PEDIATRIC FACIAL FRACTURES - ANALYSIS OF DIFFERENCES IN SUBSPECIALTY CARE

At the University of Michigan, the pediatric facial fracture call sche dule rotates through the plastic surgery, otolaryngology, and oral sur gery services. This situation provides an opportunity to evaluate diff erences in the management of pediatric facial fractures between subspe cialty groups. At this hospital, a retrospective review of all pediatr ic facial fracture cases within a 5-year period was undertaken. Sixty patients with 82 facial fractures were studied along subspecialty line s. Differences in patient groups, practice patterns, and treatment str ategies based on subspecialty assignment were found. Overall treatment followed traditional lines, with plastic surgeons involved in all typ es of pediatric facial fractures, whereas otolaryngology and oral surg eons were more limited in their operative scope, despite equal call re sponsibilities. It is believed that the managed care arena is a compet itive environment in which it will be important to know the strengths and weaknesses of the plastic surgery specialty, as well as those of c ompeting specialties, as patient contracts are negotiated. The overlap of plastic surgery, otolaryngology, and oral surgery in the care of f acial trauma could result in plastic surgeons being left off of manage d care participant lists. This study highlights plastic surgeons as ef ficient deliverers of quality care for pediatric facial fractures. Alt hough the treatment of these fractures has fallen into the duties shar ed by all three subspecialties, data such as those presented here shou ld strengthen our ability to succeed in the evolving environment of ma naged care.