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Background: The purpose of this study was to utilize a multicenter database to better understand preexisting comorbidities, postoperative complications, and hospital financial charges for pediatric patients undergoing complex midface advancement procedures. Methods: Retrospective cohort study was conducted of patients undergoing midface advancement, including Le Fort II (LF2), Le Fort III (LF3), and Monobloc procedures in the United States between 2010 and 2020 using the Pediatric Health Information System. Preexisting comorbidities, postoperative complications, and hospital admission charges among these cohorts were analyzed. Results: During the study interval, 91 patients underwent complex midface reconstruction. Median age was 12.7 years. Postoperative complication rate was 44.0%, and LF2 procedures had fewer surgical complications than LF3 ( P Conclusions: While midface advancement procedures are conceptually grouped together, LF2 has significantly lower surgical complications, blood transfusions, hospital lengths of stay, hospital admission charges, ICU lengths of stay, and ICU charges than LF3 or Monobloc procedures.

Purpose: Computed tomography (CT) scans obtained in the setting of facial trauma often report aberrations in neural anatomy, such as optic nerve stretching. While these findings have not yet been correlated with clinical findings, they raise concern for traumatic optic neuropathy (TON). This study aims to correlate radiographic optic nerve abnormalities with clinical findings in the setting of craniomaxillofacial trauma. Methods: Patient charts were queried based on ICD-9 codes for the presence of an orbital fracture. Patients were included if the CT report mentioned an anatomic abnormality of the optic nerve. Patients who expired within 24 hours of arrival, had an open globe injury, or who were not able to participate in a visual exam were excluded. An additional matched cohort of patients with orbital fractures and without optic nerve abnormalities was selected. The primary endpoint was a clinical diagnosis of TON, and secondary endpoints included the need for ophthalmologic intervention and the presence of abnormal visual acuity. Results: One-hundred and eight patients were included in the study (54 per group). Radiographic optic nerve stretching was not associated with an increased risk of TON (OR: 2.22, 95% CI: 0.71-7.02); however, it was associated with increased risk for abnormal visual acuity (OR: 2.24, 95% CI: 1.01-4.99). There was no increased need for any ophthalmologic intervention (OR: 1.93, 95% CI: 0.86-4.31). Conclusions: Alterations in orbital anatomy on CT are common after orbital fracture and may inappropriately raise concern for TON. This in turn may prompt interfacility transfer and/or emergent ophthalmology consultation. This study demonstrates that radiographic stretching of the optic nerve does not increase the odds for TON in the setting of orbital fractures. While patients with abnormal optic nerve findings did have a higher rate of abnormal visual acuity, this is a common, multifactorial finding in this setting.

Background: Orbital floor fractures constitute roughly 20% of all pediatric facial fractures. Reconstructive techniques are broadly subdivided into alloplastic and autologous. While pediatric literature exists for alloplastic orbital reconstruction, autologous orbital reconstruction studies are limited. Here we present several cases of posttraumatic pediatric orbital reconstruction utilizing autologous split rib graft. Methods: After IRB approval, a retrospective chart review was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt from 2003 to 2019. A review of relevant published literature was also performed. Results: From 2003 to 2019, 5 pediatric patients underwent orbital reconstruction with split rib graft. Of the 5 patients, 3 were female and 2 were male with an age range of 4 to 8 years old (mean 4.8). Two patients had isolated orbital blow-out fractures while 3 presented with concurrent midfacial fractures. In each patient, the orbit was reconstructed by contoured split rib corticocancellous graft. Average length of stay was 5.2 days. There were no postoperative pneumothoraces. Mean follow-up length was 18.7 months, with no rib donor site complications. Each patient had adequate orbital volume restoration with no postoperative globe malposition or persistent diplopia. Conclusion: Pediatric orbital fractures are complex and challenging injuries. While alloplastic reconstruction is common and reliable, the risks of foreign body implantation and fixation must be carefully considered in patients who have not yet reached skeletal maturity. This is especially pertinent in younger patients as orbital growth continues until approximately 9 years of age. Rib graft use for adult orbital reconstruction has been explored. Data in the pediatric literature has not been identified. Corticocancellous rib graft harvest mandates a second surgical site; however, it is relatively inconspicuous with low postoperative morbidity. Corticocancellous rib grafting is a safe and durable option for orbital reconstruction and should be considered for use in the pediatric patient with a growing facial skeleton.