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[Frontobasal fractures in children]
Insights
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.
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.
Abstract:
In 1987, four children between 5 and 13 years of age with severe frontobasal trauma and dural tears were treated operatively. A CSF rhinorrhea was manifest clinically in only two cases. In addition high-resolution computerised tomography was essential in diagnosis and planning of the operation. In each of the cases an intracranial pneumatocele indicating dural laceration was shown. The fractures were confirmed during surgery in: Case 1. The roof of the ethmoid sinus and the roof of the orbit. Case 2. Both the sphenoid sinuses. Case 3. The roof of the ethmoid sinus and the posterior wall of the frontal sinus. Case 4. The roof of the ethmoidal sinus and the posterior wall of the frontal sinus. The ontogenetically oldest part of the paranasal sinuses in the floor of the anterior cranial fossa forming the anterior part of the roof of the ethmoid bone is the site of predilection for fractures, even in children. The anterior cranial fossa was exposed in each case through a paranasal subfrontal access, in the first case combined with a frontal craniotomy by a neurosurgeon, because of the fracture of the roof of the orbit. In the second case the dural injury had to be closed at a second neurosurgical operation, because of a recurrence of the CSF leak. The third and fourth cases were treated by nasal surgery alone.