title: Characteristics of Cervical Spine Injury in Pediatric Patients With Facial Fractures.
abstract: BACKGROUND
  Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention.
  
  
  METHODS
  A retrospective review from 2000 to 2012 of all facial fractures in patients ≤ 18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected.
  
  
  RESULTS
  During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90%) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70%) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge.
  
  
  CONCLUSIONS
  In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly used for facial fracture treatment. Special caution should be used when examining patients with a depressed Glasgow Coma Scale or in those with upper midface fractures.
authors.affiliation: *Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ †Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ.
authors.forename: Jordan N
authors.initials: JN
authors.lastname: Halsey
authors.forename: Ian C
authors.initials: IC
authors.lastname: Hoppe
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Marano
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Kordahi
authors.forename: Edward S
authors.initials: ES
authors.lastname: Lee
authors.forename: Mark S
authors.initials: MS
authors.lastname: Granick
mesh_terms: D000293:Adolescent; D001368:Axis, Cervical Vertebra / Q000293:injuries; D001270:Cervical Atlas / Q000293:injuries; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000453:epidemiology; D008440:Maxillary Fractures / Q000453:epidemiology; D009515:New Jersey / Q000453:epidemiology; D009917:Orbital Fractures / Q000453:epidemiology; D021362:Palate, Hard / Q000293:injuries; D010292:Paresthesia / Q000453:epidemiology; D012189:Retrospective Studies; D012887:Skull Fractures / Q000453:epidemiology*; D015051:Zygomatic Fractures / Q000453:epidemiology