This article reviews the trends in management of preadolescent facial fractures – a challenging population due to the need to consider growth, dynamic changes in dentition, and evolving fracture patterns. In summary, conservative management is preferred in all fractures in preadolescents whenever possible with the exception of significantly displaced fractures wherein the risks associated with open reduction and internal fixation outweigh the poor outcomes associated with inadequately aligned facial fractures. When necessary, brief periods of intermaxillary fixation are acceptable in the preadolescent. However, because of the primary or mixed dentition in this age group, alternatives to traditional tooth-anchored intermaxillary fixation may be required. Occasionally, a combination of techniques is useful. Consideration should be given to resorbable plating systems given the high growth potential of the facial skeleton in this age group and the need for metallic hardware removal. The article discusses the management of various facial fractures according to the anatomical location. This includes orbital and frontal skull base fractures, zygomatic and mid face fractures, mandibular fractures and nasal fractures. For nasal fractures, the authors recommend closed reduction but in the 7 to 12 year old group, recommend a ‘watch and wait’ philosophy for minimally displaced fractures. This is because of the need for general anaesthetic, the potential for further disruption of growth of the facial bones and the low likelihood of addressing septal deviation. They recommend formal septorhinoplasty after the age of 16 if necessary. As preadolescent fractures occur in a period of growth and evolving dentition in the facial skeleton, it is mandatory for the treating surgeon to have a thorough knowledge of standard and alternative treatment options to optimally manage these patients. This is a well written article with some useful images, which describes the current management of facial fractures in the preadolescent.

Current management of facial fractures in the preadolescent.
Alhumsi TR, Gilardino MS.
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Susan A Douglas

Sheffield, UK.

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