Abstract
Object
Forehead, anterior cranial base and orbito-naso-ethmoidal fractures, combined with brain injuries and dural tears, constitute a frequent pattern of injury in infants and children less than 5 years of age when major anterior craniofacial trauma occurs. Fractures of the orbital roof, despite the common blow-out floor fractures, are considered uncommon events. In children younger than 7 years this pattern of fracture may be a consequence of nonpneumatized frontal sinuses.
Methods
Complete assessment using CT scans combined with neurosurgical, ophthalmological, anesthesiological and craniofacial reconstructive evaluations are necessary to repair the injured dura and craniofacial skeleton. The coronal approach provides the best exposure of the fractured regions to the surrounding regular structures. CT scans are useful in defining the extent and the pattern of the fractures. Once the brain and dura injuries have been managed by the neurosurgeon, the anterior cranial base must be reconstructed by applying the basic craniofacial principles, reduction and stabilization of fractures, sealing off the anterior cranial base. We present four cases of frontobasilar fractures in children, two of which involved the orbital roof.
Conclusions
The treatment of pediatric maxillofacial traumas, therefore, requires consideration of different factors from those in adults, and a different therapeutic approach: respect of the functional matrix (growth principle) and employment of the least invasive surgical approach. Fixation that adequately stabilizes the facial skeleton is also required. The need to provide rigid bony fixation in the surgical treatment of craniofacial disorders in children without impacting the growth has inspired the evolution of operative techniques and fixation devices, with the development of reabsorbable bone fixation. When bony defects are present or reconstruction of the complete orbital roof and anterior cranial base is required, autogenous cranial bone is used.
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References
Antonyshyn O, Gruss JS, Kassel EE (1989) Blow-in fractures of the orbit. Plast Reconstr Surg 84:10–20
Bardach J, Kelly KM, Jakobsen JR (1988) Simultaneous cleft lip and palate repair: an experimental study. Plast Reconstr Surg 82:31–41
Bartlett SP, Joseph B, Delozier JB III (1992) Controversies in the management of pediatric facial fractures. Clin Plast Surg 19:245–257
Burm JS, Chung CH, Suk Joon OH (1999) Pure orbital blow out fracture: new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg 103:1839–1849
Burstein F, Cohen S, Hudgins R, Boydston W (1997) Frontal basilar trauma: classification and treatment. Plast Reconstr Surg 99:1314–1323
Converse JM, Smith B (1957) Enophthalmos and diplopia in fractures of the orbital floor. Br J Plast Surg 9:265–272
Greenwald MJ, Boston D, Pensler JM, Radkowski MA (1989) Orbital roof fractures in childhood. Ophthalmology 96:491–496
Kaban LB, Mulliken JB, Murray JE (1977) Facial fractures in children. An analysis of 122 fractures in 109 patients. Plast Reconst Surg 59:15–20
Manson PH, Crawley WA, Yaremchuk MJ, Rochman GM, Hoopes JE, French JH Jr (1985) Midface fractures: advantages of immediate extended open reduction and bone grafting. Plast Reconstr Surg 76:1–12
Messinger A, Radkowski MA, Breenwald MJ, Pensler JM (1989) Orbital roof fractures in the pediatric population. Plast Reconstr Surg 84:213–218
Montag ME, Morales L Jr, Daane S (1997) Bioabsorbables: their use in pediatric craniofacial surgery. J Craniofac Surg 8:100–102
Moss ML, Rankow R (1968) The role of the functional matrix in mandible growth. Angle Orthod 38:95–103
Resnick JI, Kinney BM, Kawamoto HK Jr (1990) The effect of rigid internal fixation on cranial growth. Ann Plast Surg 25:372–374
Schultz RC (1967) Facial injuries from automobile accidents: A study of 400 consecutive cases. Plast Reconstr Surg 40:415–425
Schultz RC (1970) Supraorbital and glabellar fractures. Plast Reconstr Surg 45:227–233
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Clauser, L., Dallera, V., Sarti, E. et al. Frontobasilar fractures in children. Childs Nerv Syst 20, 168–175 (2004). https://doi.org/10.1007/s00381-003-0868-0
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DOI: https://doi.org/10.1007/s00381-003-0868-0