Reporting Pediatric Maxillofacial Trauma from Sindh’s Largest Public Sector Surgical Unit of a Tertiary Care Institute in Pakistan

Technical Summary: Reporting Pediatric Maxillofacial Trauma from Sindh's Largest Public Sector Surgical Unit

Problem Statement
Pediatric maxillofacial trauma represents a significant public health concern due to its potential impact on facial growth, function, and psychosocial development. While such injuries are less common in children than adults due to the elasticity of pediatric bones and protective soft tissues, they cause extreme stress for families and can lead to severe disfigurement if untreated. Despite the prevalence of trauma in Pakistan, there is a major scarcity of published international literature from the country, particularly from Karachi, the economic hub and capital of Sindh Province. Existing local studies are limited to the Punjab Province, leaving a gap in understanding the demographics, etiology, and injury patterns specific to the Sindh region and its diverse, high-volume patient population.

Methodology
This study is a retrospective, single-centered analysis conducted at the Department of Oral & Maxillofacial Surgery of Dow University of Health Sciences (DUHS), with patient admissions managed at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT) in Karachi.

• Study Period: August 2023 to August 2024.
• Sample Size: 215 pediatric patients (ages 1–18 years) of both genders.
• Inclusion Criteria: Patients sustaining oral and maxillofacial bony trauma (with or without soft tissue involvement) and concomitant injuries to other body parts, provided parental/guardian consent was obtained.
• Exclusion Criteria: Exclusive soft tissue injuries, prior treated maxillofacial trauma, trauma complications, oncology cases, and lack of consent.
• Data Analysis: Data was extracted from the Departmental HMIS System and analyzed using SPSS version 26. Quantitative variables (age, duration) were presented as mean/median, while qualitative variables (gender, mechanism, fracture type) were reported as frequencies and percentages. Statistical significance was determined using Chi-square or Fischer Exact tests (p ≤ 0.05).

Key Contributions and Findings
The study provides the largest clinical experience of pediatric trauma from a public sector institute in Pakistan, offering a detailed breakdown of injury patterns and demographics.

• Demographics: The cohort consisted predominantly of males (82.79%) compared to females (17.21%), with an average age of 11.25 ± 5.12 years. The majority of patients (90.7%) resided in urban areas.
• Etiology: Road Traffic Accidents (RTAs) were the leading cause of injury, accounting for 58.6% (126 cases) of the trauma. Falls from height were the second most common cause (31.16%, 67 cases). Other causes included firearm injuries (2.33%), sports injuries (6.05%), and unknown reasons (1.86%).
• Clinical Presentation: Pain was a universal symptom (100%), followed by swelling (50.2%) and bruising (25.1%).
• Fracture Patterns:
  • Bone Involvement: The mandible was the most frequently fractured bone (74.9%), followed by the maxilla (20%), zygomaticomaxillary complex (18.6%), nasal bone (12.6%), and zygomatic bone (7%).
  • Fracture Types: Compound fractures were the most common (73.02%), followed by simple fractures (13.02%), greenstick fractures (9.3%), and comminuted fractures (3.72%).
  • Polytrauma: 5.58% of patients presented with concomitant injuries to other body parts.
• Management Context: The authors highlight the use of "Prof. Katpar's Splint Technique," a cost-effective, closed reduction method for infant and pediatric mandibular fractures. This technique allows for early surgical treatment within 72 hours without the need for a second general anesthesia for splint removal.

Significance and Claims
The paper claims to fill a critical literature gap by providing the first comprehensive report on pediatric maxillofacial trauma from Karachi and Sindh Province. The authors assert that their findings confirm male predominance in trauma incidence, with RTAs and falls as the primary mechanisms, and mandibular fractures as the most frequent injury type.

The study emphasizes the need for targeted prevention strategies, specifically:

1. Policy and Awareness: The introduction of helmet usage for motorbike riders and seat belts for small children in cars, tailored to be cost-effective for low- and middle-income families in Pakistan.
2. Education: A call for the establishment of a Postgraduate Training Program in Pediatric Maxillofacial Surgery in Asia/Pakistan to address the high volume of cases and specialized needs.
3. Clinical Strategy: The promotion of conservative surgical strategies, such as the aforementioned splint technique, to mitigate complications in the rapidly healing pediatric jaw.

The authors conclude that by focusing on these prevention protocols and tailored treatment approaches, policymakers and healthcare providers can significantly reduce the incidence and severity of pediatric maxillofacial injuries in the region. The study acknowledges limitations, including its single-center design and lack of long-term follow-up data, and calls for future multi-centered and longitudinal studies to further validate these findings and management techniques.