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Frontobasilar fractures in children.
Luigi Clauser1, Vittorio Dallera, Elisabetta Sarti
1Unit of Cranio-Maxillofacial Surgery, Center for Orbital Pathology, St. Anna Hospital and University, Corso Giovecca 203, 44100, Ferrara, Italy. csr@unife.it
Summary
Pediatric craniofacial trauma, especially frontobasilar fractures, requires specialized care. Treatment prioritizes growth principles and minimally invasive techniques for optimal outcomes in young patients.
Area of Science:
- Pediatric craniofacial surgery
- Neurosurgery
- Ophthalmology
- Anesthesiology
Background:
- Major anterior craniofacial trauma in children under 5 frequently involves forehead, anterior cranial base, and orbito-naso-ethmoidal fractures, often with brain injuries and dural tears.
- Orbital roof fractures are uncommon in children, unlike more frequent orbital floor blow-out fractures.
- In children under 7, these fractures may stem from undeveloped frontal sinuses.
Observation:
- Comprehensive evaluation using CT scans alongside neurosurgical, ophthalmological, anesthesiological, and craniofacial reconstructive assessments is crucial.
- The coronal approach offers optimal surgical exposure for fractured regions.
- CT scans are vital for delineating fracture extent and patterns.
Findings:
- Post-neurosurgical management of brain and dural injuries, anterior cranial base reconstruction follows craniofacial principles: fracture reduction, stabilization, and sealing.
- Four pediatric frontobasilar fracture cases were presented, with two involving the orbital roof.
- Treatment necessitates respecting the growth principle and employing minimally invasive surgical strategies.
Implications:
- Pediatric maxillofacial trauma management differs significantly from adult treatment, emphasizing growth preservation.
- Rigid bony fixation without compromising facial growth is essential, driving innovation in fixation devices like reabsorbable materials.
- Autogenous cranial bone is utilized for reconstructing significant bony defects, including the orbital roof and anterior cranial base.