categorized into lower, middle, and upper regions. Sites of mandibular fractures included condyle, symphysis, parasymphysis, body, angle, and other regions(OR; e.g., ramus, coronoid, alveolar process). Sites of midfacial fractures were categorized as zygomatic complex(ZC), maxilla, nasal bone, orbit, naso-orbital-ethmoid (NOE), and other regions(OTR; e.g., alveolar process). Fractures of the upper face specifically referred to fractures of the frontal bone. The incidence of unilateral versus bilateral condylar fractures, as well as the number of condylar fractures associated with other mandibular fractures (symphysis, parasymphysis, body, angle, OR) was meticulously documented. Specifically, condylar fractures were categorized into intracapsular and extracapsular types when analyzing treatment approaches. Furthermore, concomitant injuries—including craniocerebral, thoracic, abdominal, limbs and other injuries—were recorded in patients with maxillofacial fractures. 2.3 Treatment strategies Treatment modalities for maxillofacial fractures comprised conservative managements and open surgical interventions. Conservative managements included observation, anti-infection, ice and medication hemostasis, mouth opening training, dental arch splint fixation of dental arch, intermaxillary fixation and traction, etc. Indications were as follows: 1) maxillofacial fractures with ambiguous dislocation, such as greenstick fractures; 2) intracapsular condylar fractures wihtout temporomandibular joint disc displacement (conformed by MRI) in patients aged 13–18 years old; 3) intracapsular fractures of the condyle with age less than 13 years old. Open surgical interventions: reduction and fixation through open incisions approach with bio-resorbable or mini-titanium plates or screws. Indications were as follows: 1) Significant displacement of the maxillofacial fractures, such as mandibular fracture accompanied by abnormal bone mobility or open wounds; 2) intracapsular condylar fractures with temporomandibular joint disc displacement(conformed by MRI) in patients aged 13–18 years old; 3) extracapsular fractures of the condyle with the angle of ramus more than 45°or the height of ramus reducing more than 5mm; 4) brow-out and brow-in orbital fracture accompanied by impaction of eye contents or a difference of more than 2mm in protrusion between the two eyeballs. 2.4 Statistical analysis Data were analyzed using SPSS, Version 27. Categorical variables were expressed as frequencies and percentages. A Chi-Square test (or Fisher’s exact test where appropriate) was performed to compare proportions, with statistical significance defined as p ≤ 0.05. For significant chi-square results, post hoc pairwise comparisons with Bonferroni correction (adjusted α = 0.05/n, where n = number of comparisons) were conducted to identify specific group differences. Effect sizes were reported using Cramer's V (interpretation thresholds: small ≥ 0.1; medium ≥ 0.3; large ≥ 0.5) or the Contingency coefficient ( C ). 3. Results 3.1 Age and sex ratio A total of 341 patients with maxillofacial fractures were included in this study, of which the mean age for the group was 12.04 ± 5.16 years (range: 0–18 years).There were 232 male patients and 109 female patients, with a sex ratio of 2.13:1. The genders among different age groups were not statistically significant (χ² = 5.115, p = 0.077, Cramér's V = 0.122). ( Table 1 ) Table 1 Gender distribution of maxillofacial fractures in children and adolescents across different age groups Age-group Male Female χ² p Cramér's V 0–6 47(63.5%) 27(36.5%) 5.115 0.077 0.122 7–12 37(58.7%) 26(41.3%) 13–18 148(72.5%) 56(27.5%) Total 232(68.0%) 109(32.0%) 3.2 Injury etiology Among 341 pediatric maxillofacial fracture patients, FAG constituted the most common injury etiology (161/341, 47.2%), followed by TA (91/341, 26.7%), FAH (58/341, 17.0%), and UT (31/341, 9.1%). ( Fig. 1 ) Pearson’s chi-square test revealed a statistically significant association between the injury etiologies and age groups (χ² = 56.545, p < 0 .001, Cramer's V = 0.288). Post hoc tests with Bonferroni adjustment (adjusted α = 0.004) revealed: for FAG, rates were significantly lower in 0–6 age group (23/74, 31.1%) than in both 7–12 age group(34/63, 54.0%) and 13–18 age group(104/204, 51.0%), whereas the two older groups did not differ; TA occurred more frequently in 13–18 age group (67/204, 32.8%) than in 7–12 age group (8/63, 12.7%); and FAH was significantly more prevalent in 0–6 age group (31/74, 41.9%) than in 7–12 age group (14/63, 22.2%) and 13–18 age group (13/204, 6.4%,). 3.3 Maxillofacial fracture site Among the patients under 18 years of age with maxillofacial fractures counted in this study, there were a total of 263 mandibular fractures, 139 midfacial fractures, and 12 suprafacial fractures. The most common site of mandibular fractures was condyle(162/263, 61.6%), followed by symphysis (101/263, 38.4%), body (62/263, 23.6%), angle (44/263, 16.7%), OR(43/263, 16.3%), and parasymphysis (42/263, 16.0%). ( Fig. 2 ) A significant association existed between mandibular fracture sites and age groups (χ² = 25.604, p = 0.004, Cramer's V = 0.168). Post hoc column proportion tests with Bonferroni adjustment (adjusted α = 0.003) revealed that symphysis fractures were significantly more common in 0–6 age group (41/119, 34.5%) compared to both the 7–12 age group (14/90, 15.6%) and the 13–18 age group (46/245, 18.8%). Among midfacial fractures, ZC was the most common (88/139, 63.3%), followed in order by maxilla (30/139, 21.6%), OTR (28/139, 20.1%), nasal bone (25/139, 18.0%), orbit (12/139, 8.6%) and NOE (9/139, 6.5%). ( Fig. 3 ) Fisher-Freeman-Halton exact test revealed a significant association between midfacial fracture sites and age groups (χ² = 16.973, p = 0.045, Cramer's V = 0.217). A total of 12 suprafacial fractures were identified, all exclusively involving frontal bone fractures. These fractures were distributed among the age groups as follows: 1 in the 0–6 age group, 3 in the 7–12 age group, and 8 in the 13–18 age group. 3.4 Statistics on condylar fractures There were 162 patients with condylar fractures, of which 82 had unilateral condylar fracture and 80 had bilateral condylar fractures. Simple unilateral condylar fracture and unilateral condylar fracture with Symphysis accounted for a larger percentage of unilateral condylar fractures, which were 40.2% (33/82) and 30.5% (25/82), respectively. In the bilateral condylar fractures group, the proportion of bilateral condylar fractures with Symphysis was larger, 60.0% (48/80). ( Table 2 ) Table 2 Condylar Fractures Condylar Fractures C p unilateral bilateral Simple 33(91.7%) 3(8.3%) 0.402 < 0.001 Symphysis 25(34.2%) 48(65.8%) 0.284 < 0.001 Parasymphysis 10(52.6%) 9(47.4%) 0.015 0.852 Body 13(43.3%) 17(56.7%) 0.069 0.377 Angle 1(33.3%) 2(66.7%) 0.047 0.618 UR 7(25.0%) 7(75.0%) 0.004 0.961 3.5 Treatment All patients were followed up for at least 6 months, and most patients achieved good treatment outcomes. However, 11 patients developed wound infections and implant exposure after surgery, 5 children experienced temporomandibular joint bone-ankylosis, and 7 children showed significant facial asymmetry. 3.5.1 Mandibular noncondylar fractures(Fig. 4 ) Of the 286 treated mandibular noncondylar fractures, a total of 50 were managed with conservative treatment(17.5%) and a total of 236 underwent open surgery(82.5%).The surgical treatment rate was high in these sites, such as the Symphysis(91/100, 91.0%), Angle (40/44, 90.9%), Parasymphysis (36/41, 87.8%), Body (46/60, 76.7%),and OR(23/41, 56.1%). ( Fig. 5 ) A significant correlation was noted between treatment methods and mandibular fracture sites (χ² = 29.192, p < 0.001, Cramer's V = 0.3) 3.5.2 Condylar fractures(Fig. 6 ) Of the 232 treated condylar fractures, there were a total of 120 intracapsular condylar fractures (51.7%) and 112 extracapsular condylar fractures (48.3%). A higher proportion of intracapsular condylar fractures were treated conservatively (92/120 76.7%), whereas a higher rate of extracapsular condylar fractures underwent open surgery (80/112, 71.4%). ( Table 3 ) There were significant differences in the treatment methods between the two types of condylar fractures (χ² = 53.857, p < 0.001, Cramer's V = 0.482). Table 3 Treatment of Condylar Fractures Conservative treatment Surgical treatment χ² p intracapsular 92 28 53.857 < 0.001 extracapsular 32 80 3.5.3 Midfacial fractures (Fig. 7 ) There were a total of 188 treated midfacial fracture, of which 72 were treated conservatively(38.3%), 116 were treated with open surgery(61.7%). As for the subdivisions of the midface, the open surgical treatment rates of ZC, Orbit and Maxilla were higher than the conservative treatment rates, with surgical treatment rates of 81.6% (71/87), 66.7% (8/12) and 55.2% (16/29), respectively. The conservative treatment rates was higher than the surgical treatment rates in the rest subdivisions, which were 70.8% (17/24) for Nasal Bone, 63.0% (17/27) for OTR, and 55.6% (5/9) for NOE, respectively. ( Fig. 8 ) A significant correlation was noted between treatment methods and midfacial fracture sites (χ² = 34.075, p < 0.001, Cramer's V = 0.426). 3.5.4 Upper facial fractures All the upper facial fractures were frontal fractures, in which the conservative treatment rate was higher than the surgical rate, 83.3% (10/12) versus 16.7% (2/12), respectively. 3.6 Concomitant injuries Of the 341 maxillofacial fracture patients, a total of 58 were combined with fractures in other parts of the body, 32 with craniocerebral injuries, 27 with thoracic injuries, and 6 with abdominal injuries. 4. Discussion Maxillofacial fractures in minors account for less than 15% of all facial fractures[ 9 – 11 ]. Maxillofacial injuries in minors are mostly confined to soft tissue and alveolar bone, with a low incidence of maxillofacial fractures [ 12 ]. However, pediatric maxillofacial fractures are associated with higher mortality and more severe injuries than non-maxillofacial fractures, as well as longer hospital stays, intensive care unit stays and higher hospital costs[ 10 , 13 ]. Furthermore, pediatric maxillofacial fractures exhibit diverse clinical patterns influenced by multiple factors, varying in severity and location, and potentially leading to complications [ 11 ]. Therefore, the related research on pediatric maxillofacial fractures still needs to be carried out to better assist clinicians in the diagnosis and treatment process and the accurate judgment at the first visit. The observed male predominance of pediatric maxillofacial fractures in our study (68.0%, male:female = 2.13:1) aligns with findings from prior studies, possibly attributed to boys' higher levels of physical activity and participation in outdoor pursuits, thereby elevating the susceptibility to injuries[ 8 , 14 , 15 ]. In addition, the genders among different age groups were not statistically significant (P = 0.077), but males had the highest proportion in the adolescent group (72.5%, male:female = 2.64:1). The patients included in this study were categorized into three different age groups, 0–6 years old, 7–12 years old and 13–18 years old, respectively. This type of age distribution was preferred because it encompasses three critical stages of development (preschool, school and adolescence)[ 11 ]. FAG was the most common cause of injury for maxillofacial fractures in minors which is consistent with previous studies[ 7 ]. However, some studies have shown that TA is the most common cause of injury for maxillofacial fractures in adolescents[ 8 , 15 ]. Overall, the causes of maxillofacial fractures in pediatric patients vary by region, culture, living environment and socioeconomic characteristics[ 14 ]. In addition, the FAH was the most common cause of injury in the 0–6 age group. The study found there were statistically significant differences in the causes of injury among three age groups (P < 0.001). This phenomenon can be interpreted by the changes of parents ' sense of supervision and prevention, minors' sense of self-protection and the social environment that minors contact. Previous literature indicated that mandibular fractures are a common type of pediatric maxillofacial fracture, comprising an estimated 40–70% of pediatric facial trauma cases[ 16 , 17 ]. Mandibular fractures accounted for 77.1% (263/341)in our study. Among these mandibular fractures, condyle and symphysis were found to be the most common sites in minors, accounting for 61.6% and 38.4%. This may be attributed to the inherent structural vulnerability of these two locations, combined with the existence of tooth germs within the mandibular body and the insufficient calcification of cortical bone in minors[ 1 ]. ZC was the most common part of midfacial fracture in minors, accounting for 63.31%. This is due to pneumatization and the development of the paranasal sinuses, which ensure additional resistance to fractures in children[ 18 ]. In addition, there was a statistically significant difference in mandibular fracture sites among three age groups (P = 0.004). The Symphysis incidence in 0–6 age group was significantly different from that in the other two groups. As the growth center of mandible, the high frequency of condylar fractures (61.6%) in this study raises concerns regarding potential pediatric facial deformities, malocclusion and dysfunction (even temporomandibular join ankylosis) in the future[ 19 , 20 ]. Consequently, a comprehensive investigation into condylar fractures was undertook. Previous studies have found that isolated unilateral condylar fractures are often more severe than condylar fractures associated with other fractures, and unilateral condylar fractures are more often associated with mandibular angle fractures[ 21 , 22 ]. It is difficult to confirm or disprove these views in this study. However, children with unilateral condylar fractures were found to have a higher incidence of isolated fractures and a moderate correlation with single fractures compared with bilateral condylar fractures in this study ( C = 0.402, p < 0.001). And bilateral condylar fractures were less likely to be isolated and more likely to be associated with other mandibular fractures, which is similar to the findings of related studies and further found a weak positive correlation with Symphysis compared with unilateral condylar fractures ( C = 0.284, p < 0.001)[ 22 , 23 ]. This study suggests that many condylar fractures may be caused by indirect forces exerted on the mandible. Therefore, this condition in children should be paid particular attention to avoid missed diagnosis and misdiagnosis. In recent years, with the advent of new surgical techniques and instruments, the debate over whether to choose surgical or conservative treatment for pediatric maxillofacial fractures has continued[ 23 – 25 ]. All patients were followed up for at least 6 months, and most of them achieved good treatment outcomes via our treatment strategies. Similar to some studies[ 26 , 27 ], although certain principles for the reduction and stabilization of oral and maxillofacial fractures applicable to adults can also be uesd in pediatric patients, this study found that there are some key points or precautions for surgical intervention. For example: 1) minimizing iatrogenic injuries to avoid secondary damages that are detrimental to fracture healing during the surgery;2) trying to use absorbable materials to avoid secondary surgery and affecting bone development; 3) restoring the continuity of facial bones, but don’t pursue anatomical reduction and solid internal fixation; 4) attempting to preserve the periosteum and reposition it as much as possible. In addition, condylar fractures in children were classified into intracapsular and extracapsular condylar fractures[ 24 , 28 ]. In the study, the treatment methods of condylar fracture under this classification were focused and there are significant differences in the treatment methods between the two types of condylar fractures (p < 0.001). Notably, conservative management was predominant for intracapsular fractures (76.7%), whereas extracapsular fractures were primarily addressed through open surgical intervention (71.4%). The relatively high rate of surgical intervention for pediatric condylar fractures may be attributed to the continuous refinement of surgical techniques, instruments and good treatment strategy. However, the study also has some limitations. The retrospective nature of this research may determine that the data recorded at the time of admission, as well as the data recorded at the follow-up, may be incorrect or incomplete. It could also be limited by a single institution’s scope, which may reduce the generalizability of the study. Another limitation is the absence of a long-term follow-up. We would like to point out, the research hospital has the largest medical center of oral and maxillofacial surgery in southeastern China. 5. Conclusions In conclusion, this study demonstrated that there are different clinical epidemiological features and characteristics of pediatric maxillofacial fractures in different age groups. Appropriate treatment strategies are crucial for achieving better therapeutic outcomes. These findings may assist practitioners in avoiding misdiagnosis and inappropriate treatments, while promoting the implementation of protective measures to reduce the incidence of pediatric maxillofacial fractures. Abbreviations FAG Fall at ground level TA Traffic accidents FAH Fall from a height UT Unspecified trauma OR Other mandibular fracture regions (e.g., ramus, coronoid, alveolar process) ZC Zygomatic complex NOE Naso-orbital-ethmoid OTR Other midfacial fracture regions (e.g., alveolar process) Declarations 7.1 Ethics approval and consent to participate This retrospective study was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University, which was carried out in compliance with the guidelines outlined in the 2008 Declaration of Helsinki and its subsequent amendments. The legal guardians of the minors who participated in the study signed informed consent forms authorizing the anonymous use of their medical information. Patients aged 18 years provided informed consent forms themselves, allowing the anonymous use of their medical data. 7.2 Consent for publication The legal guardians of the minors and the patients aged 18 years signed informed consent forms authorizing the anonymous use of their medical data. 7.3 Availability of data and materials Not applicable. 7.4 Competing interests The authors declare that they have no competing interests. 7.5 Funding Not applicable. 7.6 Authors’ contribution Li Huang, Lisong Lin and Canyang Jiang contributed to the study conception and design. Data collection was performed by Yan Jiang and Xiaojing Zhang. Data analysis was performed by Xiaojing Zhang and Yali Wen . The first draft of the manuscript was written by Canyang Jiang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. 7.7 Acknowledgments We appreciate all patients in this study for their participation, understanding and cooperation. 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Cite Share Download PDF Status: Published Journal Publication published 17 Dec, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 25 Aug, 2025 Reviews received at journal 23 Aug, 2025 Reviews received at journal 20 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviewers invited by journal 13 Aug, 2025 Editor invited by journal 31 Jul, 2025 Editor assigned by journal 29 Jul, 2025 Submission checks completed at journal 29 Jul, 2025 First submitted to journal 24 Jul, 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. 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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-7201314","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502944722,"identity":"9b588c55-3b2c-4330-8e20-67f41243d394","order_by":0,"name":"Canyang Jiang","email":"","orcid":"","institution":"the First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Canyang","middleName":"","lastName":"Jiang","suffix":""},{"id":502944723,"identity":"d039a203-0758-482e-8aa2-9fa60e4160c4","order_by":1,"name":"Yan Jiang","email":"","orcid":"","institution":"the First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Jiang","suffix":""},{"id":502944727,"identity":"4e2dfe12-b83b-4078-b2df-6d72e3f104be","order_by":2,"name":"Xiaojing Zhang","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaojing","middleName":"","lastName":"Zhang","suffix":""},{"id":502944732,"identity":"87863210-7e4f-4e12-92cb-990a96972ce3","order_by":3,"name":"Yali Wen","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yali","middleName":"","lastName":"Wen","suffix":""},{"id":502944739,"identity":"7c2d9a8f-f233-4058-a1d0-4106bde2de02","order_by":4,"name":"Lisong Lin","email":"","orcid":"","institution":"the First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lisong","middleName":"","lastName":"Lin","suffix":""},{"id":502944741,"identity":"1274aad5-7093-4e13-8ede-e83d677b4530","order_by":5,"name":"Li Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIie3PvwuCQBTA8SdCLqeuJ2H9C4kQgf+MLrpkc4PJTTcZ/S0RRFsHgg2de/0RQWtDkb9mvTHovstb3od3ByCT/WCGipo50QirpzpMRh1xERMm0JIga4QQ0fQCv06bKFOuIYa1FxCtZAMPM0Jryy9xBuURA48Cglb+AEFzrNMiPtdEoXlAMJoNEutNiwg15CNIxjpN/JYQMeJ6NmVO9ZfDwi8il6JlPzFN7twfNJ0iXO5vz8SzdxrvJ105AGYAfn1XZL8qre4RwV2ZTCb7u75mpj62MQSSrQAAAABJRU5ErkJggg==","orcid":"","institution":"the First Affiliated Hospital of Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2025-07-24 04:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7201314/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7201314/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-07283-6","type":"published","date":"2025-12-17T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89573884,"identity":"c1948388-124b-4e00-a824-2d5a67c80dcb","added_by":"auto","created_at":"2025-08-21 12:49:34","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41294,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of etiology according to age\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/c720876af308cc4864da0bb0.jpg"},{"id":89573885,"identity":"93defde8-69dd-4e7c-ab2e-feec474e8bcd","added_by":"auto","created_at":"2025-08-21 12:49:34","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48657,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of mandibular fractures according to age\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/ff7b2cf0bb39cfb53469ed18.jpg"},{"id":89575546,"identity":"ac8a0da1-45ef-45c7-92af-f2a56dd80e4e","added_by":"auto","created_at":"2025-08-21 12:57:34","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37580,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of midfacial fractures according to age\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/db138d223759f107584b1b73.jpg"},{"id":89573886,"identity":"5eabdcba-2910-40ee-8691-8587c5c1b960","added_by":"auto","created_at":"2025-08-21 12:49:34","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":107618,"visible":true,"origin":"","legend":"\u003cp\u003e“Boy, 6Y, Traffic accident, Comminuted fracture of left mandibular body”; A. Preoperative condition: continuity interruption of mandible, dislocation of fracture fragment; B. Postoperative 3-day condition: restoration of mandibular continuity, fixation with absorbable plates and nails; C. Half a year after surgery: The mandibular fracture has healed.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/96b6bf103234601a23fa301e.jpg"},{"id":89575993,"identity":"8e495c7e-91d6-4bb6-856e-d85b9c84a6fc","added_by":"auto","created_at":"2025-08-21 13:05:34","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":39767,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of treatment modalities according to sites\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/ee5f87ceefe2f170500dc81e.jpg"},{"id":89573913,"identity":"6b438f7b-214f-4c6f-875c-60c709890154","added_by":"auto","created_at":"2025-08-21 12:49:39","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":94559,"visible":true,"origin":"","legend":"\u003cp\u003e“Girl, 6Y, Fall，Right intracapsular condylar fracture”; A. The temporomandibular joint disc and free condyle block moved forward with limited mouth opening; B. Conservative treatment methods: interdental traction in the anterior teeth area with posterior dental pads; C. 3 months after surgery: new bone formation in the right condyle, stable occlusal relationship, and end of intervention treatment; D. Half a year after surgery: the reconstruction of the right condyle morphology was completed, and the height of the ascending branch was restored; E. One year after surgery: the morphology of the right condyle returned to normal, the temporomandibular joint disc was reduced, and the mouth opening returned to normal.\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/29f7212347d5fad801252abc.jpg"},{"id":89573893,"identity":"f81d08aa-7bd1-42ba-98bf-a0953fb8b619","added_by":"auto","created_at":"2025-08-21 12:49:35","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":96425,"visible":true,"origin":"","legend":"\u003cp\u003e“Girl, 5Y, Traffic accident, Right zygomatic complex fracture”; A. Preoperative condition: significant misplacement of the infraorbital margin; B. Postoperative 3-day condition: continuous recovery of the infraorbital margin, fixation with absorbable plates and nails；C-F. Half a year to 3 years after surgery: The bone formation process in the right zygomatic area was normal, and the bilateral zygomatic faces were symmetrical.\u003c/p\u003e","description":"","filename":"7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/dbfa19eacd435f8c39dc2433.jpg"},{"id":89573888,"identity":"74f7c695-7362-4678-ae7a-7e86d7c0a9f7","added_by":"auto","created_at":"2025-08-21 12:49:34","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":38393,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of treatment modalities according to sites\u003c/p\u003e","description":"","filename":"8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/8beb048da50cd28a1d51de35.jpg"},{"id":98814236,"identity":"2b1bdf06-ced2-4523-91fd-80a863066363","added_by":"auto","created_at":"2025-12-22 16:11:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1286248,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7201314/v1/535eae1f-c791-469b-ab6e-4d06b0a004a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Epidemiology, Patterns and Treatment of Maxillofacial Fractures in children and adolescents: A 15- Year Retrospective Study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eWith the rapid development of society and changes in lifestyle, maxillofacial fractures are occurring with increasing frequency. But several factors contribute to the lower incidence of facial fractures in children and adolescents compared to adults. These include the relatively lower mineralization degree of the facial skeleton, thicker fat pads, reduced pneumatization of the paranasal sinuses, and greater flexibility of the sutures[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Besides, from infancy through the mixed dentition, the cranium is proportionally larger than the face providing relative protection against facial injuries[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, maxillofacial fractures not only affect the normal function of the oral and maxillofacial region, but also have profound impacts on pediatric appearance, leading to long-term psychological burdens[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. On the one hand, facial fractures in children and adolescents differ from those in adults in terms of the causes, anatomical structures, and treatment responses[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. On the other hand, the facial bones of pediatric patients remain in a dynamic developmental phase, conferring them with a significantly stronger regenerative capacity compared to adults [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The treatment of pediatric facial fractures varies based on the confirmed diagnosis and must account for children\u0026rsquo;s and adolescents\u0026rsquo; active growth. However, There are different clinical characteristics among different age groups in children. Moreover, there are different treatment strategies for different types of maxillofacial fractures, then improper treatment can lead to deformities or functional impairments, significantly affecting their future quality of life[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, research on maxillofacial fractures in children and adolescents holds significantly practical importance for improving treatment outcomes, reducing complications and protecting the mental health.\u003c/p\u003e\u003cp\u003eThe aim of this study is to delve into the epidemiology, etiology, clinical characteristics, and treatment strategies of maxillofacial fractures in children and adolescents, as well as to explore effective interventional methods and rehabilitation guidance to provide scientific evidence for clinical diagnosis and treatment. By summarizing and combining the existing research findings with new clinical data, this paper aims to offer a comprehensive analysis of the current status and trends of maxillofacial fractures in children and adolescents, providing theoretical support and practical guidance for related medical work.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Object of study\u003c/h2\u003e\u003cp\u003e To complete this retrospective study, medical records and imaging data of patients with maxillofacial fractures admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Fujian Medical University between January 2010 and December 2024 were analyzed, and some patients were followed up by phone. The following criteria were required for patients to be included in the study: patients aged 18 years or less; patients who had confirmed diagnosis of maxillofacial fractures by the imaging examination; patients who were followed-up for at least 6 months after intervention or treatment. Patients who lacked complete medical records or imaging data, had a history of prior or pathological maxillofacial fractures, or were lost to follow-up were excluded from the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data collection\u003c/h2\u003e\u003cp\u003eAge, sex, etiology, fracture type, treatment, and concomitant injuries were collected from the data of the enrolled patients. Patients were divided into three age groups: \u0026le;6 years, 7\u0026ndash;12 years, and 13\u0026ndash;18 years. Injury etiology was classified as: fall at ground level(FAG), traffic accidents(TA), fall from a height(FAH), and unspecified trauma(UT). Fractures in the maxillofacial region can be categorized into lower, middle, and upper regions. Sites of mandibular fractures included condyle, symphysis, parasymphysis, body, angle, and other regions(OR; e.g., ramus, coronoid, alveolar process). Sites of midfacial fractures were categorized as zygomatic complex(ZC), maxilla, nasal bone, orbit, naso-orbital-ethmoid (NOE), and other regions(OTR; e.g., alveolar process). Fractures of the upper face specifically referred to fractures of the frontal bone.\u003c/p\u003e\u003cp\u003eThe incidence of unilateral versus bilateral condylar fractures, as well as the number of condylar fractures associated with other mandibular fractures (symphysis, parasymphysis, body, angle, OR) was meticulously documented. Specifically, condylar fractures were categorized into intracapsular and extracapsular types when analyzing treatment approaches. Furthermore, concomitant injuries\u0026mdash;including craniocerebral, thoracic, abdominal, limbs and other injuries\u0026mdash;were recorded in patients with maxillofacial fractures.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Treatment strategies\u003c/h2\u003e\u003cp\u003eTreatment modalities for maxillofacial fractures comprised conservative managements and open surgical interventions.\u003c/p\u003e\u003cp\u003eConservative managements included observation, anti-infection, ice and medication hemostasis, mouth opening training, dental arch splint fixation of dental arch, intermaxillary fixation and traction, etc. Indications were as follows: 1) maxillofacial fractures with ambiguous dislocation, such as greenstick fractures; 2) intracapsular condylar fractures wihtout temporomandibular joint disc displacement (conformed by MRI) in patients aged 13\u0026ndash;18 years old; 3) intracapsular fractures of the condyle with age less than 13 years old.\u003c/p\u003e\u003cp\u003eOpen surgical interventions: reduction and fixation through open incisions approach with bio-resorbable or mini-titanium plates or screws. Indications were as follows: 1) Significant displacement of the maxillofacial fractures, such as mandibular fracture accompanied by abnormal bone mobility or open wounds; 2) intracapsular condylar fractures with temporomandibular joint disc displacement(conformed by MRI) in patients aged 13\u0026ndash;18 years old; 3) extracapsular fractures of the condyle with the angle of ramus more than 45\u0026deg;or the height of ramus reducing more than 5mm; 4) brow-out and brow-in orbital fracture accompanied by impaction of eye contents or a difference of more than 2mm in protrusion between the two eyeballs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS, Version 27. Categorical variables were expressed as frequencies and percentages. A Chi-Square test (or Fisher\u0026rsquo;s exact test where appropriate) was performed to compare proportions, with statistical significance defined as p\u0026thinsp;\u0026le;\u0026thinsp;0.05. For significant chi-square results, post hoc pairwise comparisons with Bonferroni correction (adjusted α\u0026thinsp;=\u0026thinsp;0.05/n, where n\u0026thinsp;=\u0026thinsp;number of comparisons) were conducted to identify specific group differences. Effect sizes were reported using Cramer's V (interpretation thresholds: small\u0026thinsp;\u0026ge;\u0026thinsp;0.1; medium\u0026thinsp;\u0026ge;\u0026thinsp;0.3; large\u0026thinsp;\u0026ge;\u0026thinsp;0.5) or the Contingency coefficient (\u003cem\u003eC\u003c/em\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Age and sex ratio\u003c/h2\u003e\u003cp\u003eA total of 341 patients with maxillofacial fractures were included in this study, of which the mean age for the group was 12.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16 years (range: 0\u0026ndash;18 years).There were 232 male patients and 109 female patients, with a sex ratio of 2.13:1. The genders among different age groups were not statistically significant (χ\u0026sup2; = 5.115, p\u0026thinsp;=\u0026thinsp;0.077, Cram\u0026eacute;r's V\u0026thinsp;=\u0026thinsp;0.122). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\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\u003eGender distribution of maxillofacial fractures in children and adolescents across different age groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCram\u0026eacute;r's V\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47(63.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27(36.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e5.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37(58.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26(41.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e148(72.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56(27.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e232(68.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e109(32.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Injury etiology\u003c/h2\u003e\u003cp\u003eAmong 341 pediatric maxillofacial fracture patients, FAG constituted the most common injury etiology (161/341, 47.2%), followed by TA (91/341, 26.7%), FAH (58/341, 17.0%), and UT (31/341, 9.1%).\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e Pearson\u0026rsquo;s chi-square test revealed a statistically significant association between the injury etiologies and age groups (χ\u0026sup2; = 56.545, p\u0026thinsp;\u0026lt;\u0026thinsp;0 .001, Cramer's V\u0026thinsp;=\u0026thinsp;0.288). Post hoc tests with Bonferroni adjustment (adjusted α\u0026thinsp;=\u0026thinsp;0.004) revealed: for FAG, rates were significantly lower in 0\u0026ndash;6 age group (23/74, 31.1%) than in both 7\u0026ndash;12 age group(34/63, 54.0%) and 13\u0026ndash;18 age group(104/204, 51.0%), whereas the two older groups did not differ; TA occurred more frequently in 13\u0026ndash;18 age group (67/204, 32.8%) than in 7\u0026ndash;12 age group (8/63, 12.7%); and FAH was significantly more prevalent in 0\u0026ndash;6 age group (31/74, 41.9%) than in 7\u0026ndash;12 age group (14/63, 22.2%) and 13\u0026ndash;18 age group (13/204, 6.4%,).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Maxillofacial fracture site\u003c/h2\u003e\u003cp\u003eAmong the patients under 18 years of age with maxillofacial fractures counted in this study, there were a total of 263 mandibular fractures, 139 midfacial fractures, and 12 suprafacial fractures.\u003c/p\u003e\u003cp\u003eThe most common site of mandibular fractures was condyle(162/263, 61.6%), followed by symphysis (101/263, 38.4%), body (62/263, 23.6%), angle (44/263, 16.7%), OR(43/263, 16.3%), and parasymphysis (42/263, 16.0%).\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e A significant association existed between mandibular fracture sites and age groups (χ\u0026sup2; = 25.604, p\u0026thinsp;=\u0026thinsp;0.004, Cramer's V\u0026thinsp;=\u0026thinsp;0.168). Post hoc column proportion tests with Bonferroni adjustment (adjusted α\u0026thinsp;=\u0026thinsp;0.003) revealed that symphysis fractures were significantly more common in 0\u0026ndash;6 age group (41/119, 34.5%) compared to both the 7\u0026ndash;12 age group (14/90, 15.6%) and the 13\u0026ndash;18 age group (46/245, 18.8%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong midfacial fractures, ZC was the most common (88/139, 63.3%), followed in order by maxilla (30/139, 21.6%), OTR (28/139, 20.1%), nasal bone (25/139, 18.0%), orbit (12/139, 8.6%) and NOE (9/139, 6.5%). \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e Fisher-Freeman-Halton exact test revealed a significant association between midfacial fracture sites and age groups (χ\u0026sup2; = 16.973, p\u0026thinsp;=\u0026thinsp;0.045, Cramer's V\u0026thinsp;=\u0026thinsp;0.217).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA total of 12 suprafacial fractures were identified, all exclusively involving frontal bone fractures. These fractures were distributed among the age groups as follows: 1 in the 0\u0026ndash;6 age group, 3 in the 7\u0026ndash;12 age group, and 8 in the 13\u0026ndash;18 age group.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Statistics on condylar fractures\u003c/h2\u003e\u003cp\u003eThere were 162 patients with condylar fractures, of which 82 had unilateral condylar fracture and 80 had bilateral condylar fractures. Simple unilateral condylar fracture and unilateral condylar fracture with Symphysis accounted for a larger percentage of unilateral condylar fractures, which were 40.2% (33/82) and 30.5% (25/82), respectively. In the bilateral condylar fractures group, the proportion of bilateral condylar fractures with Symphysis was larger, 60.0% (48/80). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\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\u003eCondylar Fractures\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCondylar Fractures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eC\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eunilateral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ebilateral\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSimple\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33(91.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymphysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25(34.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48(65.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParasymphysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(52.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9(47.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13(43.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(56.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.377\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAngle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.618\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7(25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(75.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.961\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Treatment\u003c/h2\u003e\u003cp\u003eAll patients were followed up for at least 6 months, and most patients achieved good treatment outcomes. However, 11 patients developed wound infections and implant exposure after surgery, 5 children experienced temporomandibular joint bone-ankylosis, and 7 children showed significant facial asymmetry.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e3.5.1 Mandibular noncondylar fractures(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/h2\u003e\u003cp\u003eOf the 286 treated mandibular noncondylar fractures, a total of 50 were managed with conservative treatment(17.5%) and a total of 236 underwent open surgery(82.5%).The surgical treatment rate was high in these sites, such as the Symphysis(91/100, 91.0%), Angle (40/44, 90.9%), Parasymphysis (36/41, 87.8%), Body (46/60, 76.7%),and OR(23/41, 56.1%).\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e A significant correlation was noted between treatment methods and mandibular fracture sites (χ\u0026sup2; = 29.192, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cramer's V\u0026thinsp;=\u0026thinsp;0.3)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.5.2 Condylar fractures(Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/h2\u003e\u003cp\u003eOf the 232 treated condylar fractures, there were a total of 120 intracapsular condylar fractures (51.7%) and 112 extracapsular condylar fractures (48.3%). A higher proportion of intracapsular condylar fractures were treated conservatively (92/120 76.7%), whereas a higher rate of extracapsular condylar fractures underwent open surgery (80/112, 71.4%). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e There were significant differences in the treatment methods between the two types of condylar fractures (χ\u0026sup2; = 53.857, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cramer's V\u0026thinsp;=\u0026thinsp;0.482).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTreatment of Condylar Fractures\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConservative treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurgical treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eχ\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eintracapsular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e53.857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eextracapsular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.5.3 Midfacial fractures (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/h2\u003e\u003cp\u003eThere were a total of 188 treated midfacial fracture, of which 72 were treated conservatively(38.3%), 116 were treated with open surgery(61.7%). As for the subdivisions of the midface, the open surgical treatment rates of ZC, Orbit and Maxilla were higher than the conservative treatment rates, with surgical treatment rates of 81.6% (71/87), 66.7% (8/12) and 55.2% (16/29), respectively. The conservative treatment rates was higher than the surgical treatment rates in the rest subdivisions, which were 70.8% (17/24) for Nasal Bone, 63.0% (17/27) for OTR, and 55.6% (5/9) for NOE, respectively. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e A significant correlation was noted between treatment methods and midfacial fracture sites (χ\u0026sup2; = 34.075, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cramer's V\u0026thinsp;=\u0026thinsp;0.426).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.5.4 Upper facial fractures\u003c/h2\u003e\u003cp\u003eAll the upper facial fractures were frontal fractures, in which the conservative treatment rate was higher than the surgical rate, 83.3% (10/12) versus 16.7% (2/12), respectively.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Concomitant injuries\u003c/h2\u003e\u003cp\u003eOf the 341 maxillofacial fracture patients, a total of 58 were combined with fractures in other parts of the body, 32 with craniocerebral injuries, 27 with thoracic injuries, and 6 with abdominal injuries.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eMaxillofacial fractures in minors account for less than 15% of all facial fractures[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Maxillofacial injuries in minors are mostly confined to soft tissue and alveolar bone, with a low incidence of maxillofacial fractures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, pediatric maxillofacial fractures are associated with higher mortality and more severe injuries than non-maxillofacial fractures, as well as longer hospital stays, intensive care unit stays and higher hospital costs[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, pediatric maxillofacial fractures exhibit diverse clinical patterns influenced by multiple factors, varying in severity and location, and potentially leading to complications [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, the related research on pediatric maxillofacial fractures still needs to be carried out to better assist clinicians in the diagnosis and treatment process and the accurate judgment at the first visit.\u003c/p\u003e\u003cp\u003eThe observed male predominance of pediatric maxillofacial fractures in our study (68.0%, male:female\u0026thinsp;=\u0026thinsp;2.13:1) aligns with findings from prior studies, possibly attributed to boys' higher levels of physical activity and participation in outdoor pursuits, thereby elevating the susceptibility to injuries[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In addition, the genders among different age groups were not statistically significant (P\u0026thinsp;=\u0026thinsp;0.077), but males had the highest proportion in the adolescent group (72.5%, male:female\u0026thinsp;=\u0026thinsp;2.64:1).\u003c/p\u003e\u003cp\u003eThe patients included in this study were categorized into three different age groups, 0\u0026ndash;6 years old, 7\u0026ndash;12 years old and 13\u0026ndash;18 years old, respectively. This type of age distribution was preferred because it encompasses three critical stages of development (preschool, school and adolescence)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. FAG was the most common cause of injury for maxillofacial fractures in minors which is consistent with previous studies[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, some studies have shown that TA is the most common cause of injury for maxillofacial fractures in adolescents[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Overall, the causes of maxillofacial fractures in pediatric patients vary by region, culture, living environment and socioeconomic characteristics[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, the FAH was the most common cause of injury in the 0\u0026ndash;6 age group. The study found there were statistically significant differences in the causes of injury among three age groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This phenomenon can be interpreted by the changes of parents ' sense of supervision and prevention, minors' sense of self-protection and the social environment that minors contact.\u003c/p\u003e\u003cp\u003ePrevious literature indicated that mandibular fractures are a common type of pediatric maxillofacial fracture, comprising an estimated 40\u0026ndash;70% of pediatric facial trauma cases[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Mandibular fractures accounted for 77.1% (263/341)in our study. Among these mandibular fractures, condyle and symphysis were found to be the most common sites in minors, accounting for 61.6% and 38.4%. This may be attributed to the inherent structural vulnerability of these two locations, combined with the existence of tooth germs within the mandibular body and the insufficient calcification of cortical bone in minors[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. ZC was the most common part of midfacial fracture in minors, accounting for 63.31%. This is due to pneumatization and the development of the paranasal sinuses, which ensure additional resistance to fractures in children[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition, there was a statistically significant difference in mandibular fracture sites among three age groups (P\u0026thinsp;=\u0026thinsp;0.004). The Symphysis incidence in 0\u0026ndash;6 age group was significantly different from that in the other two groups.\u003c/p\u003e\u003cp\u003eAs the growth center of mandible, the high frequency of condylar fractures (61.6%) in this study raises concerns regarding potential pediatric facial deformities, malocclusion and dysfunction (even temporomandibular join ankylosis) in the future[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Consequently, a comprehensive investigation into condylar fractures was undertook. Previous studies have found that isolated unilateral condylar fractures are often more severe than condylar fractures associated with other fractures, and unilateral condylar fractures are more often associated with mandibular angle fractures[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It is difficult to confirm or disprove these views in this study. However, children with unilateral condylar fractures were found to have a higher incidence of isolated fractures and a moderate correlation with single fractures compared with bilateral condylar fractures in this study (\u003cem\u003eC\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.402, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). And bilateral condylar fractures were less likely to be isolated and more likely to be associated with other mandibular fractures, which is similar to the findings of related studies and further found a weak positive correlation with Symphysis compared with unilateral condylar fractures (\u003cem\u003eC\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.284, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This study suggests that many condylar fractures may be caused by indirect forces exerted on the mandible. Therefore, this condition in children should be paid particular attention to avoid missed diagnosis and misdiagnosis.\u003c/p\u003e\u003cp\u003eIn recent years, with the advent of new surgical techniques and instruments, the debate over whether to choose surgical or conservative treatment for pediatric maxillofacial fractures has continued[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. All patients were followed up for at least 6 months, and most of them achieved good treatment outcomes via our treatment strategies. Similar to some studies[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], although certain principles for the reduction and stabilization of oral and maxillofacial fractures applicable to adults can also be uesd in pediatric patients, this study found that there are some key points or precautions for surgical intervention. For example: 1) minimizing iatrogenic injuries to avoid secondary damages that are detrimental to fracture healing during the surgery;2) trying to use absorbable materials to avoid secondary surgery and affecting bone development; 3) restoring the continuity of facial bones, but don\u0026rsquo;t pursue anatomical reduction and solid internal fixation; 4) attempting to preserve the periosteum and reposition it as much as possible. In addition, condylar fractures in children were classified into intracapsular and extracapsular condylar fractures[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the study, the treatment methods of condylar fracture under this classification were focused and there are significant differences in the treatment methods between the two types of condylar fractures (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, conservative management was predominant for intracapsular fractures (76.7%), whereas extracapsular fractures were primarily addressed through open surgical intervention (71.4%). The relatively high rate of surgical intervention for pediatric condylar fractures may be attributed to the continuous refinement of surgical techniques, instruments and good treatment strategy.\u003c/p\u003e\u003cp\u003eHowever, the study also has some limitations. The retrospective nature of this research may determine that the data recorded at the time of admission, as well as the data recorded at the follow-up, may be incorrect or incomplete. It could also be limited by a single institution\u0026rsquo;s scope, which may reduce the generalizability of the study. Another limitation is the absence of a long-term follow-up. We would like to point out, the research hospital has the largest medical center of oral and maxillofacial surgery in southeastern China.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn conclusion, this study demonstrated that there are different clinical epidemiological features and characteristics of pediatric maxillofacial fractures in different age groups. Appropriate treatment strategies are crucial for achieving better therapeutic outcomes. These findings may assist practitioners in avoiding misdiagnosis and inappropriate treatments, while promoting the implementation of protective measures to reduce the incidence of pediatric maxillofacial fractures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFAG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Fall at ground level\u0026nbsp;\u003cbr\u003eTA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Traffic accidents\u0026nbsp;\u003cbr\u003eFAH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Fall from a height\u0026nbsp;\u003cbr\u003eUT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Unspecified trauma\u003cbr\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Other mandibular fracture regions (e.g., ramus, coronoid, alveolar process)\u003cbr\u003eZC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Zygomatic complex\u003cbr\u003eNOE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Naso-orbital-ethmoid\u003cbr\u003eOTR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Other midfacial fracture regions (e.g., alveolar process)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e7.1 Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University, which was carried out in compliance with the guidelines outlined in the 2008 Declaration of Helsinki and its subsequent amendments. The legal guardians of the minors who participated in the study signed informed consent forms authorizing the anonymous use of their medical information. Patients aged 18 years provided informed consent forms themselves, allowing the anonymous use of their medical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.2 Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe legal guardians of the minors and the patients aged 18 years signed informed consent forms authorizing the anonymous use of their medical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.3 Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.4 Competing interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.5 Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.6 Authors’ contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi Huang, Lisong Lin and Canyang Jiang contributed to the study conception and design. Data collection was performed by Yan Jiang and Xiaojing Zhang. Data analysis was performed by Xiaojing Zhang and Yali Wen . The first draft of the manuscript was written by Canyang Jiang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.7 Acknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate all patients in this study for their participation, understanding and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAndrew TW, Morbia R, Lorenz HP. Pediatric Facial Trauma. Clin Plast Surg. 2019;46(2):239-247.\u003c/li\u003e\n\u003cli\u003eCleveland CN, Kelly A, DeGiovanni J et al. Maxillofacial trauma in children: Association between age and mandibular fracture site. Am J Otolaryngol. 2021;42(2):102874.\u003c/li\u003e\n\u003cli\u003eWheeler J, Phillips J. Pediatric facial fractures and potential long-term growth disturbances. Craniomaxillofac Trauma Reconstr. 2011;4(1):43-52.\u003c/li\u003e\n\u003cli\u003eChandra SR, Zemplenyi KS. Issues in Pediatric Craniofacial Trauma. Facial Plast Surg Clin North Am. 2017;25(4):581-591.\u003c/li\u003e\n\u003cli\u003eMassenburg BB, Sanati-Mehrizy P, Taub PJ. Surgical Treatment of Pediatric Craniofacial Fractures: A National Perspective. J Craniofac Surg. 2015;26(8):2375-2380.\u003c/li\u003e\n\u003cli\u003eHatef DA, Cole PD, Hollier LH. Contemporary management of pediatric facial trauma. Current Opinion in Otolaryngology \u0026amp; Head \u0026amp; Neck Surgery. 2009;17(4):308-314.\u003c/li\u003e\n\u003cli\u003eZhou W, An J, He Y et al. Analysis of pediatric maxillofacial trauma in North China: Epidemiology, pattern, and management. Injury. 2020;51(7):1561-1567.\u003c/li\u003e\n\u003cli\u003eBataineh AB. Pattern and management of maxillofacial fractures in Jordanian children and adolescents. Med Oral Patol Oral Cir Bucal. 2023;28(3):e272-e277.\u003c/li\u003e\n\u003cli\u003eVyas RM, Dickinson BP, Wasson KL et al. Pediatric facial fractures: current national incidence, distribution, and health care resource use. J Craniofac Surg. 2008;19(2):339-349; discussion 350.\u003c/li\u003e\n\u003cli\u003eSoleimani T, Greathouse ST, Sood R et al. Epidemiology and resource utilization in pediatric facial fractures. J Surg Res. 2016;200(2):648-654.\u003c/li\u003e\n\u003cli\u003eSegura-Palleres I, Sobrero F, Roccia F et al. Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study. Dent Traumatol. 2022;38(3):213-222.\u003c/li\u003e\n\u003cli\u003eBraun TL, Xue AS, Maricevich RS. Differences in the Management of Pediatric Facial Trauma. Semin Plast Surg. 2017;31(2):118-122.\u003c/li\u003e\n\u003cli\u003eImahara SD, Hopper RA, Wang J et al. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):710-716.\u003c/li\u003e\n\u003cli\u003eMarc KK, Bakary O, Alexandre De Mis\u0026egrave;res OO et al. Children mandibular fractures: Epidemiological and anatomo-clinical aspects. Heliyon. 2024;10(3):e24947.\u003c/li\u003e\n\u003cli\u003eBarbosa KGN, de Macedo Bernardino \u0026Iacute;, d\u0026apos;Avila S et al. Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents. Oral Maxillofac Surg. 2017;21(2):131-145.\u003c/li\u003e\n\u003cli\u003eOwusu JA, Bellile E, Moyer JS et al. Patterns of Pediatric Mandible Fractures in the United States. JAMA Facial Plast Surg. 2016;18(1):37-41.\u003c/li\u003e\n\u003cli\u003eOdom EB, Snyder-Warwick AK. Mandible Fracture Complications and Infection: The Influence of Demographics and Modifiable Factors. Plast Reconstr Surg. 2016;138(2):282e-289e.\u003c/li\u003e\n\u003cli\u003eTotonchi A, Sweeney WM, Gosain AK. Distinguishing anatomic features of pediatric facial trauma. J Craniofac Surg. 2012;23(3):793-798.\u003c/li\u003e\n\u003cli\u003eZhou HH, Han J, Li ZB. Conservative treatment of bilateral condylar fractures in children: case report and review of the literature. Int J Pediatr Otorhinolaryngol. 2014;78(9):1557-1562.\u003c/li\u003e\n\u003cli\u003eBottini GB, Roccia F, Sobrero F. Management of Pediatric Mandibular Condyle Fractures: A Literature Review. J Clin Med. 2024;13(22).\u003c/li\u003e\n\u003cli\u003eSilvennoinen U, Iizuka T, Lindqvist C et al. Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period. J Oral Maxillofac Surg. 1992;50(10):1032-1037.\u003c/li\u003e\n\u003cli\u003eZhou HH, Liu Q, Cheng G et al. Aetiology, pattern and treatment of mandibular condylar fractures in 549 patients: a 22-year retrospective study. J Craniomaxillofac Surg. 2013;41(1):34-41.\u003c/li\u003e\n\u003cli\u003eZachariades N, Mezitis M, Mourouzis C et al. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg. 2006;34(7):421-432.\u003c/li\u003e\n\u003cli\u003eMcLeod NM, Keenan M. Towards a consensus for classification of mandibular condyle fractures. J Craniomaxillofac Surg. 2021;49(4):251-255.\u003c/li\u003e\n\u003cli\u003eSharif MO, Fedorowicz Z, Drews P et al. Interventions for the treatment of fractures of the mandibular condyle. Cochrane Database Syst Rev. 2010;(4):Cd006538.\u003c/li\u003e\n\u003cli\u003eSiy RW, Brown RH, Koshy JC et al. General management considerations in pediatric facial fractures. J Craniofac Surg. 2011;22(4):1190-1195.\u003c/li\u003e\n\u003cli\u003eJuncar RI, Moca AE, Juncar M et al. Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study. Children (Basel). 2023;10(5).\u003c/li\u003e\n\u003cli\u003eIrgebay Z, Glenney AE, Cheng L et al. Fracture Patterns, Associated Injuries, Management, and Treatment Outcomes of 530 Pediatric Mandibular Fractures. Plast Reconstr Surg. 2024;154(3):556e-568e.\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":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"maxillofacial fractures, epidemiology, treatment, children and adolescents","lastPublishedDoi":"10.21203/rs.3.rs-7201314/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7201314/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough pediatric maxillofacial fractures are uncommon relative to the adult counterparts, a comprehensive understanding of this trauma type is critical to the short- and long-term prevention and treatment for minors. The objective of this study was to describe the main clinical epidemiology, characteristics and treatment of pediatric maxillofacial fractures in different age groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was a retrospective study that was conducted for 15 years in a tertiary hospital for oral and maxillofacial surgery from southeast China. Age, sex, etiology, type of fracture, treatment and concomitant injury were collected from the data of the enrolled patients. The patients were categorized into three groups according to age: ≤6 years old, 7–12 years old, and 13–18 years old. Statistical analysis was conducted mainly using Chi-Square test (p ≤ 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 341 patients with maxillofacial fractures were followed up for at least 6 months, then most patients achieved good treatment outcomes in this study. The mean age was 12.04±5.16 years and the male-to-female ratio was 2.13∶1. Fall from a height (FAH) was the primary cause of maxillofacial fractures in 0-6 age group, whereas Fall at ground level (FAG) predominated in both 7–12 age group and 13–18 age group. There were a total of 263 mandibular fractures, 139 midfacial fractures, and 12 suprafacial fractures. Among the mandibular fractures, patients with unilateral condylar fractures were more likely to have isolated fractures than those with bilateral fractures (\u003cem\u003eC \u003c/em\u003e= 0.402, p \u0026lt; 0.001), whereas bilateral condylar fractures, compared to unilateral ones, showed a weak positive correlation with symphyseal fractures (\u003cem\u003eC\u003c/em\u003e= 0.284, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are different clinical epidemiological features and characteristics of pediatric maxillofacial fractures in different age groups. Appropriate treatment strategies are crucial for achieving better therapeutic outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"Clinical Epidemiology, Patterns and Treatment of Maxillofacial Fractures in children and adolescents: A 15- Year Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 12:49:30","doi":"10.21203/rs.3.rs-7201314/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-25T06:31:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-23T08:20:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-20T07:21:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T13:32:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1045712470358429457954317404072894712","date":"2025-08-19T13:23:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296409440947844480896656147380959583826","date":"2025-08-19T04:28:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87922295466167733701133606591244262667","date":"2025-08-18T01:37:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237757415394650838368003140770763518140","date":"2025-08-15T14:47:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T01:02:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209442325619716336374066337494358980587","date":"2025-08-14T22:24:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-14T01:25:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-31T09:45:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T01:54:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-30T01:53:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-07-24T04:22:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51044a65-7982-473c-9748-ea41cf594d2c","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:06:33+00:00","versionOfRecord":{"articleIdentity":"rs-7201314","link":"https://doi.org/10.1186/s12903-025-07283-6","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-12-17 15:57:23","publishedOnDateReadable":"December 17th, 2025"},"versionCreatedAt":"2025-08-21 12:49:30","video":"","vorDoi":"10.1186/s12903-025-07283-6","vorDoiUrl":"https://doi.org/10.1186/s12903-025-07283-6","workflowStages":[]},"version":"v1","identity":"rs-7201314","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7201314","identity":"rs-7201314","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}