(Jurnal Plastik Rekonstruksi, 2024.
Vol 11.
No 1, 28-.
CRANIOFACIAL
Article RETROSPECTIVE SINGLE-CENTRE DESCRIPTIVE STUDY OF CHARACTERISTIC AND MANAGEMENT OF PAEDIATRIC VS
ADULT PATIENTS PRESENTING WITH CRANIOMAXILLOFACIAL
FRACTURE
Vika Tania1,2*).
Siti Handayani1,2.
Imam Susanto1,2, & Ines Hadianesti Rodjani1 Faculty of Medicine.
Universitas Indonesia.
Jakarta.
Indonesia Division of Plastic Reconstructive & Aesthetic Surgery.
Department of Surgery.
Faculty of Medicine Universitas Indonesia.
Jakarta.
Indonesia
ABSTRACT
Introduction: Pediatric facial fractures are recognized as separate entities from those occurring in the adult.
They differ significantly in their epidemiology, diagnosis and treatment.
An understanding of the cause, severity, and distribution of maxillofacial and skull vault trauma and associated injuries can assist in establishing clinical and research priorities for prevention and effective treatment of these injuries.
Because there were no studies of maxillofacial injuries in a large series in Cipto Mangunkusumo Hospital, we retrospectively analyzed the characteristics of facial injury treated at our hospital from January 2009 to December 2013.
Method: This research is a descriptive study to calculate and compare pediatric and adult maxillofacial fractures between 2009 until 2013.
Total sampling of all medical record of maxillofacial trauma patient who came to Cipto Mangunkusumo Hospital form January 2009 until December 2013 was recorded.
All data including age, gender, distribution of fracture site, etiology of fracture and fracture treatment were noted.
Severity of mandibular and midface fracture also recorded along with their specific fracture distribution.
Results: We recorded 409 patients with Craniomaxilofacial (CMF) injuries for 5 previous years that being treated in Cipto Mangunkusumo Hospital.
of these patients were pediatrics patient with age younger than 18 years old.
From the gender distribution we can see that most of the patient were male .
3%) with motorcycle as the main cause of trauma .
6%).
We can also see that midface fractures was highly suffered not only in adult patient but also in the pediatrics .
7%) with orbital, nasal and zygomatic complex fractures as the top three most common fracture site.
As for isolated mandible fractures share 22.
7% from total fractures, and 18.
6% suffered from both midface and mandible fracture.
From all of these trauma patients, only 42.
3% underwent open reduction and internal fixation surgery, while 28.
9% refuse treatment.
Conclusion: Maxillofacial trauma is not common in children.
however, the incidence is increasing in this country.
Although the principles of treatment follow as the adultAos, a few special considerations have to be taken into account in order to improve quality of life of the child in both short and long term.
A multidisciplinary approach in the management is therefore highly recommended.
Preventive measures and treatment plans in children and adult should be designed while keeping in mind their difference.
Keywords: Maxillofacial.
Trauma.
Fracture Latar Belakang: Fraktur wajah pada anak-anak diakui sebagai entitas yang terpisah dari yang terjadi pada orang Fraktur wajah pada anak-anak berbeda secara signifikan dalam epidemiologi, diagnosis, dan Pemahaman mengenai penyebab, tingkat keparahan, dan distribusi trauma pada wajah dan tengkorak serta cedera terkait dapat membantu dalam menentukan prioritas klinis dan penelitian untuk pencegahan dan perawatan yang efektif terhadap cedera tersebut.
Karena tidak ada studi mengenai cedera maxillofacial dalam jumlah besar di Rumah Sakit Cipto Mangunkusumo, kami menganalisis secara retrospektif karakteristik cedera wajah yang ditangani di rumah sakit kami dari Januari 2009 hingga Desember 2013.
Metode: Penelitian ini adalah studi deskriptif untuk menghitung dan membandingkan fraktur maxillofacial pada anak-anak dan dewasa antara tahun 2009 hingga 2013.
Semua rekam medis pasien trauma maxillofacial yang datang ke Rumah Sakit Cipto Mangunkusumo dari Januari 2009 hingga Desember 2013 dicatat dengan metode pengambilan sampel total.
Semua data, termasuk usia, jenis kelamin, distribusi lokasi fraktur, etiologi fraktur, dan pengobatan fraktur dicatat.
Tingkat keparahan fraktur mandibula dan fraktur midface juga dicatat bersamaan dengan distribusi fraktur spesifiknya.
Received: 04-03-2024.
Revised: 14-04-2024.
Accepted: 10-06-2024 Copyright by Tania.
Handayani.
Susanto.
, & Rodjani.
I H.
, .
iC P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
Published by Lingkar Studi Bedah Plastik Foundation.
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Retrospective single-centre descriptive study of characteristic and management of paediatric vs adult patientsA Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
Hasil: Kami mencatat 409 pasien dengan cedera kraniomaksilofasial (CMF) selama 5 tahun terakhir yang dirawat di Rumah Sakit Cipto Mangunkusumo.
Sebanyak 17,6% .
dari pasien-pasien tersebut adalah pasien pediatrik dengan usia di bawah 18 tahun.
Dari distribusi jenis kelamin, terlihat bahwa sebagian besar pasien adalah laki-laki .
,3%), dengan sepeda motor sebagai penyebab trauma utama .
,6%).
Kami juga melihat bahwa fraktur midface banyak dialami tidak hanya oleh pasien dewasa tetapi juga oleh pasien pediatrik .
,7%), dengan fraktur orbital, nasal, dan kompleks zygomatik sebagai tiga lokasi fraktur yang paling umum.
Fraktur mandibula yang terisolasi menyumbang 22,7% dari total fraktur, dan 18,6% mengalami fraktur kombinasi midface dan mandibula.
Dari semua pasien trauma ini, hanya 42,3% yang menjalani operasi reduksi terbuka dan fiksasi internal, sementara 28,9% menolak perawatan.
Kesimpulan: Trauma maxillofacial tidak umum terjadi pada anak-anak.
namun, insidensinya sedang meningkat di negara ini.
Meskipun prinsip-prinsip perawatan mengikuti prinsip yang sama dengan pada orang dewasa, beberapa pertimbangan khusus perlu diperhatikan untuk meningkatkan kualitas hidup anak baik dalam jangka pendek maupun jangka panjang.
Oleh karena itu, pendekatan multidisiplin dalam penanganan sangat dianjurkan.
Langkah-langkah pencegahan dan rencana perawatan pada anak-anak dan dewasa harus dirancang dengan mempertimbangkan perbedaan di antara keduanya.
Kata Kunci: Maksilofasial.
Trauma.
Fraktur Conflicts of Interest Statement:
The author.
listed in this manuscript declare the absence of any conflict of interest on the subject matter or materials discussed.
INTRODUCTION
Pediatric facial fractures are recognized as separate entities from those occurring in the They differ significantly in their epidemiology, diagnosis and treatment.
The pediatric population is defined by the Indonesian Pediatric association as those younger than 18 years of age.
In the epidemiologic study of trauma, the etiology of maxillofacial trauma varies from one country to another because of different social, cultural, and environmental conditions.
Globally, the main causes are road traffic accident, assault, fall, and sport injury.
The clinical characteristics of trauma change with social circumstances, geopolitical upheaval, technologic advances, and environmental changes.
Numerous surveys of facial injuries have shown that the incidence and pattern of fractures of the maxillofacial region have changed during the years.
An understanding of the cause, severity, and distribution of maxillofacial and skull vault trauma and associated injuries can assist in establishing clinical and research priorities for prevention and effective treatment of these Because there were no studies of maxillofacial injuries in a large series in Cipto Mangunkusumo Hospital, we retrospectively analyzed the characteristics of facial injury treated at our hospital from January 2009 to December 2013, to determine their demographic, distribution and their management.
METHOD
This research is a descriptive study to calculate and compare pediatric and adult maxillofacial fractures between 2009 until 2013.
Total sampling of all medical record of maxillofacial trauma patient who came to Cipto Mangunkusumo Hospital form January 2009 until December 2013 was recorded.
All data including age, gender, distribution of fracture site, etiology of fracture and fracture treatment were noted.
Severity of mandibular and midface fracture also recorded along with their specific fracture distribution.
RESULTS
Craniomaxilofacial (CMF) injuries for 5 previous years that being treated in Cipto Mangunkusumo Hospital.
of these patients were pediatrics patient with age younger than 18 years old (Chart .
From the gender distribution we can see that most of the patient were male .
with motorcycle as the main cause of trauma .
6%) (Chart 2.
Tabel.
We can also see that Copyright by Tania.
Handayani.
Susanto.
, & Rodjani.
I H.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Tania.
Handayani.
Susanto.
, & Rodjani.
I H.
, .
Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
midface fractures was highly suffered not only in adult patient but also in the pediatrics .
with orbital, nasal and zygomatic complex fractures as the top three most common fracture As for isolated mandible fractures share 7% from total fractures, and 18.
6% suffered from both midface and mandible fracture.
From all of these trauma patients, only 42.
underwent open reduction and internal fixation surgery, while 28.
9% refuse treatment.
The remaining patient underwent conservative treatment including closed reduction, dental occlusion fixation (MMF) and observations.
Tabel 2.
Distribution of fracture etiology Etiology Pediatric < 18 *With *Without Motor Assault Sports Fall Chart 1.
Age Distribution Number of patient <18 years old Ou18 years old Other 0 .
%) Total .
Adult A 18 Fracture Mandible Midface Mandible Midface Total Mandible Midface Mandible Midface Total Chart 2.
Gender Distribution Number of patient Severity Pediatric <18 male female <18 years old Number of Single Double Triple or more Total Tabel 1.
Distribution of fracture site Mandible Middle Mandible middle Total .
*With *Without Motor Assault Fall Work Hit Total .
Refuse 4 .
Conservative 7 .
%) 19 .
Surgical 10 .
Number .
Severity Adult
A 18
Single Double Triple or more Total
Number of Adult
A 18
Mandibl Middle Mandibl Total .
Pediatric <18 Condyle Symphysis Body Angle Ramus Coronoid Alveolar Total Number .
Mandibular
Adult
A 18
Condyle Symphysis Body Angle Ramus Coronoid Alveolar Total Copyright by Tania.
Handayani.
Susanto.
, & Rodjani.
I H.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Number .
Tabel 5.
Specific distribution on mandible fracture Mandibular Pediatric <18 Motorcycle Ou18 years old Number .
Adult
A 18
Number .
Tabel 4.
Severity of mandibular fracture Etiology Tabel 3.
Distribution of fracture management Pediatric <18 Motorcycle Number .
Number .
Retrospective single-centre descriptive study of characteristic and management of paediatric vs adult patientsA Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
Tabel 6.
Severity of midface fracture increases the risk of skull fractures and intracranial injuries.
With age the fracture frequency shifts from the upper face .
ith frontal and orbital fractures more common in the first 5 years of lif.
, to the lower face .
ith mandible fractures having a higher incidence after 6 years and into adulthoo.
2,3 This theory differs from the data that we conclude in Cipto Mangunkusumo Hospital.
From this study, we can see that midface fractures outnumbered mandibular fractured both in pediatric and adult Severity Pediatric <18 Single Double Triple or more Total Number .
Adult
A 18
Severity Number of Single Double Triple or more Total .
Tabel 7.
Specific Distribution on midface fracture Midface Pediatric <18 ZCF Arch Lefort I Lefort II Lefort i Sagittal NOE Nasal Orbital Ethmoid Maxilla Alveolar Palate Total Number .
Adult
A 18
Midface Number of ZCF 98 .
Arch 49 .
Lefort I 9 .
Lefort II 14 .
Lefort i Sagittal NOE Nasal 62 .
Orbital 95 .
Ethmoid Maxilla Alveolar 13 .
Palate Total
DISCUSSION
In Cipto Mangunkusumo Hospital, the etiology of trauma in pediatric population is similar to adult, with motorcycle accident being the most common, particularly involving boys and man.
This is probably attributed to the high use of motorcycle as the main vehicle for transport to work and school among Indonesians.
Among all motorcycle accident, most of the riders not using helmet as a protector, this also can be the reasons of high facial fractures.
1 In Indonesia, the age to obtain a rider license is 17 years old.
however this study showed that many children below this age were riding illegally which again, is not uncommon in this country.
Theoretically, the higher cranial to facial proportion in children reduces the risk that frontal impact will cause facial fracture, but This data maybe bias because most of the pediatric patient that was included in this study was older than 12 years old.
Developing teeth and sinuses affect the way fractures form.
At birth, sinuses have not yet developed and exist only as a bud of mucosa surrounded by cancellous bone.
Therefore, the facial skeleton in the child is composed of solid blocks of bone, in contrast to that of the adult skeleton whose sinuses are surrounded by buttresses that dissipate injury leading to more common fracture patterns.
This solid architecture makes the pediatric facial skeleton more resistant to trauma and more reliable to unusual fracture patterns.
In general, bone bearing mixed dentition is more resistant to Regarding the severity of midfacial fracture, most of it was single fractures with the most fractures involved was orbital, nasal and zygoma both in pediatric and adult populations.
A review article by Haug and Foss revealed that Le Fort fractures were least common facial fractures encountered in children.
5 Ferrerira et al reaffirmed that Le Fort fractures were found exclusively in patient older than 10 years.
6 Le Fort fractures are most common in the older patients when the paranasal sinuses are fully developed.
We did register 2 Lefort 1 fractures and 1 Lefort 2 fractures in Cipto Mangunkusumo Hospital for the last 5 years.
Regarding the severity of mandible fracture, children are prone to single and double fracture at the same percentage, while most of adult suffered from a single mandible fracture.
Symphysis fracture was the most common ste fracture both in children .
6%) and adult .
2%).
An infant with a minimal fracture does not require operative intervention, while an older child with a grossly displaced comminuted Copyright by Tania.
Handayani.
Susanto.
, & Rodjani.
I H.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Tania.
Handayani.
Susanto.
, & Rodjani.
I H.
, .
Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
fracture is best served with open reduction internal fixation (ORIF).
Unfortunately, most patients fall in the large watershed area in between, where the experience and preference of the surgeon will often times determine the course of management.
Until further evidence is available to provide accurate guidelines as to the degree of reduction accepted, it rests upon the surgeon to decide for each case individually whether closed or open reduction is warranted, and in doing so consider the degree of displacement, the feasibility of open reduction, and the age of the patient.
8 In this study, majority of the fractures in the adult were managed by open reduction .
%).
On the other hand, about 43% of the fractures in children were also treated by open surgical approach.
These percentages of surgical treatment in pediatric patients were higher compared to other studies abroad.
The rate of treatment refusal was high in Cipto Mangunkusumo Hospital.
1% in children and 4% in adult.
This refusal mostly causes by financial problems.
REFERENCES