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Pediatric Frontal Sinus Fractures: A Controversy Revisited
Parit A. Patel, Anthony Vu, Wendy Chen, Matthew Wilkening, and Christopher B. Gordon
University of Cincinnati/Cincinnati Children's Hospital
2012-02-15
Presenter: Anthony Vu
Affidavit:
A majority of the original work was completed by the first author and the presenting author.
Director Name: W. John Kitzmiller
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
It meets the conference objectives by providing information to assess, treat, and manage complications in pediatric craniofacial trauma patients.
How will your presentation be used by practicing physicians in the audience?
Our presentation will provide guidelines for treating patients with similar conditions.
Pediatric frontal sinus fractures are a rare entity, when they occur they can be devastating injuries. Many authors recommend operative treatment for frontal sinus fractures based on the amount of displacement of the posterior table relative to its width. We aimed to identify risk factors for displaced versus non-displaced fractures. We sought to draw associations between cases that required operative and non-operative management in order to create a treatment algorithm.
At our institution, a total of 47 patients were identified to have frontal sinus fractures between 1992 and 2010. The patient's records in our trauma database and CT scans were reviewed in a retrospective manner. Patients were stratified into two cohorts based on the presence of displacement of the frontal sinus; displaced versus non-displaced. We identified risk factors, associated injuries and complications related to the cohorts.
Of the 47 patients, the mean age was 11.4 and the age range was from 4 to 17 years. Nineteen (40.4%) were categorized as displaced fractures and 28 (59.5%) were non-displaced. Of the displaced fractures, 14 (73.7%) required operative intervention. The displaced group was associated with a 47% incidence of an intracranial bleed, 21% for the non-displaced group. The complication rates for the displaced and non-displaced groups were 10.5% and 10.7% respectively. The patients that received operative intervention were associated with lower GCS values.
To date, this is the largest series of pediatric frontal sinus fractures reported. Identifying risk factors and associated injuries will allow practitioners to better treat this patient population.
