Contemporary Management of Facial Fractures in Children With a Concomitant Concussion: A Narrative Review

Abstract

Pediatric traumatic brain injuries (TBI) are a substantive health burden globally and a major cause of childhood morbidity. Facial fractures are commonly associated with TBI, though the exact incidence is not known. In pediatric patients, facial fractures, especially those that require operative intervention, pose unique challenges when accompanied by a diagnosis of concussion and add complexity to the management decisions of surgical planning of facial fractures. This narrative review explores the contemporary management of facial fractures in children with concomitant concussions. The article discusses the challenges in diagnosing and treating these complex cases, including defining and classifying TBI, the natural history of TBI, ongoing research in biomarkers and imaging techniques, risks of anesthesia in TBI, specific anesthesia management, and optimal time interval for operative fixation of facial fractures. The authors also include a clinical management guide to guide clinicians in navigating these complex clinical factors. Overall, this review highlights the importance for recognizing and properly managing concomitant concussions in pediatric facial fractures cases.