Background: Bicycle accidents can be a significant source of childhood morbidity. While many of these patients will present with facial injuries, the characteristics and patterns of bicycle-related pediatric maxillofacial injuries remain inadequately investigated.

Objectives: To determine any patterns of maxillofacial injuries sustained by pediatric patients in bicycle accidents and assess any predisposing factors influencing these injuries.

Study Design/Methods: Retrospective review of bicycle-related injuries evaluated at Children's National Medical Center, Washington, DC, between January 1, 1989 and June 30, 2006.

Results: Of 700 cases of bicycle-related injuries, 185 patients (26%) sustained facial injuries. When grouped by age, 4% were 0-4, 38% were 5-9, 49% were 10-14, and 9% were 15-19 years old. Males accounted for 82% of all patients with facial injuries. Helmet use was reported by 2.1% of patients, denied by 86% of subjects, and unknown in 12% of cases. During the school year (September-May) 62% of injuries occurred, while the remaining 38% occurred during summer vacation (June-August). Soft tissue facial trauma was the most common sustained injury (48%), followed by soft tissue oral cavity injuries (16%), facial fractures (14%), ocular injury (10%), dentoalveolar trauma (9%), and auricular injury (3%). Mandibular fractures accounted for 38% of facial fractures, with nasal bone (34%), midfacial (19%), and frontal bone (9%) fractures constituting the remainder. The majority of facial fractures were observed in the age groups 10-14 (64%) and 5-9 (25%). Hospital discharge was within twenty-four hours of admission in 55% of children, between 1 and 3 days in 24% of patients, and greater than three days in 21% of cases.

Conclusions: Facial injuries from bicycle-injuries in children represent a cause of significant morbidity and serious health concern. The high risk patient for facial injury is the male child aged 5-14. Bicycle helmets may be a protective factor for all patients, as the majority of children with facial injuries denied helmet use.