Mechanism patterns and age variations in pediatric cranio-maxillofacial trauma: a 5-year analysis of the national trauma data bank

Abstract

Purpose: Pediatric craniomaxillofacial trauma presents unique diagnostic and management challenges due to the anatomical and developmental characteristics of children. Methods: This retrospective study analyzed 795,431 pediatric trauma cases (ages 0–18 years) from the National Trauma Data Bank (2017–2022) to characterize injury patterns and risk factors. Results: Among 119,324 cases (15.0%) involving craniomaxillofacial fractures, incidence increased significantly with age, from 0.93% in infants to 5.59% in adolescents. Motor vehicle collisions were the leading mechanism, doubling fracture risk (odds ratio 2.39, 95% confidence interval 2.19–2.59), while proper restraint use reduced risk by 43% (odds ratio 0.572, 95% confidence interval 0.52–0.62). Falls were the predominant mechanism in younger children, whereas motor vehicle collisions, assault, and firearm-related injuries increased with age. Fracture patterns shifted developmentally: cranial vault fractures dominated in younger children, while cranial base, midface, mandibular, and dental fractures became prevalent in older populations. Conclusion: These findings emphasize the need for age-specific prevention strategies, including improved restraint compliance and targeted injury mitigation programs, to reduce the burden of pediatric facial trauma.