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Pediatric Nasoorbitoethmoid Fractures: A Single Institution's Fifteen Year Experience
Anne E. Glenney, BA1; Zhazira Irgebay, BA 1; Lucille G. Cheng, BA2; Alexander J. Comerci, BS2; Joseph W. Mocharnuk, BA1; Madeleine K. Bruce, BA1; Erin E. Anstadt, MD1; Lucas A. Dvoracek, MD1; Joseph E. Losee, MD1; Jesse A. Goldstein, MD 1
University of Pittsburgh Medical Center (UPMC)
2023-01-30
Presenter: Anne E. Glenney
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study describes characteristics, management, and outcomes of pediatric NOE fractures seen at a single institution.
Methods: A retrospective review of patients under 18 years who presented to our institution from 2006 to 2021 with facial fractures was conducted; patients with NOE fractures were included. Data collected included demographics, mechanism of injury, management, and outcomes, and NOE fractures were sub-divided in accordance with the Markowitz and Manson classification system.
Results: 58 patients met inclusion criteria; 77.6% presented with Type I fractures, 17.2% with Type II, and 5.2% with Type III. The most common cause of injury was motor vehicle accidents (MVAs, 39.7%) and sports (31%). GCS and injury mechanism were not predictive of injury severity in the pediatric population (p=0.353, p=0.493). Orbital fractures were the most common associated fractures (n=55, 94.8%); parietal bone fractures were more likely in Type III fractures (p=0.047). LeFort III fractures were more likely in type II fractures (p=0.011). Soft tissue and neurological injuries were the most common associated injuries regardless of NOE fracture type (81% and 58.6%, respectively). There was no significant difference in type of operative management or in the rates of adverse outcomes between types of NOE fractures.
Conclusions: These findings suggest that pediatric NOE fractures, though rare, present differently from adult NOE fractures and that revisiting predictive heuristics and treatment strategies is warranted in this population.
