Clauser Luigi, Dallera Vittorio, Sarti Elisabetta, Tieghi Riccardo
Unit of Cranio-Maxillofacial Surgery, Center for Orbital Pathology, St. Anna Hospital and University, Corso Giovecca 203, 44100, Ferrara, Italy.
Childs Nerv Syst. 2004 Mar;20(3):168-75. doi: 10.1007/s00381-003-0868-0. Epub 2004 Feb 13.
Forehead, anterior cranial base and orbito-naso-ethmoidal fractures, combined with brain injuries and dural tears, constitute a frequent pattern of injury in infants and children less than 5 years of age when major anterior craniofacial trauma occurs. Fractures of the orbital roof, despite the common blow-out floor fractures, are considered uncommon events. In children younger than 7 years this pattern of fracture may be a consequence of nonpneumatized frontal sinuses.
Complete assessment using CT scans combined with neurosurgical, ophthalmological, anesthesiological and craniofacial reconstructive evaluations are necessary to repair the injured dura and craniofacial skeleton. The coronal approach provides the best exposure of the fractured regions to the surrounding regular structures. CT scans are useful in defining the extent and the pattern of the fractures. Once the brain and dura injuries have been managed by the neurosurgeon, the anterior cranial base must be reconstructed by applying the basic craniofacial principles, reduction and stabilization of fractures, sealing off the anterior cranial base. We present four cases of frontobasilar fractures in children, two of which involved the orbital roof.
The treatment of pediatric maxillofacial traumas, therefore, requires consideration of different factors from those in adults, and a different therapeutic approach: respect of the functional matrix (growth principle) and employment of the least invasive surgical approach. Fixation that adequately stabilizes the facial skeleton is also required. The need to provide rigid bony fixation in the surgical treatment of craniofacial disorders in children without impacting the growth has inspired the evolution of operative techniques and fixation devices, with the development of reabsorbable bone fixation. When bony defects are present or reconstruction of the complete orbital roof and anterior cranial base is required, autogenous cranial bone is used.
前额、前颅底及眶鼻筛骨折，合并脑损伤及硬脑膜撕裂，是5岁以下婴幼儿发生严重前颅面外伤时常见的损伤模式。眶顶骨折，尽管眶底爆裂骨折较为常见，但仍被认为是罕见事件。在7岁以下儿童中，这种骨折模式可能是由于额窦未气化所致。
采用CT扫描结合神经外科、眼科、麻醉科及颅面重建评估进行全面评估，对于修复受损的硬脑膜和颅面骨骼是必要的。冠状入路能最佳地暴露骨折区域及其周围的正常结构。CT扫描有助于确定骨折的范围和类型。一旦神经外科医生处理了脑和硬脑膜损伤，就必须应用基本的颅面原则重建前颅底，复位并固定骨折，封闭前颅底。我们报告4例儿童额基底骨折病例，其中2例累及眶顶。
因此，小儿颌面部创伤的治疗需要考虑与成人不同的因素，并采用不同的治疗方法：尊重功能基质（生长原则）并采用微创外科手术方法。还需要对面部骨骼进行充分稳定的固定。在不影响儿童生长的情况下，为颅面疾病的外科治疗提供坚固的骨固定的需求推动了手术技术和固定装置的发展，可吸收骨固定技术应运而生。当存在骨缺损或需要重建完整的眶顶和前颅底时，使用自体颅骨。
