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

Pediatric craniomaxillofacial trauma presents unique diagnostic and management challenges due to the anatomical and developmental characteristics of children. 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. 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. 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.