Midfacial fractures in children

The purpose of the study was to present a modern classification and discuss the treatment of midfacial fractures in children. From the beginning of 1 January 1998 to 31 October 2000, 147 children were treated for different craniofacial fractures. Among them 28 patients (19 %) had extensive midfacial fractures complicated by impaired vision and/or CNS dysfunction and were treated surgically. The fractures were divided into: zygomatico-orbital (1 pt) and zygomatico-orbito-maxillary (5 pts), isolated orbital wall fractures (14 pts) and naso-orbital dislocations (2 pts), upper facial portion dislocations (2 pts) and fronto-naso-orbital (2 pts) or cranio-orbital fractures (2 pts). Clinical examination revealed mainly dysfunction of facial morphology and aesthetics (enophthalmos, telecanthus), CSF leakage, impairment of vision and restricted eyeball movements. Ophthalmological, neurological and radiological (Waters view, CT, NMR) examinations were performed in all cases. The treatment consisted of bone repositioning, reconstruction with autologous bone grafts and three-dimensional stabilisation using titanium plates. Twenty-three pts were operated on before and 5 pts after 7th day after trauma. The restoration of normal facial morphology was achieved in 26 patients. In 2 cases it was impossible because of the destruction of soft tissue and an extremely extensive bony trauma. Better reposition of bony fragments, prompt healing and better final results were achieved in patients operated before day 7 after trauma. Achieving good results in midfacial fractures requires prompt and adequate treatment and a multidisciplinary (paediatric, maxillofacial, plastic surgeons, neurosurgeon, ophthalmologist) team.