Pediatric Maxillofacial Fractures: A 10-Year Retrospective Analysis of 549 Cases With Emphasis on Facial Injury Severity Score Validation and COVID-19 Impact.

BACKGROUND

Pediatric maxillofacial fractures (PMFs) represent a distinct clinical entity due to their unique features. However, objective tools that inform surgical decision-making and stratify risk in PMF remain limited. In particular, the clinical utility of the Facial Injury Severity Score (FISS) in predicting management strategies and outcomes, as well as its behavior during extraordinary periods such as the COVID-19 pandemic, remains unclear.

PURPOSE: The purpose of this study was to measure the association between FISS and surgical intervention in PMF, including shifts during the COVID-19 pandemic.

STUDY DESIGN, SETTING, AND SAMPLE: A retrospective cohort study was conducted at Bursa Uludag University, in the Department of Plastic, Reconstructive, and Aesthetic Surgery. The study included subjects aged 0 to 17 years who were treated for confirmed maxillofacial fractures between 2015 and 2024. Exclusion criteria were soft tissue injuries without fracture, craniofacial anomalies, and incomplete records.

PREDICTOR VARIABLE: The predictor variable was injury severity measured using FISS.

MAIN OUTCOME VARIABLES: The primary outcome was therapeutic intervention, coded as operative versus nonoperative management. The treatment outcome was defined by the presence or absence of complications.

COVARIATES: Covariates included age group, sex, etiology, fracture site, concomitant injuries, treatment timing, and trauma period (pre-COVID-19, COVID-19, and post-COVID-19) ANALYSES: Descriptive and inferential analyses were performed using χ2, Mann-Whitney U, Kruskal-Wallis, and logistic regression tests. Statistical significance was defined as P value < .05.

RESULTS

The cohort consisted of 549 subjects with a mean age of 12.1 years (SD 4.3), of whom 422 (76.9%) were male. Mandibular fractures were the most common (n = 411, 43.9%). FISS was significantly associated with operative management, with higher scores observed in surgically treated subjects (P < .001). In multivariable logistic regression, each one-point increase in FISS was associated with a 2.69-fold increase in the odds of surgical intervention (P < .001). During the COVID-19 period, subjects demonstrated markedly higher injury severity (P = .01) and surgical rates compared with the pre-COVID period (P < .001).

CONCLUSIONS AND RELEVANCE: Higher FISS values were associated with operative management. Adolescent age was associated with an increased surgical intervention. The COVID-19 period was associated with higher odds of operative treatment, reflecting shifts in trauma severity and presentation patterns.