Le Fort Fractures in Kids: Do They Happen? The 30-year Experience at the Johns Hopkins Hospital
Alexandra Macmillan, MBBS, Joseph Lopez, MD MBA, JD Luck, BA, Muhammad Faateh, MBBS, Robin Yang, DDS MD, Edward Davidson, MBBS, Anthony P. Tufaro, DDS MD, Paul Manson, MD, Amir Dorafshar, MBChB.
Johns Hopkins Hospital, Baltimore, MD, USA.
Purpose: Currently, it is unclear whether Le Fort fractures occur in the pediatric population. The purpose of this study was to examine the etiology, incidence, and patterns of management of children with severe facial trauma associated with pterygoid-plate fractures.
Methods: We studied all pediatric patients with pterygoid-plate fractures that presented to our institute from 1990-2013. Patient charts and radiological imaging were reviewed and demographics, fracture characteristics and treatment outcomes recorded. Fractures were categorized into three groups: Group 1: Simple, lacking key features of Le Fort-type fractures, Group 2: Le Fort-like, lacking 1 feature of Le Fort-type fractures and Group 3: Le Fort-type fracture patterns. Univariate methods were employed to compare groups.
Results: Of the 24 patients identified, 75% were male, mean age was 8.6, mean ISS 23.7 and mean GCS 9.7. The two most common causes of these fractures patterns were MVA (67%) and pedestrian (25%). 60% were managed operatively. 58% patients had skull fractures, 45.8% intracranial trauma, and 17% developed meningitis. One patient had a C-Spine injury. Group 1 had 8, group 2 had 4 and group 3 had 12 patients. Significant differences were age 5.9 vs 10.4 between group 1 vs group 3 (p=0.004). No differences in ISS, operative repair, complications, LOS, presence of skull fractures or intracranial trauma were found between these groups.
Conclusion: We present the largest study of pediatric patients presenting with pterygoid fractures associated with facial trauma. We find Le Fort-type fractures present in older children but younger children rarely display Le Fort-like patterns.
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