Frontobasilar fractures in children

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.