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[Frontobasal fractures in children].

A Fiebach¹, H Landolt

¹Universitätsklinik und Poliklinik für HNO-Krankheiten, Kantonsspital, Basel.

|July 1, 1989

Summary

Pediatric frontobasal trauma with dural tears requires advanced imaging like high-resolution CT scans for diagnosis. Surgical intervention, often involving paranasal subfrontal access, is crucial for treating these complex injuries in children.

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Area of Science:

Neurosurgery
Pediatric Traumatology
Otolaryngology

Background:

Severe frontobasal trauma in children presents unique diagnostic and surgical challenges.
Dural tears associated with such trauma can lead to cerebrospinal fluid (CSF) leaks, increasing complication risks.

Observation:

Four pediatric patients (ages 5-13) with severe frontobasal trauma and dural tears underwent operative treatment.
Clinical manifestation of CSF rhinorrhea was present in only two cases.
High-resolution computed tomography (CT) was vital for diagnosing intracranial pneumatocele and planning surgical repair.

Findings:

Surgical confirmation revealed fractures in the ethmoid sinus, orbit roof, sphenoid sinuses, and frontal sinus posterior wall.
The anterior cranial fossa, particularly the ethmoid bone's anterior roof, is a common fracture site in pediatric frontobasal trauma.
Surgical approaches included paranasal subfrontal access, sometimes combined with frontal craniotomy, and nasal surgery alone.

Implications:

Early and accurate diagnosis using high-resolution CT is essential for effective management of pediatric frontobasal trauma.
Tailored surgical strategies, considering fracture location and severity, are necessary for successful repair of dural tears.
Understanding the predilection sites for fractures aids in surgical planning and minimizing complications like recurrent CSF leaks.

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