| Presenter: Sanjay Naran, MD, University of Pittsburgh
Authors: Sanjay Naran (1), Christopher Kinsella (2), Zoe MacIsaac (1), Evan Katzel (1), Michael Bykowski (1), Sameer Shakir (1), Roee Rubinstein (3), Joseph Losee (4)
(1) University of Pittsburgh, Pittsburgh, PA, (2) Saint Louis university, Saint Louis, MO, (3) Southern California Permanente Medical Group, Woodland Hills, CA, (4) Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Sanjay Naran, MD
University of Pittsburgh
The pediatric facial skeleton fractures in patterns distinct from those of the adult; this has implications in their diagnosis and management, which may go unrecognized. To highlight the mechanistic, anatomic, and diagnostic peculiarities of pediatric facial fractures, we reviewed the patterns of injury at our institution with respect to frequency and trajectory.
A retrospective review of patients presenting with facial fractures to our pediatric institution between 2004-2007 was performed. Isolated fractures of the nose, mandible, or skull were excluded. Demographics, cause of injury, fracture patterns, associated injuries, management, and follow-up information was gathered. CT scans were reviewed, characterizing fracture length, displacement, trajectory and severity. Adverse outcomes were the subject of further subanalysis.
1520 patients with craniofacial fractures over this period presented to our institution; 314 of these patients had combination fractures, involving at least two of the facial thirds; 151 of these patients had a complete data set with follow-up that could be reviewed, making up the cohort for this study. Average age at injury was 9.5±4.7 years, with a male predominance (66.9%). Mechanism of injury was predominantly motor vehicle (37.1%). Associated injuries included intracranial bleed (37.1%), ophthalmologic (27.2%), and CSF leak (3.3%). Patterns of fracturing displayed near consistent obliquity, with only eight patients (5.3%) displaying a LeFort type facial fractures. Five patients died as a result of their injuries. Treatment upon initial presentation was primarily conservative (61.3%). Follow-up averaged 2.4±2.3 years. Follow-up evaluations informed a decision to later operate on five patients for a diagnosis of a growing skull fracture. For these patients, the cranial limb of their fracture most often extended obliquely across the frontal bone, with an inferior extension that irregularly disrupted the orbital roof and walls.
This series of pediatric facial fractures near consistently demonstrated oblique fracture patterns, in contrast to the typical adult fracture patterns described by LeFort. The main determinant of these patterns is thought to be the immature anatomy of the pediatric skull and face. The rapidly growing skull and brain further predispose these patients to serious complications, in particular growing skull fractures.