Prevalence and Etiology of Pediatric Maxillofacial Injuries: A Unicenter-based Retrospective Study.

BACKGROUND: Children are uniquely susceptible to craniofacial trauma because of their greater cranial mass-to-body ratio. The craniofacial injuries comprise approximately 11.3% of an overall pediatric emergency, and its etiology affects the incidence, clinical presentation, and treatment modalities, which are influenced by sociodemographic, economic, and cultural factor of the population being studied. MATERIALS AND METHODS: A retrospective review to analyze the epidemiology of facial injuries in pediatric population (age range-0-16 years), divided into three age groups, i.e., group I (0-5 years), group II (6-11 years) and group III (12-16 years), was carried out over a 3-year span, in order to determine the facial injury pattern, mechanism and concomitant injury by age. RESULTS: A total of 1,221 patients with facial injuries, reporting to our trauma center and outpatient department were identified. Majority of these injuries were encountered among boys (64%). Motor vehicle collision (46.5%) was the most common cause of facial fracture and dentoalveolar injuries in group II and group III, while fall was the most common cause among the group I (30.2%). Mandible was the most commonly fractured bone (34.7%) followed by nasal (33.3%), maxilla (17.5%), and zygoma (14.3%). More than 50% sustained concomitant injuries. CONCLUSION: The importance of epidemiological analysis lies in the identification of trauma burden, which could help motivate and develop more efficient ways to plan resources allocation and deliver adequate care and preventive steps. Improvisation upon National Prevention Programs could lower incidences of such injuries. HOW TO CITE THIS ARTICLE: Bhutia DP, Singh G, Mohammed S, et al. Prevalence and Etiology of Pediatric Maxillofacial Injuries: A Unicenter-based Retrospective Study. Int J Clin Pediatr Dent 2019;12(6):528-531.

Hydroxyapatite collagen scaffold with autologous bone marrow aspirate for mandibular condylar reconstruction.

PURPOSE: This study was designed with the aim to assess the efficiency of hydroxyapatite/collagen (HA/Col) bio-scaffold with bone marrow aspirate (BMA) to reconstruct mandibular condyle in patients with temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: Seven pediatric patients with TMJ ankylosis, who visited our outpatient clinic and whose parents opted for this procedure, were included in this study. After a history and clinical examination for TMJ movements, computed tomography (CT) scans were obtained. Interposition arthroplasty, with or without coronoidectomy, was performed to gain at least 35 mm of mouth opening. A 2-ml quantity of BMA was aspirated from the posterior iliac crest. A HA/Col block was carved to shape the condyle, and was fixed to the ramus using a plate and screws. A collagen sponge soaked in BMA was interposed in between the graft and ramal end, and the temporal fascia was rotated between the glenoid fossa and graft. Physiotherapy was started on postoperative day 10. All patients were followed up for 1 year. Success was graded on the basis of the mouth opening and TMJ score based on efficiency of chewing, speech, activity, recreation, mood, and anxiety on a five-point ordinal scale. RESULTS: The mean age was 9.71 years (range 5-14 years), and the male-to-female ratio was 5:2. The mean preoperative mouth opening was 4.14 mm, which improved to 34.57 mm at 1-year follow-up. The mean protrusive movement improved from 0 to 2.86 mm. The mean success score was 4.43 out of 5. The mean TMJ score improved from 2.38 to 3.94. CONCLUSION: A HA/Col bio-scaffold with bone marrow aspirate is a safe and cost-effective alternative for reconstruction of the mandibular condyle, particularly in growing individuals with high osteogenic potential.

Simultaneous maxillomandibular distraction osteogenesis in hemifacial microsomia: Report of 7 cases.

INTRODUCTION: The goal in treating Hemifacial microsomia (HFM) is to improve facial symmetry, allow functional jaw movement, obtain stable occlusion, and achieve patient satisfaction. This study was planned with an aim to assess the outcome of simultaneous maxillomandibular distraction osteogenesis in hemifacial microsomia. MATERIAL & METHODS: Seven patients with hemifacial microsomia were included in this study and demographic data was obtained. Simultaneous maxillo-mandibular distraction was planned for correction of maxillary cant, vertical ramal lengthening and midline, by performing unilateral mandibular osteotomy in ramus and distractor fixation, a Le Fort I osteotomy, with fixation at contralateral zygomatic buttress and intermaxillary elastics. Derriford Appearance Scale was used to measure individual responses to address problems of appearance. RESULTS: 6 males and 1 female, with age range 18-26 years, mean 22.14 were included in the study. Maxillary occlusal cant varied from 4-16°, mean 9.85° and distraction achieved ranged from 12-19 mm, mean 15.57. Preoperatively DAS score ranged from 42-61, mean 51.7 and improved to 10-27, mean 18.4. 100% success was achieved in 5 cases, while other two showed 96% and 99% success. CONCLUSION: Simultaneous maxillomandibular distraction osteogenesis improves facial esthetics and obviates the need for postoperative orthodontics, minimizing the treatment period.

A novel step osteotomy for correction of hemifacial microsomia - A case report.

Facial asymmetry is one of the commonest facial anomalies, with reported incidence as high as 34%. Hemifacial microsomia (HFM) has an incidence of 1 in every 4000-5600 children and is one of the commonest causes of facial asymmetry. The standard treatment of HFM is orthognathic surgery by bilateral saggital split osteotomy (BSSO) or distraction osteogenesis (DO) of the mandible, both of which involve prolonged periods of occlusal adjustments by an orthodontist. Here, we present distraction of the mandible by means of a novel modified step osteotomy to correct the facial asymmetry in a case of hemifacial microsomia without disturbing the occlusion. This novel technique can prove to be a new tool in the maxillofacial surgeons armamentarium to treat facial asymmetry.