Pediatric Maxillofacial Fractures: A 10-Year Retrospective Analysis of 549 Cases With Emphasis on Facial Injury Severity Score Validation and COVID-19 Impact.

Publication date: Jul 01, 2026

Pediatric maxillofacial fractures (PMFs) represent a distinct clinical entity due to their unique features. However, objective tools that inform surgical decision-making and stratify risk in PMF remain limited. In particular, the clinical utility of the Facial Injury Severity Score (FISS) in predicting management strategies and outcomes, as well as its behavior during extraordinary periods such as the COVID-19 pandemic, remains unclear. The purpose of this study was to measure the association between FISS and surgical intervention in PMF, including shifts during the COVID-19 pandemic. A retrospective cohort study was conducted at Bursa Uludag University, in the Department of Plastic, Reconstructive, and Aesthetic Surgery. The study included subjects aged 0 to 17 years who were treated for confirmed maxillofacial fractures between 2015 and 2024. Exclusion criteria were soft tissue injuries without fracture, craniofacial anomalies, and incomplete records. The predictor variable was injury severity measured using FISS. The primary outcome was therapeutic intervention, coded as operative versus nonoperative management. The treatment outcome was defined by the presence or absence of complications. Covariates included age group, sex, etiology, fracture site, concomitant injuries, treatment timing, and trauma period (pre-COVID-19, COVID-19, and post-COVID-19) ANALYSES: Descriptive and inferential analyses were performed using χ, Mann-Whitney U, Kruskal-Wallis, and logistic regression tests. Statistical significance was defined as P value

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