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True Pediatric Craniofacial Fractures: Trajectories and Ramifications
Sanjay Naran, MD, Roee Rubinstein, MD, Christopher Kinsella, MD, Zoe MacIsaac, MD, Joseph Losee, MD.
University of Pittsburgh
2013-03-14
Presenter: Sanjay Naran, MD
Affidavit:
The material proposed for presentation in this abstract, in its entirety, represents the original work of the resident.
Director Name: Joseph Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
To highlight mechanistic, anatomic, and diagnostic peculiarities of craniofacial fractures in the pediatric population, we reviewed multilevel true craniofacial fractures (continuous fractures involving the cranial and upper facial skeleton and traversing the skull base) at our institution. Given the tight adherence of the dura to the calvarium in this population, we predicted an increased risk for dural injury and growing skull fractures (GSF).
METHODS:
A retrospective review of true craniofacial fractures seen between 2004-2007 was performed. Demographics, and peri-trauma elements were gathered. Attention was paid to fracture patterns and the incidence of GSFs.
RESULTS:
54 patients were identified. 61.1% were male, with an average age of 7.98±4.74 years. Mechanisms of injury included motor vehicle (40.7%), and sports-related (33.3%). Associated injuries included ophthalmologic (18.5%), intracranial bleed (50%), and CSF leak (3.7%). Fractures displayed near consistent obliquity, with one patient displaying a hemi-LeFort III type fracture. Usually, the cranial limb of these fractures extended obliquely across the frontal bone, with an inferior extension that irregularly disrupted the orbital roof and walls. Treatment was primarily conservative (75.9%). Follow-up evaluations informed a decision to later operate on four patients (7.4%) for a diagnosis of a GSF. All patients demonstrated healed fractures at their last follow-up (minimum of 36 months post-injury).
CONCLUSION:
Pediatric craniofacial fractures demonstrate oblique fracture patterns, in contrast to the adult LeFort patterns. The rapidly growing skull and brain place these patients at increased risk for GSFs (7.6%, versus 1.6% in adults).
