Pediatric Maxillofacial Fractures: Patterns of Injury, Surgical Indications, and Treatment Outcomes: A Five-Year Retrospective Study

<b>Background:</b> Pediatric craniofacial fractures represent a distinct clinical entity characterized by unique anatomical and developmental factors that differentiate them from adult facial trauma. Despite their relative rarity, these injuries pose diagnostic and therapeutic challenges due to the presence of active growth centers and the potential for long-term functional and esthetic sequelae. <b>Methods</b>: A retrospective observational study was conducted among pediatric patients aged 0-17 years treated for craniofacial fractures between 2020 and 2024 at the Department of Cranio-Maxillofacial Surgery, University Hospital in Kraków, Poland. Demographic data, injury mechanisms, fracture distribution, treatment modality, and associated injuries were analyzed. Multivariate logistic regression was applied to identify predictors of surgical intervention. <b>Results:</b> Ninety-eight patients met the inclusion criteria. The mean age was 12 years, with a male predominance. Midfacial fractures were most common, with orbital floor fractures representing the single most frequent injury. Surgical management was performed in 72 cases, predominantly using the transconjunctival approach and autologous bone grafting. Orbital floor fractures were identified as the only independent predictor of operative treatment (<i>p</i> < 0.05). Central nervous system trauma was the most frequent concomitant injury. No significant changes in etiology or fracture distribution were observed during the COVID-19 pandemic. <b>Conclusions:</b> Pediatric craniofacial trauma follows a reproducible, age- and mechanism-dependent pattern. Effective management requires individualized, growth-preserving, and function-oriented treatment strategies. Standardization of care protocols and multicenter prospective studies are essential to optimize outcomes and develop evidence-based, age-specific guidelines for the management and prevention of pediatric facial fractures.