What is the management and treatment of a 3-year-old patient with a facial injury due to a fall, and what complications should be watched for?

From the Guidelines

For a 3-year-old with a facial injury from a fall, immediate assessment and management are crucial to prevent complications and ensure the best possible outcome, with a focus on monitoring for signs of infection, concussion, and other potential complications, as recommended by recent guidelines 1. The management of a 3-year-old with a facial injury from a fall involves several key steps.

• First, assess the severity of the injury, looking for signs such as deep cuts, significant facial swelling, broken teeth, eye injuries, persistent bleeding, or signs of concussion.
• Clean minor cuts with mild soap and water, then apply gentle pressure with a clean cloth to stop bleeding.
• For pain relief, give weight-appropriate doses of acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours), as suggested by pediatric guidelines 1.
• Apply ice wrapped in a cloth for 15-20 minutes to reduce swelling.
• Seek immediate medical attention if there are deep cuts requiring stitches, significant facial swelling, broken teeth, eye injuries, persistent bleeding, or signs of concussion (vomiting, drowsiness, confusion, unequal pupils).
• Watch for signs of infection over the next few days, including increased redness, warmth, swelling, pus, or fever.
• Also, monitor for behavioral changes that might indicate head injury, such as unusual irritability, balance problems, or changes in eating or sleeping patterns, as highlighted in recent studies on pediatric trauma 1.
• In cases of dental trauma, follow the guidelines for the management of dental trauma in a primary care setting, which include observing, providing soft foods for a week, and taking dental radiographs to rule out root fractures, as outlined in 1.
• For orbital injuries, which can occur in children after falls, suspect orbital injury if there is periorbital soft tissue swelling, ecchymosis, hyphemia, subconjunctival hemorrhage, diplopia, restriction of ocular movement, or vision loss, and consider imaging to assess the extent of the injury, as recommended in 1.
• The most recent and highest quality study on orbital imaging and vision loss in children 1 emphasizes the importance of prompt assessment and appropriate imaging to prevent long-term complications.
• Overall, children's facial injuries often heal well due to good blood supply, but prompt assessment and appropriate care are essential to prevent complications, as emphasized in recent guidelines and studies 1.

From the Research

Management and Treatment of Facial Injuries in a 3-Year-Old

• The primary management of pediatric soft tissue injuries, including assessment, cleansing, surgical technique, anesthesia, and considerations for special wounds, is crucial in the treatment of facial injuries in children 2.
• The secondary management of pediatric facial injury, including scar revision, management of scar hypertrophy/keloids, and staged surgical correction, should also be considered 2.
• Facial trauma in children can be categorized into limited, transfacial, and smash fractures, and treatment may be conservative or surgical, depending on the severity of the injury 3.
• Computed tomography (CT) is superior to conventional radiography, tomography, and MRI in detecting facial fractures, defining their direction, extent, and displacement 3.

Assessment and Evaluation

• Patients with facial trauma must be assessed in a systematic way to avoid missing any injury, following the Advanced Trauma Life Support (ATLS) system of care 4.
• Life- and sight-threatening injuries must be excluded during the primary and secondary surveys, and special attention must be paid to sight-threatening injuries in stabilized patients 4.
• The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging, and nasal fractures are the most frequent isolated facial fractures 4.
• Isolated nasal fractures are principally diagnosed through history and clinical examination, and closed reduction is the most frequently performed treatment for isolated nasal fractures 4.

Watch for Complications

• Patients with traumatic brain injury (TBI) may have concomitant facial fractures, and simultaneous head and facial CT scans can help assess facial fractures in these patients 5.
• Fractures of the lower third of the face and orbit are easily overlooked in routine head CT scans but often require surgical intervention 5.
• It is essential to be aware of the unique diagnostic challenges in the pediatric population, as differences from adult anatomy and physiology can result in vastly different injury profiles 6.
• The increased ratio of the cranial mass relative to the body leaves younger patients more vulnerable to craniofacial trauma, and proper assessment and treatment are crucial to ensure optimal outcomes 6.