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Pediatric facial fractures: occurrence of pneumocephalus and relation to fracture patterns
Zhazira Irgebay, BA; Jesse A. Goldstein, MD; Joseph E. Losee, MD
University of Pittsburgh
2022-01-26
Presenter: Zhazira Irgebay
Affidavit:
This student was responsible for over half of the conception, design, data collection, analysis of data, and abstract drafting for this project.
Director Name: Vu T Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Traumatic pneumocephalus is a poorly characterized complication of facial fracture patients. This study evaluated the etiology of the occurrence of pneumocephalus in facial fracture patients and its relation to fracture patterns.
Methods: We performed a retrospective review of pediatric patients who were evaluated at a pediatric level I trauma center from 2005 to 2021 for facial fractures. Data included demographics, etiology, documentation of pneumocephalus, types of facial fracture, and associated injuries.
Results: Facial fractures were diagnosed in 3334 patients. One hundred thirty-six patients met the inclusion criteria (4.1%). The average age was 9.3 +/- 4.5 years. On average, the lowest GCS score was 12.5 +/- 4.2. The most common cause of injury was motor vehicle accidents (n = 58, 42.6%). Orbital fractures were the most common associated facial fractures (n = 116, 85.3%, p<0.001). Skull fractures were seen in 86.0% of the pneumocephalus patients; frontal (n = 64, 47.1%, p<0.001), frontal sinus (n =39, 28.7%, p<0.001), and sphenoid fractures were the most common (n = 42, 30.9%, p<0.001). All pneumocephalus patients had neurological injuries, loss of consciousness (n = 51, 37.5%, p<0.001) and subdural hemorrhage being the most common (n = 40, 29.4%, p<0.001). Pneumocephalus patients were more likely to require intensive care (OR, 24.4 [95% CI, 16.7-35.5]) and less likely to undergo operative treatment (OR, 0.3 [95% Cl: 0.2-0.5]) compared to patients without pneumocephalus.
Conclusions: Pediatric facial fracture patients presenting with pneumocephalus are a poorly characterized population. Our study describes the unique characteristics of this understudied population.
