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The age dependent relationship between facial fractures and skull fractures
James Chan1, Michelle A Putnam, Paul J Feustel
1Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, A71, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Insights
Facial fractures are more common with skull fractures in adults than children. The risk of combined facial and skull fractures increases exponentially with age in children, indicating developmental influences on craniofacial injuries.
Area of Science:
- Trauma surgery
- Pediatric surgery
- Orthopedic surgery
Background:
- Facial and skull fractures are common injuries in trauma patients.
- The relationship between facial and skull fractures and age is not well-established.
Purpose of the Study:
- To investigate the age-dependent relationship between facial fractures and skull fractures.
- To provide clinical evidence supporting the association between craniofacial injuries and developmental stage.
Main Methods:
- A retrospective chart review was conducted at a tertiary level-one trauma center.
- Data from 201 children and 139 adults with skull fractures (with or without facial fractures) between 1991 and 1997 were analyzed.
- Patient demographics, fracture patterns, Glasgow Coma Scale (GCS), injury mechanism, and outcomes were recorded.
Main Results:
- Adults exhibited a significantly higher incidence of facial fractures associated with skull fractures compared to children (P < 0.001).
- An exponential increase in combined facial and skull fractures was observed from infancy to adolescence.
- Children with combined facial and skull fractures had a significantly lower GCS than those with skull fractures alone (P < 0.001).
Conclusions:
- The pattern of craniofacial injuries, including combined facial and skull fractures, is influenced by the developmental stage of the craniofacial skeleton.
- Clinical observations in children and adults demonstrate a variable pattern of these injuries related to age.
Objective:
To provide clinical evidence to support the age dependent relationship between facial fractures and skull fractures.
Design:
Retrospective chart review of all children and adults admitted with combined facial fractures and skull fractures and skull fractures alone between January 1991 and November 1997.
Setting:
The Albany Medical Center Hospital, a tertiary level-one trauma center.
Patients:
Two hundred and one children, ages 1 month to 17 years, with skull fractures (frontal, parietal, or temporal), and 41 children with concurrent facial fractures were included in this study. One hundred and thirty-nine adults, ages 18-90 years, with skull fractures, and 70 adults with concurrent facial fractures were also studied.
Outcome Measures:
The gender, age, skull fracture, facial fracture, Glasgow coma score (GCS), mechanism of injury, and outcome of all patients admitted with frontal, parietal, or temporal fractures with or without facial fractures.
Results:
There are a significantly greater (P < 0.001) number of facial fractures associated with skull fractures among adults as compared to children. Moreover, there is an exponential rise in facial fractures associated with skull fractures between infancy and adolescence. The GCS of children with combined facial and skull fractures is significantly lower than in those with skull fractures only (P < 0.001).
Conclusion:
The spectrum of craniofacial injuries is related to the specific developmental stage of the craniofacial skeleton. This is demonstrated by the variable pattern of combined facial and skull fractures observed clinically in children and adults.
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