CHARACTERISTICS OF THE CIRCUMSTANCES OF FORMATION, CLINICAL AND MORPHOLOGICAL MANIFESTATIONS, COURSE AND ASSESSMENT OF THE DEGREE OF GRAVITY OF DAMAGE IN CASES OF FACIAL INJURIES IN CHILDREN AND ADOLESCENTS

Abstract

This study aims to examine the characteristics of facial injuries in children and adolescents by analyzing age- and gender-specific variations to enhance forensic medical assessments. Pediatric maxillofacial injuries differ significantly from adult cases in mechanism, clinical presentation, and long-term outcomes. These differences necessitate the establishment of age-specific criteria for determining the severity of injuries. The significance of this research stems from its focus on incorporating the unique physiological and anatomical aspects of children's bodies into forensic evaluations of facial injuries, considering their potential to cause not only temporary health impairments but also long-lasting functional and cosmetic consequences. Objective. To investigate the circumstances, clinical and morphological patterns, progression, and severity assessment of facial injuries in children and adolescents, with attention to age and gender differences. Materials and Methods. The research encompassed 203 Expert Conclusions from the archives of the Kyiv Regional and Kyiv City Clinical Bureau of Forensic Medical Examination, 177 Expert Conclusions from the Dnipro Regional Bureau of Forensic Medical Examination, and 123 inpatient records from the Department of Maxillofacial Surgery at Kyiv Children's Hospital No. 7. These data pertained to forensic investigations of facial trauma cases in pediatric populations. The study design incorporated a detailed analysis based on both gender and age groups to explore relevant patterns. Results The findings revealed that males were more frequently affected by facial injuries, comprising 350 cases (69.6%) out of 503 analyzed, compared to 153 cases (30.4%) involving females. Among all pediatric cases, younger school-aged children (3–6 years) accounted for 132 cases (26%), while older school-aged children (12–18 years) comprised the largest subgroup with 197 cases (40%). Morphological analysis showed that in children under 3 years, injuries were primarily confined to the soft tissues of the face and oral cavity. Conversely, children aged 7–11 years and adolescents were more prone to maxillofacial traumas, including fractures of the facial skull bones, often accompanied by mild to severe traumatic brain injuries. Statistical analysis demonstrated no significant differences in the average healing times among contused, bite-related, and lacerated facial wounds across different pediatric age groups (p > 0.05). Conclusions. Facial injuries in children and adolescents demonstrate distinct age-related patterns. In children under 3 years and preschoolers, soft tissue injuries of the face and oral cavity are predominant. In contrast, school-aged children (7–11 years) and adolescents experience higher incidences of maxillofacial injuries, including fractures to the facial skeleton, often in conjunction with traumatic brain injuries. Subperiosteal fractures—commonly involving the alveolar processes of the lower jaw—are characteristic among younger children, whereas fractures of nasal bones, upper maxillary processes, orbital walls, mandibular structures, and dental injuries are prevalent in older age groups. In assessing injury severity across pediatric populations, criteria such as health disorder duration, risk of unfavorable outcomes, and potential for permanent disability should be prioritized. Particular attention should be given to bite-related and lacerated wounds, as they frequently result in disfiguring scars and functional impairments (e.g., nasal breathing difficulties, chewing issues, asymmetry, salivation disturbances). This underscores the need for evaluating permanent disabilities when assessing forensic implications for pediatric facial trauma.

Keywords

• Forensic Medical Examination; Children; Facial Trauma; Bodily Injuries; Degree of Gravity