S5B-02 SESSION 5B: TRAUMA FACE THE FREQUENCY OF CERVICAL SPINE INJURIES IN PEDIATRIC CRANIOMAXILLOFACIAL TRAUMA PATIENTS – THE 20-YEAR EXPERIENCE AT THE JOHNS HOPKINS HOSPITAL

Abstract

Introduction: Craniomaxillofacial (CMF) fractures are accepted as injuries at high risk for concomitant cervical spine or spinal cord injuries. However, there is a paucity of studies investigating the relationship between CMF fractures and cervical spine injuries (CSI) in the pediatric population. The purpose of this study was to investigate the frequency of CSI after CMF trauma at a level-1, pediatric, tertiary, trauma center. Methods: A retrospective cohort review of all pediatric patients (ages 0–15) who presented to the Johns Hopkins Hospital from 1990–2010 with CMF fractures were examined for concurrent CSI injuries. Patient charts were reviewed for mechanism of injury, dentition stage, type of CSI, location of CMF fracture patterns, and overall outcome. Results: A total of 2966 pediatric patients (ages 0–15) were identified from 1990 to 2010 to have suffered CMF fractures, with an average age of 7 ± 4.73 years, and 1897 (64.0%) male. Of these patients, only five children were found to have concomitant CSIs (0.169% frequency). The frequency of CSI in CMF fracture patients with deciduous, mixed, and permanent dentition was 0%, 0.307%, and 0.441%, respectively. Of the five identified cases, four had concomitant middle-third facial skeleton fractures, four had concomitant upper-thirds cranial skeletal fracture, and two had concomitant lower-thirds cranial skeletal fractures. Conclusion: The frequency of CSIs in children with CMF fractures is significantly lower (0.169%) than the reported ranges in adults (3.69–24%). No child of deciduous dentition was found to have a CSI. The lack of CSI in deciduous CMF fracture patients could be explained by the anatomic differences between pediatric and adult cervical spines. The higher frequency of CSI in CMF trauma patients of mixed or permanent dentition also suggests that the use of the NEXUS and CCS may be efficacious in this population. However, future prospective studies will be required to develop pediatric-specific risk-stratification tools for this unique population. Until such studies are performed, we recommend that all high-risk CMF trauma patients be assessed clinically and stabilized with a cervical collar. If indicated, plain radiography with two views should be obtained. If plain radiography is inconclusive and there remains an increased index of suspicion, a CT scan or a T2 (STIR) MRI should be utilized to rule out bony or ligamentous injuries