Paediatric maxillofacial fractures have increased in incidence and their nature and aetiology have changed during three decades

The safety of children's living environment is affected by several factors. Safer living environments have been offered as one explanation to decreases in children's fractures. Earlier studies provide evidence of a decreasing trend in children's fractures in the past decades. The objective of this study was to investigate demographic and clinical features of paediatric maxillofacial fractures during three time periods. A retrospective cross-sectional single-centre study was designed. The study included 474 patients aged ≤ 15 years admitted to Helsinki University Hospital in Finland with maxillofacial fractures during 1980-1989, 1993-2002 and 2013-2018. Maxillofacial fractures increased by 25% during the study period. The increase was greater in boys (28%) than in girls (19%), and significant in age groups 0-5 years (71%) and 13-15 years (32%). Exclusively mandibular fractures decreased by 20%, while exclusively midfacial fractures increased more than four-fold and exclusively upper-third fractures five-fold. Being hit by object and falls from height increased more than two-fold. A temporary increase in assaults and decrease in bicycle accidents in the middle period of the study was observed. During the three decades, paediatric maxillofacial fractures have increased and both fracture type and underlying aetiology have changed. These findings reflect improvements in diagnostics, traffic safety, regulations and technology. The role of factors such as interpersonal violence and economic fluctuation on the incidence of childhood maxillofacial fractures is discussed.