Nguyen Brittany N, Edwards Mary J, Srivatsa Shachi, Wakeman Derek, Calderon Thais, Lamoshi Abdularouf, Wallenstein Kim, Fabiano Tiffany, Cantor Brittany, Bass Kathryn, Narayan Ananth, Zohn Ralph, Chess Mitchell, Thomas Richard D
Department of Surgery, Albany Medical Center, Albany, New York, USA.
Surgery, Albany Medical College, Albany, New York, USA.
Trauma Surg Acute Care Open. 2022 Apr 24;7(1):e000899. doi: 10.1136/tsaco-2022-000899. eCollection 2022.
Facial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT is a useful screening tool to identify children requiring dedicated facial CT.
We conducted a multicenter retrospective review of children aged 18 years and under with blunt facial injury who underwent both CT of the face and head from 2014 through 2018 at five pediatric trauma centers. Penetrating injuries and animal bites were excluded. Imaging and physical examination findings as well as interventions for facial fracture were reviewed. Clinically significant fractures were those requiring an intervention during hospital stay or within 30 days of injury.
322 children with facial fractures were identified. Head CT was able to identify a facial fracture in 89% (287 of 322) of children with facial fractures seen on dedicated facial CT. Minimally displaced nasal fractures, mandibular fractures, and dental injuries were the most common facial fractures not identified on head CT. Only 2% of the cohort (7 of 322) had facial injuries missed on head CT and required an intervention. All seven had mandibular or alveolar plate injuries with findings on physical examination suggestive of injury.
In pediatric blunt trauma, head CT is an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT will usually exclude a clinically significant facial fracture.
III.
钝器伤患儿中面部损伤很常见。大多数是软组织撕裂伤和牙齿损伤，临床检查时很容易发现。需要手术干预的骨折很少见。目前缺乏儿童颌面CT应用的指南。我们假设头部CT是一种有用的筛查工具，可用于识别需要进行专门面部CT检查的儿童。
我们对2014年至2018年期间在五个儿科创伤中心接受面部和头部CT检查的18岁及以下钝器面部损伤儿童进行了多中心回顾性研究。穿透伤和动物咬伤被排除在外。回顾了影像学和体格检查结果以及面部骨折的干预措施。具有临床意义的骨折是指在住院期间或受伤后30天内需要干预的骨折。
共识别出322例面部骨折患儿。头部CT能够在专门面部CT上发现的89%（322例中的287例）面部骨折患儿中识别出面部骨折。轻度移位的鼻骨骨折、下颌骨骨折和牙齿损伤是头部CT未发现的最常见面部骨折。该队列中只有2%（322例中的7例）的面部损伤在头部CT上漏诊且需要干预。所有7例均有下颌骨或牙槽板损伤，体格检查有损伤迹象。
在儿童钝器伤中，头部CT是面部骨折的优秀筛查工具。在没有下颌骨或牙齿损伤临床证据的情况下，正常的头部CT通常可排除具有临床意义的面部骨折。
III级。
