Frequency of Cervical Spine Injuries in Pediatric Craniomaxillofacial Trauma

Publication date: Available online 27 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Helen Xun, Joseph Lopez, Halley Darrach, Richard J. Redett, Paul Manson, Amir Dorafshar

ABSTRACT

Purpose

In pediatric craniomaxillofacial (CMF) trauma patients, evaluation for cervical spine injury (CSI) is critical, but there are no studies investigating CSI in this unique population. The aim of this study was to measure the frequency of CSI in pediatric CMF fracture population.

Methods

A retrospective cohort study of all pediatric patients who presented to the Johns Hopkins Hospital Emergency Department with CMF fractures were examined for concurrent CSI injuries. Patient charts were reviewed for mechanism of injury, type and level of CSI, type and location of CMF fracture patterns, and overall outcome. Data was analyzed for correlation and statistical significance.

Results

A total of 2966 pediatric patients (ages 0-15) were identified from 1990 to 2010 to have suffered CMF fractures, with an average age of 7 ± 4.73 years, and 1897 (64.0%) male. Of these patients, only five children were found to have concomitant CSIs (0.169% frequency). The frequency of CSI in CMF fracture patients with deciduous, mixed, and permanent dentition was 0, 0.307, and 0.441%, respectively. Of the five identified cases, four had concomitant middle-third facial skeleton fractures, four had concomitant upper-thirds cranial skeletal fracture, and two had concomitant lower-thirds cranial skeletal fractures.

Conclusion

CSIs in pediatric CMF fracture patients are rare, with a frequency of 0.169%; this is significantly lower than the reported ranges in adults (3.69 to 24%). No child of deciduous dentition was found to have a CSI. The lack of CSI in deciduous CMF fracture patients could be explained by the anatomic differences between pediatric and adult cervical spines and supports conservative imaging for children in this age group.

Level of Evidence

III

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