Addressing the Challenges in Pediatric Facial Fractures: A Narrative Review of Innovations in Diagnosis and Treatment

Abstract

Background/Objectives: Pediatric facial fractures present unique challenges due to the anatomical, physiological, and developmental differences in children’s facial structures. The growing facial bones in children complicate diagnosis and treatment. This review explores the advancements and complexities in managing pediatric facial fractures, focusing on innovations in diagnosis, treatment strategies, and multidisciplinary care. Methods: A narrative review was conducted, synthesizing data from English-language articles published between 2001 and 2024. Relevant studies were identified through databases such as PubMed, Scopus, Lilacs, Embase, and SciELO using keywords related to pediatric facial fractures. This narrative review focuses on anatomical challenges, advancements in diagnostic techniques, treatment approaches, and the role of interdisciplinary teams in management. Results: Key findings highlight advancements in imaging technologies, including three-dimensional computed tomography (3D CT) and magnetic resonance imaging (MRI), which have improved fracture diagnosis and preoperative planning. Minimally invasive techniques and bioresorbable implants have revolutionized treatment, reducing trauma and enhancing recovery. The integration of multidisciplinary teams, including pediatricians, psychologists, and speech therapists, has become crucial in addressing both the physical and emotional needs of patients. Emerging technologies such as 3D printing and computer-assisted navigation are shaping future treatment approaches. Conclusions: The management of pediatric facial fractures has significantly advanced due to innovations in imaging, surgical techniques, and the growing importance of interdisciplinary care. Despite these improvements, long-term follow-up remains critical to monitor potential complications. Ongoing research and collaboration are essential to refine treatment strategies and improve long-term outcomes for pediatric patients with facial trauma.

1. Introduction

Pediatric facial fractures pose unique challenges for surgeons due to the distinct anatomical and physiological characteristics of children’s facial structures [1]. The majority of facial fractures in pediatric individuals are observed in male children, who represented 64% of the cases, with a total incidence of 14.1% [2]. These injuries were most commonly seen in adolescents aged 13 to 18 years, with a higher prevalence in urban areas compared to rural regions [2]. The causes of fractures can be varied: motor vehicle collisions were the principal cause at 46.5%, while falls were also commonly observed at 30.2% [3]. The mandible was the most frequently fractured bone at 34.7%, followed by the nasal bones at 33.3%, the maxilla at 17.5%, and the zygoma at 14.3% [3]. Additionally, more than half of the children with facial fractures sustained other injuries, highlighting the severity of these trauma events [3]. Facial fractures in pediatric patients are frequently part of broader patterns of trauma, especially in the context of high-energy incidents like motor vehicle collisions [4], highlighting the need for a comprehensive approach to their diagnosis and treatment.

Each year, pediatric traumatic head trauma accounts for more than 500,000 visits to the emergency room and around 60,000 hospitalizations across the United States [5]. These injuries can range from minor concussions to serious brain trauma [5]. The management of pediatric facial fractures must address the immediate healing of the injury for the preservation of normal craniofacial development [6]. In addition, treatment plans must be tailored to account for the child’s age and the potential impact of the injury on future growth [7]. Pediatric fractures can involve only nasal bones, mandible, or more complex multi-bone fractures, often complicating surgical decisions [7]. Furthermore, the presence of growing dentition and differences in anatomy compared to adults adds complexity to the treatment [8]. Children also confront adhering to postoperative instructions, making them susceptible to complications [9]. A previous study [9] found that complications after facial fractures occurred in 21.6% of pediatric patients. The most common was an infection, which was observed in 50% of cases, followed by malocclusion at 25%, hypertrophic scarring at 12.5%, and the presence of fistulas at 12.5%. Another study also highlighted the main complications as facial asymmetry, infection, dysfunction, hypertrophic scarring, and malocclusion [10].

Beyond physical considerations, managing pediatric facial fractures requires a multifactorial approach [11]. This management must take into account the psychological impact on young patients, who may experience significant emotional distress due to altered appearance or long recovery periods [11]. Additionally, pediatric patients may encounter difficulties in following treatment plans, including post-operative limitations [6]. The involvement of the child’s family and the importance of providing emotional and psychological support cannot be overstated [12]. Furthermore, pediatric patients may face other complications compared to adults, including malocclusion or the involvement of developing dentition, which necessitates specialized care from dentistry [13].

Therefore, this narrative review aims to examine the key anatomical challenges and innovative solutions in diagnosing and treating pediatric facial fractures. The article focuses on recent advancements in diagnostic tools, surgical techniques, and the role of interdisciplinary care, which are essential to addressing the complexities of pediatric trauma. Special attention is given to innovations such as three-dimensional imaging technologies, virtual surgical planning, and the use of bioresorbable materials, all of which have improved diagnostic accuracy and surgical precision. Additionally, the increasing use of minimally invasive techniques is highlighted, as these allow for reduced trauma and quicker recovery, both of which are especially beneficial in pediatric populations. Finally, the review emphasizes the importance of collaborative care and future perspectives in managing the comprehensive needs of pediatric patients with facial fractures.

2. Materials and Methods

To provide a comprehensive overview of current practices and emerging strategies in pediatric facial trauma management, a narrative review of the literature was conducted according to the SANRA scale [14]. Data were collected from English-language articles published between January 2001 and January 2024. The following major databases were used for the search: Lilacs, SciELO, Embase, Scopus, and PubMed/Medline. The search terms included combinations of keywords such as “pediatric”, “facial fracture”, and “facial trauma in pediatrics”.

Articles were selected based on their relevance to pediatric facial fractures, focusing on studies that provided insights into diagnostic advancements, treatment strategies, and multidisciplinary care approaches. Both clinical studies and review articles were included to ensure a broad understanding of the current landscape and emerging innovations.

2.1. Selection Criteria

2.1.1. Inclusion Criteria for the Selected Studies Were

Study Type: This review includes peer-reviewed articles encompassing original research studies (such as clinical trials, cohort studies, case reports, and observational studies), as well as systematic and narrative reviews that focus on pediatric facial fractures.

Time Frame: Studies published between January 2001 and November 2024 were considered to capture the evolution of diagnostic methods and treatment innovations in pediatric facial fractures over the past two decades while allowing sufficient time to assess their clinical outcomes.

Language: Only articles published in English were included.

Relevance: Studies were selected based on their direct relevance to the diagnosis, surgical treatment, multidisciplinary care approaches, or technological innovations in managing pediatric facial fractures.

Research Question Framework: To define the research question, a PICO (Population, Intervention, Comparison, Outcome) approach was utilized with the following specifications:

• Population: Pediatric patients with facial fractures. This includes fractures resulting from trauma, which necessitate diagnostic or therapeutic interventions. Pediatrics were considered as individuals under 18 years of age, based on the previous definition [15].
• Intervention: Studies that focus on advancements in diagnostic techniques and treatment strategies for pediatric facial fractures.
• Comparison: While no specific control group was required for this narrative review, studies that compare traditional versus newer treatment methods or those that highlight specific approaches in the management of pediatric facial fractures were included.
• Outcome: The outcomes of interest include improvements in fracture diagnosis, surgical outcomes, recovery times, complication rates, and overall treatment effectiveness, including both physical and emotional outcomes for pediatric patients.

2.1.2. Exclusion Criteria

Studies that focused exclusively on adult populations (over 18 years old) or geriatric facial fractures were excluded from this review. Additionally, articles with combined data from both adults and pediatrics were only included if the pediatric-specific data were available and relevant to our analysis. Articles lacking separate pediatric data were excluded to ensure that the review focused specifically on pediatric facial fractures.

Articles that did not offer direct insights into clinical management or studies on animal models.

Studies focused exclusively on non-surgical management or those without clear clinical implications for pediatric care.

Studies focus on non-facial fractures or fractures outside the craniofacial region.

Studies include patients with severe comorbid conditions (congenital syndromes, severe neurological disorders, immunocompromised patients, and non-trauma-related facial injuries) that may affect the management of facial fractures.

2.2. Data Synthesis

A descriptive synthesis was employed to categorize the findings under thematic sections. These themes encompass anatomical challenges, diagnostic methods, multidisciplinary approaches, and treatment advancements, including the management of dental trauma in the treatment of pediatric facial fractures. Innovations such as 3D imaging technologies, minimally invasive surgical methods, bioresorbable materials, and the use of computer-assisted navigation were specifically highlighted.

This narrative review is organized into subtopics according to the themes to present the findings analytically. Key information on long-term follow-up care and psychosocial considerations for pediatric patients was also integrated, reflecting the holistic approach to treating these complex cases.

By synthesizing and organizing the findings in this manner, this narrative review article aimed to provide a clear and structured overview of the evolving state of knowledge in pediatric facial trauma management, offering insights into both established practices and cutting-edge strategies.

2.3. Quality Assessment

While no formal quality assessment tool, such as the risk of bias or grading of recommendations, was employed across all studies, the quality of the included studies was considered during the synthesis process. Factors such as study design, sample size, relevance to pediatric populations, and the clarity of conclusions were assessed to ensure that the studies included were of adequate quality to inform clinical practice and future research directions. In cases where methodological rigor varied, the synthesis noted this to provide a transparent view of the evidence base.

3. Results

3.1. Anatomical Challenges in Pediatric Facial Fractures

Facial fractures in pediatric patients commonly result from falls, sports-related injuries, motor vehicle accidents, or interpersonal trauma [16,17]. The spectrum of fractures can range from relatively simple nasal fractures to more complex injuries involving the mandible, zygoma, or multiple facial bones [17]. Consequently, recognizing the mechanism of injury and the extent of trauma is crucial for tailoring appropriate treatment strategies for each specific case, ensuring both effective healing and optimal functional outcomes.

Specifically, a recent study [12] on the prevalence of facial fractures found that the mandible was the most commonly fractured bone, accounting for 71% of cases. The fractures were particularly frequent in boys and often resulted from falls during the summer months. Following mandibular fractures, maxillary, zygomatic, and naso-orbito-ethmoid fractures were also commonly observed. Dentoalveolar trauma, affecting the teeth and surrounding bone, was another frequent injury. The highest incidence of mandibular fractures was seen in children aged 8 to 12 years. Due to anatomical differences, the prevalence of bone fractures in pediatric patients varies with age. In children under two years, the frontal bone is particularly vulnerable due to its prominent projection [18].

Pediatric facial anatomy presents distinct questions compared to adult structures, as shown in Table 1. Children have smaller, more delicate bones and a higher proportion of cartilage, especially on nasal bone [19]. These features make their fractures more prone to displacement and make difficulties in surgical reduction [20]. Also, this anatomical variability poses significant obstacles in both the accurate diagnosis and treatment of facial fractures, as well as in achieving stable clinical outcomes [21]. Moreover, the fact that a child’s face continues to grow and develop adds a layer of complexity since fractures in this developmental phase can disrupt normal craniofacial growth patterns [20,21]. Given that the facial skeleton is still in a state of dynamic development, pediatric maxillofacial surgeons must carefully consider the long-term implications of their interventions, particularly when dealing with facial bones that have not yet reached full maturity.

It is important to highlight earlier research on skull protection [22], which describes the diploe as a spongy bone structure situated between the outer and inner cortical layers of the skull. This three-layer architecture acts as a protective buffer against impacts to the brain [22]. However, the full development of this protective structure is not achieved until around the age of two. In infancy, the skull begins with a single layer, and its thickness increases rapidly during the first two years of life [22]. This research suggests that infants under the age of two are especially vulnerable to the serious consequences of cranial trauma [22].

Definitely another critical concern in the management of pediatric facial fractures is the potential impact on facial growth and development [20]. Surgical approaches must strike a delicate balance between addressing immediate trauma and preserving the natural growth process [20]. Any intervention that alters the normal growth trajectory of facial bones can result in aesthetic consequences such as facial asymmetry [20]. Surgeons have difficulty predicting and mitigating potential disruptions to the intricate developmental processes of the growing facial skeleton [20]. Achieving a stable fracture reduction while safeguarding the patient’s future craniofacial growth remains one of the main key considerations in pediatric maxillofacial surgery [23]. Specifically, mandible trauma in children can implicate temporomandibular joint ankylosis [24,25].

What is also important is that surgeons must exercise great care when a child’s facial sutures are either underdeveloped or have not fused properly, especially regarding the presence of fontanels on the skull [23]. The fontanels are usually closed by the time about 2 years old [26] (Figure 1). In such cases, the sutures may create the appearance of an additional bone or a more complex structure, so surgeons must be aware of this to avoid misinterpretation during procedures.

Future research should address gaps in clinical trials and anatomical studies on pediatric facial fractures, focusing on age-specific treatment strategies based on anatomical features. Given children’s unique bone structure and ongoing facial growth, there is a clear need for widespread treatment guidelines that account for these factors. Developing such guidelines can be crucial for improving the management and long-term outcomes of pediatric facial fractures.

Table 1. Anatomical challenges in pediatric facial fractures.

Anatomical Feature	Description	Challenges	Implications for Treatment
Smaller, More Delicate Facial Bones	In pediatric patients, facial bones are smaller and more fragile compared to adults [4].	Increased risk of displacement during trauma. Higher fragility of bones.	Surgeons must exercise extra caution to avoid misalignment during reduction.
Fontanels and Cranial Sutures	In younger children (particularly infants under 2 years old), the skull contains soft spots (fontanels) and unfused sutures that may mimic fractures or complicate diagnosis [27].	May be mistaken for fractures during radiographic evaluation. Incomplete or delayed suture fusion can present challenges in interpretation.	Surgeons must be cautious to differentiate between true fractures and soft spots in the skull.
Craniofacial Growth Disruptions	Fractures in facial growth during key developmental periods (infancy and early childhood) can lead to long-term deformities, including asymmetries or developmental delays in craniofacial structures [28].	Fractures during key growth periods can lead to long-term deformities or functional deficits. Potential for aesthetic issues	Preservation of craniofacial growth is essential. Surgeons must balance immediate fracture stabilization with long-term facial development.
Diploe not completely formed	The three-layer architecture of the diploe is not completely formed until 2 years of age [22].	High risk for non-accidental blunt force trauma	Surgeons need caution to identify cranial fractures

Table 1. Anatomical challenges in pediatric facial fractures.

Anatomical Feature	Description	Challenges	Implications for Treatment
Smaller, More Delicate Facial Bones	In pediatric patients, facial bones are smaller and more fragile compared to adults [4].	Increased risk of displacement during trauma. Higher fragility of bones.	Surgeons must exercise extra caution to avoid misalignment during reduction.
Fontanels and Cranial Sutures	In younger children (particularly infants under 2 years old), the skull contains soft spots (fontanels) and unfused sutures that may mimic fractures or complicate diagnosis [27].	May be mistaken for fractures during radiographic evaluation. Incomplete or delayed suture fusion can present challenges in interpretation.	Surgeons must be cautious to differentiate between true fractures and soft spots in the skull.
Craniofacial Growth Disruptions	Fractures in facial growth during key developmental periods (infancy and early childhood) can lead to long-term deformities, including asymmetries or developmental delays in craniofacial structures [28].	Fractures during key growth periods can lead to long-term deformities or functional deficits. Potential for aesthetic issues	Preservation of craniofacial growth is essential. Surgeons must balance immediate fracture stabilization with long-term facial development.
Diploe not completely formed	The three-layer architecture of the diploe is not completely formed until 2 years of age [22].	High risk for non-accidental blunt force trauma	Surgeons need caution to identify cranial fractures

3.2. Innovations in Diagnostic Tools

Diagnosing facial fractures in pediatrics presents unique complexities, primarily due to the limited ability to accurately communicate symptoms [29]. In these cases, surgeons must rely on a combination of physical examination, clinical signs, and imaging studies to make a precise diagnosis [29]. However, a significant concern remains to obtain high-quality imaging without exposing children to excessive radiation, which is particularly critical in patients who may require repeated imaging during their treatment [29]. Moreover, the emotional and psychological impact of facial fractures should not be underestimated [4]. Children often experience anxiety, depression, and self-esteem issues as a result of altered appearance during recovery [4], making comprehensive care essential.

Recent advancements in imaging technologies have significantly improved the diagnosis and preoperative planning of pediatric facial fractures [30], as shown in Table 2. Three-dimensional (3D) computed tomography (CT) [31] and magnetic resonance imaging (MRI) [32] have emerged as essential tools in the management of these cases. The 3D CT, for example, provides highly detailed, three-dimensional virtual reconstruction, which enables maxillofacial surgeons to visualize complex fracture patterns and better understand the intricate relationships between developing facial structures before surgery [31]. This is particularly useful for detecting subtle fractures that might be overlooked with traditional radiographs, ensuring more accurate diagnoses and treatment plans. Additionally, MRI is particularly advantageous in cases involving the temporomandibular joint and soft tissues, offering excellent soft tissue contrast and revealing injuries that may not be apparent on CT scans [32].

In the past, diagnosing pediatric facial trauma required a delicate balance between obtaining accurate images and minimizing radiation exposure. However, advancements in 3D CT and high-resolution MRI now allow for precise diagnostics while significantly reducing radiation risks [31]. These technologies provide detailed, high-quality imaging, allowing surgeons to appropriately assess facial fractures and distinguish craniofacial sutures and fontanels. Also, the enhanced precision offered by these imaging modalities facilitates the use of minimally invasive techniques, which can significantly reduce surgical trauma and improve recovery times for pediatric patients [31].

Recently, AI has been utilized to facilitate identify children with minor head trauma, enabling healthcare providers to assess the need for CT scans more accurately and avoid unnecessary imaging [33]. The cautious use of AI to develop accurate diagnoses and individualized treatment strategies can hold great promise for enhancing outcomes and minimizing the risk of complications in maxillofacial surgery [34], especially for pediatrics. Conversely, another recent study suggests that AI may struggle to identify fractures across age groups as sutures and vascular grooves become more prominent in older children, potentially mimicking or obscuring fractures on radiographs [35].

New studies should focus on refining imaging techniques for pediatric facial fractures to balance diagnostic accuracy with minimizing radiation exposure. Studies are needed to improve AI systems for identifying fractures across age groups. Additionally, further professional education and investments in imaging technologies are essential to enhance diagnosis in pediatric patients.

Table 2. Innovations in pediatric facial fracture diagnosis.

Innovation	Implications for Diagnostic	Benefits
3D CT Imaging and Virtual Reconstruction	Improved diagnostic accuracy over traditional 2D radiographs. In addition, the virtual reconstruction has lowered the incidence of misdiagnosis [36].	Use of 3D imaging and CT scans to improve diagnosis [31].
MRI for Soft Tissue Evaluation	Increased soft tissue detection [37].	Provides a comprehensive assessment of both bone and soft tissue injuries [37].
Artificial Intelligence (AI) in Imaging exams	Increased diagnostic accuracy and faster diagnosis [38].	Higher diagnostic accuracy and reduces radiologist workload [38].

Table 2. Innovations in pediatric facial fracture diagnosis.

Innovation	Implications for Diagnostic	Benefits
3D CT Imaging and Virtual Reconstruction	Improved diagnostic accuracy over traditional 2D radiographs. In addition, the virtual reconstruction has lowered the incidence of misdiagnosis [36].	Use of 3D imaging and CT scans to improve diagnosis [31].
MRI for Soft Tissue Evaluation	Increased soft tissue detection [37].	Provides a comprehensive assessment of both bone and soft tissue injuries [37].
Artificial Intelligence (AI) in Imaging exams	Increased diagnostic accuracy and faster diagnosis [38].	Higher diagnostic accuracy and reduces radiologist workload [38].

3.3. Multidisciplinary Approach to Pediatric Facial Fracture Management

Pediatric patients often face challenges in following treatment plans, particularly when it comes to postoperative restrictions or the use of medications. Young children may not fully comprehend the importance of these guidelines, which can jeopardize treatment success and increase the risk of complications [11]. Furthermore, managing pediatric facial fractures typically requires a multidisciplinary approach, especially during the acute phase of trauma [21]. The team often includes oral and maxillofacial surgeons, plastic surgeons, otolaryngologists, pediatric specialists, and other healthcare professionals [21]. Coordinating care among these specialists can be complex, but it is crucial to ensure optimal clinical outcomes for the child.

Interdisciplinary collaboration has become a cornerstone in managing pediatric facial trauma, particularly in the postoperative period [39]. Healthcare teams, which may include nutritionists, physiotherapists, speech therapists, orthodontists, and other specialists, work together to create comprehensive and integrated treatment plans. This collaborative approach addresses not only the immediate needs of the child but also long-term functional and aesthetic goals, ensuring holistic care throughout recovery [39].

Thus, managing pediatric facial fractures presents unique questions, particularly regarding children who often struggle to understand the importance of these measures, which can compromise treatment outcomes and increase the risk of complications. Effective management of such cases requires a multidisciplinary approach involving surgeons and a wide range of healthcare professionals. The collaborative nature of care ensures that both the immediate and long-term needs of the child are addressed, promoting optimal functional and aesthetic recovery. Furthermore, using protective devices, such as helmets and seatbelts, is crucial in preventing facial trauma in children, reducing the risk of serious injuries from accidents and falls [40,41]. Alarmingly, recent advancements in electric motor vehicles have notably heightened the risk of craniofacial fractures in pediatric patients [42]. Equally concerning is the fact that the majority of children sustaining high-impact facial trauma were not wearing helmets [42].

In terms of anesthesia, most pediatric facial fractures require general anesthesia for effective management, as even minor trauma can complicate diagnosis and treatment [6]. Some cases of skin lacerations can be treated under sedation [6]. Some cases, such as skin lacerations, may be addressed under sedation; however, suturing oral mucosal lacerations under sedation alone presents additional tasks [6]. These cases have become a challenge for the surgeon and can be an emotionally traumatic experience for children [6]. These types of injuries can be particularly traumatic for children, highlighting the importance of a well-prepared anesthesiology team working closely with the maxillofacial surgeons to manage both the physical and emotional aspects of the procedure.

Long-term follow-up care is essential for pediatric facial fractures to monitor growth, development, and any potential late complication [10,43]. Ensuring that children receive appropriate and consistent follow-up care can be logistically hard, especially for families with limited resources or those living in remote areas. The emotional toll on families is also significant. Parents often experience feelings of guilt, fear, and stress as they support their children through recovery [44]. Hence, emotional support and clear educational resources to families is an integral component of pediatric care [44]. Providing emotional support and education to families should be a critical component of care.

In this sense, managing facial fractures in children is undoubtedly complex, requiring a holistic and multidisciplinary approach [45]. Given the unique challenges of anatomical variability, growth, trauma identification, psychological impacts, and the need for long-term care, each case demands individualized treatment strategies [1]. Addressing these challenges through innovative techniques and collaborative care ensures that pediatric patients receive optimal treatment and support for both their physical and emotional well-being.

More investigations should focus on improving pediatric adherence to treatment plans, enhancing interdisciplinary collaboration, and exploring strategies for better education on postoperative care. It is also necessary to develop professional training programs to improve healthcare providers’ ability to manage these complex cases. Governmental programs should support protective devices in preventing facial trauma and develop solutions for long-term follow-up care, especially for families with limited resources.

3.4. Advances in Treatment Technology

Determining the optimal surgical approach for pediatric facial fractures involves intricate decision-making [21]. Surgeons must assess factors such as the child’s age, the type and severity of the fracture, and the child’s overall health while balancing the urgency of intervention with the potential effects of the surgery [11]. Additionally, aesthetic troubles, such as facial symmetry and function, must be weighed alongside the need for fracture stability, adding another layer of complexity.

One notable advancement in the field of pediatric facial fracture management is the integration of 3D printing technology [46]. Surgeons can now create accurate, patient-specific models and customized implants for a child’s facial bones, facilitating more precise preoperative planning [47,48,49]. This technology allows for a better understanding of each patient’s unique anatomy, enabling the development of surgical strategies that reduce complications and can improve clinical outcomes [12,13]. Importantly, it can be applied for an impression of a splint for use in pediatric mandibular fracture according to the individual dentition of the child [48].

Additionally, traditional surgical approaches to facial fractures in pediatric patients often involve substantial incisions and significant tissue disruption. However, recent advancements in minimally invasive techniques have transformed the management of pediatric facial fractures [50]. Endoscopic procedures and percutaneous fixation methods now allow surgeons to access and repair fractures with minimal scarring and reduced risk of postoperative complications [51]. This shift accelerates recovery and improves aesthetic outcomes, which is particularly important in raising children.

Historically, metallic plates were the standard for facial fracture repair [52]. However, these plates can present complications, particularly as children grow and their facial structures [53]. No consensus guidelines have been established regarding the removal of metallic plates in the pediatric population [54]. The introduction of bioresorbable plates represents a game-changing innovation [53,55]. Bioresorbable plates gradually dissolve over time, eliminating the need for additional surgeries to remove them and significantly reducing the risks associated with permanent plates, such as infection, presence of tooth germs, and inadequate facial development [53,55].

It is fundamental to recognize that pediatric patients face exceptional challenges for using internal fixation with plates. Children’s smaller bone dimensions, lower bone density, and the presence of dental germs complicate the treatment [6]. Additionally, the location of the inferior alveolar nerve differs from that in adults, which affects the management of mandibular fractures [55,56]. The presence of both deciduous and permanent dentition further complicates the placement of internal fixation devices, as the developmental stage of the dental structure must be carefully considered during surgery [56,57]. Besides 3D-printed splints, as reported, external fixation in mandibular fractures can also be performed using fiber splints [58] or orthodontic archwires [59] as an alternative to stabilize the fracture while preserving growth and development. Also, low-intensity pulsed ultrasound with an external splint showed promising benefits for mandibular fracture [60]. It can possibly act by stimulating angiogenesis, increasing bone regeneration, and enhancing mineralization, thus quickening healing [60].

In recent years, 3D computer-assisted navigation systems have become invaluable in pediatric facial fracture surgery [61]. Three-dimensional navigation systems offer significant advantages in the management of pediatric fractures, particularly in improving preoperative planning and surgical precision [62]. These systems allow for detailed, patient-specific models that enable surgeons to assess fractures and surrounding structures more accurately, which is crucial for children with smaller and more complex bone anatomy [62]. The precision provided by real-time, three-dimensional visualization can ensure accurate alignment of fractures, especially near growth plates, reducing the risk of long-term functional or developmental issues. Additionally, 3D navigation facilitates minimally invasive procedures, minimizing soft tissue damage, postoperative pain, and recovery time, which is particularly important for pediatric patients [63,64]. Thus, these systems can also reduce operating time and anesthesia exposure, enhancing patient safety.

Moreover, 3D navigation improves healing outcomes by ensuring proper fracture alignment, reducing the chances of deformities. It is especially beneficial in managing complex fractures, offering detailed views that help restore joint and bone integrity. The ability to monitor healing through follow-up 3D imaging further enhances long-term care by detecting issues early. While the initial costs of 3D navigation systems are high, they can ultimately be cost-effective by reducing revision surgeries and complications. Overall, the integration of 3D navigation into pediatric fracture management improves both clinical outcomes and recovery times, making it a valuable tool for surgeons.

Remote consultations and monitoring allow for ongoing assessment of the child’s healing process without the need for frequent in-person visits [61]. This innovation improves surgical outcomes and reduces the likelihood of errors, making the surgical process more efficient and reliable. Telemedicine has also emerged as an important tool in the postoperative care of pediatric facial fracture patients [65]. Remote consultations and monitoring allow for ongoing assessment of the child’s healing process without the need for frequent in-person visits [33]. This not only increases accessibility but also enhances the efficiency of follow-up care, ensuring that recovery is closely monitored by the multidisciplinary team [33]. However, the limitations of telemedicine in maxillofacial surgery evaluations should be acknowledged. Assessing clinical signs such as septal hematoma, intraoral malocclusion, and facial contour asymmetries can be particularly difficult during a remote consultation [66].

Despite advancements, predicting and achieving favorable long-term functional outcomes in pediatric facial fractures remains intriguing [67]. Clinicians must anticipate potential complications such as malocclusion or impaired nerve function, which may develop over time [67]. Consequently, complete follow-up is essential to ensure that any evolving needs are addressed as the child grows and develops.

Future research should focus on optimizing pediatric facial fracture treatments with 3D printing, minimally invasive methods, and bioresorbable plates, as there are currently few clinical trials and systematic reviews on this topic. Studies should create protocols to address challenges like smaller bone dimensions and mixed dentition. The effectiveness of computer-assisted navigation and telemedicine should be explored, along with long-term follow-up to monitor complications. Furthermore, professional instruction is essential for implementing these innovations effectively.

Table 3. Innovations in pediatric facial fracture management.

Innovation	Implications for Treatment	Benefits
3D Printing	Customization of implants and surgical guides and improved pre-surgical planning [47,48,49]	Reduction in surgery time and post-operative complications in pediatric procedures.
Bioresorbable Plates and Screws	Reduced need for hardware removal and lower infection rates [68]	Ideal for growing children, minimizing impact on bone growth.
Endoscopic-Assisted Surgery	Reduced recovery time and less scarring [51]	Faster recovery and shorter hospital stays.
Telemedicine for Postoperative Follow-up	Reduced follow-up visits and increased patient satisfaction [69]	Convenient for patients and families, especially those in remote areas. Reduces strain on hospital resources.
Low-Intensity Pulsed Ultrasound (LIPUS)	Faster bone healing and reduction in nonunion rates [60]	Non-invasive and easy to administer. Safe for use in pediatric patients

exhibits the main innovations in treatment and their advantages in treating pediatric facial fractures.

3.5. Dental Trauma and Pediatric Facial Fractures

Dental trauma is often associated with pediatric facial fractures, adding an extra level of complexity to the treatment [21]. Recent research has focused on new treatment protocols for dental injuries in children. For example, autotransplantation is being studied for the management of avulsed or non-reimplanted teeth [13]. Also, autotransplantation in the case of avulsed and not reimplanted teeth in the traumatic area is being studied [70]. Additionally, bone grafts are used to preserve alveolar bone volume for future dental rehabilitation [71]. In this context, dental implants offer a viable option to replace the edentulous space in patients once facial bone maturation is complete, or alternatively, removable prosthetics can be used until that stage [72].

Dental trauma in children is also responsible more for luxation and not dental fractures in children since the bones are more flexible than adults [13]. Dental luxation and avulsion are usual in children due to their more flexible bone structure. Thus, it requires particular attention [73]. While reimplantation of deciduous teeth is not recommended, reimplantation of permanent teeth is still considered a standard practice [73]. In cases where immediate reimplantation is not possible, storing the avulsed tooth in an appropriate solution like milk can improve the success of reimplantation [73].

Future research should investigate the potential of stem pulp cells in regenerating damaged dental pulp following dental trauma [74]. Additionally, upcoming initiatives should focus on advancing facial trauma treatments, emphasizing the integration of dentistry within a multidisciplinary care team to monitor malocclusion and ensure proper tooth eruption after trauma [75].

3.6. Addressing Key Challenges and Advances in Each Pediatric Facial Fracture Management

The management of pediatric facial fractures presents unique complexities. Each type of fracture, from nasal to mandibular to orbital, requires specialized approaches to minimize complications such as airway obstruction, malocclusion, nerve damage, and long-term cosmetic deformities. However, recent innovations in imaging, surgical techniques, and materials have significantly improved diagnosis, treatment precision, and recovery for young patients.

Lastly,

Table 4. Common facial fractures in pediatric patients, associated challenges, and each recent innovation in their management.

Facial Fracture	Challenges	Innovations and Advances
Nasal Fractures	Difficulty in diagnosing very young children due to communication [76]; Risk of septal hematoma or airway obstruction [76].	Use of 3D imaging and CT scans to improve diagnosis [77]. Ultrasound-guided closed reduction in nasal fractures [78].
Mandibular Fractures	Challenge in maintaining reduction and avoiding malocclusion [45]; Risk of tooth injury or infection [79].	Use of bioresorbable plates for fixation to avoid metal plate removal [80]. Use of 3D-printed custom plates for precision [81].
Zygomatic Fractures	Complex anatomy and risk of nerve damage (e.g., infraorbital nerve) [57]; Swelling can complicate diagnosis and treatment [82].	Minimally invasive technique reduction [64].
Orbital Fractures	Risk of visual disturbances, orbital injury, or diplopia; Need for precise repair to avoid long-term cosmetic issues [83].	The use of 3D modeling for preoperative planning and the use of absorbable materials for floor reconstruction [84].
Le Fort Fractures	Can involve airway obstruction and require early intervention [16]; Complexity in managing pediatric craniofacial growth and development [85].	Virtual surgical planning and 3D printing to create custom models for surgical correction [86].
Frontal Bone Fractures	Can affect the sinuses or cause cerebrospinal fluid leaks [87]. Potential for cosmetic deformities [88].	Minimally invasive techniques for sinus drainage and reconstruction [89].
Dental and Alveolar Fractures	Risk of tooth loss or malocclusion [73]. Difficulty in treating fractures due to varying developmental stages [13,73].	Advances in dental implants and prosthetics for pediatric patients [90]. Use of splints and orthodontic devices for alignment [91].

outlines the key challenges associated with various types of pediatric facial fractures, along with the most notable innovations and advances that have emerged to address these issues. These innovations, including the use of 3D imaging, bioresorbable materials, virtual surgical planning, and minimally invasive techniques, are transforming the landscape of pediatric facial trauma care, leading to better outcomes and reduced risk of complications.

3.7. Considerations and Emerging Directions

The treatment of pediatric facial fractures involves challenges that extend far beyond the initial surgical intervention. From diagnostic uncertainties to the delicate balance of growth considerations and psychological impacts, healthcare professionals must navigate a complex clinical landscape. Addressing these challenges requires a patient-centered approach that incorporates ongoing research and collaboration, with a focus on both the physical and emotional well-being of the child.

Innovations in pediatric facial fracture management have significantly advanced our ability to provide effective, integrated care. However, challenges persist, emphasizing the need for continued research, interdisciplinary teamwork, and a holistic understanding of each patient’s unique needs. As we advance in the treatment of pediatric facial fractures, ensuring a comprehensive, patient-centered approach will remain essential to achieving the appropriate clinical outcomes without negative emotional impacts.

Despite these advancements, ongoing research and collaboration across medical disciplines are essential to address the remaining questions about pediatric facial trauma. Long-term follow-up and monitoring are crucial for identifying and managing potential complications, such as malocclusion or facial nerve dysfunction [8]. Furthermore, the emotional well-being of both the patient and their family must remain a central consideration throughout the treatment.

Looking ahead, the future of pediatric facial fracture treatment will likely involve further refinement of existing techniques, along with the exploration of AI. Ongoing research, interdisciplinary collaboration, and continued innovation will be key to optimizing treatment and ensuring the best possible outcomes for pediatric patients with facial fractures. A key disadvantage of digital health technologies is the substantial initial investment needed, which often includes the acquisition of costly equipment and implementation. Another point observed was the lack of randomized controlled clinical trials assessing these new technologies for the diagnosis and treatment of facial fractures in pediatric patients.

The following Figure 2 aims to list the main challenges and innovations highlighted in the present article.

3.8. Limitations of the Study

This narrative review presents several limitations that should be considered when interpreting its findings. Firstly, it synthesizes literature published between 2001 and 2024, which may limit the studies by time. Moreover, the review is confined to English-language articles, potentially omitting significant research published in other languages and limiting its scope. Although this narrative review follows the SANRA scale [14], the narrative method introduces a degree of subjectivity, as the review does not adhere to a systematic method, which could lead to biases in study selection, interpretation, and synthesis. This subjective nature also means that studies of varying quality may be included, and without standardized data extraction methods, there is a risk of skewing results toward specific treatment strategies or diagnostic tools. While the review highlights key advancements, such as three-dimensional imaging and minimally invasive surgical techniques, it lacks a comparative analysis of their efficacy, limitations, age-related considerations, and cost-effectiveness, thereby leaving gaps in understanding their relative impact on patient outcomes. Additionally, the review’s reliance on secondary data limits the ability to assess the long-term outcomes of these innovations in pediatric facial fracture management, a crucial aspect given the unique developmental concerns in pediatric patients.

4. Conclusions

The management of pediatric facial fractures presents unique challenges that require a multidisciplinary and patient-centered approach. Key considerations include the anatomical differences in children’s faces, the potential impact on growth and development, the psychological and emotional effects on young patients, and the need for specialized diagnostic and treatment methods. Advancements in imaging technologies, minimally invasive surgical techniques, bioresorbable implants, and multidisciplinary care have revolutionized the management of these fractures, improving both functional and aesthetic outcomes. Additionally, the integration of innovations such as 3D printing, computer-assisted navigation, and telemedicine has further enhanced the precision and accessibility of care, enabling more personalized treatment strategies.