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Oral ibuprofen and oral or rectal paracetamol can be used, but if the patient is in apparently acute severe pain, intranasal fentanyl can be used as an adjunct which will give immediate relief. Her most immediate concern currently is pain which must be addressed before the examination is attempted. This girl has a patent airway and no respiratory or cardiovascular compromise.

Nasal bone fractures are the most common fracture of childhood, followed by madibular, orbital, frontal skull and midface.Īll patients should be managed from an ABCDE approach. Due to the relative protrusion of the frontal bone from birth, younger children are more likely to have frontal bone and orbital floor fractures, with the incidence of nasal, zygomatic-maxillary complex and mandibular fractures becoming more common in later years, associated with play activities and sports.

Increased fat pads and soft tissue structures act as buffers to injury.įacial fractures occur less commonly in children than in adults, and often follow a particular ‘top down’ pattern of injury in accordance with age.

The presence of unerupted permanent teeth adds strength to maxilla and mandible.

The structure of bone means it is more elastic and resistant to fracture, but more prone to Greenstick fracture.

Pneumatisation of the sinuses occurs in a stepwise fashion, leaving the facial bones more dense.

Relative protrusion of the frontal bone from birth protects the smaller midface.

Paediatric anatomy differs slightly in the following ways, which affects the likelihood of fracture and injury pattern: Above is a depiction of the adult facial bones.