Skull and skull base injuries in children and adolescents : Results of amonocentric analysis

Abstract

The present study comprises aretrospective analysis of skull, skull base, and midface fractures in children, to provide clinical orientation for their management. To date, only few data are available on these injuries in this patient group. Data from inpatient cases diagnosed with amidface, skull, or skull base fracture in the Children's Hospital Auf der Bult from 2015 to 2020 were evaluated. Age, gender, fracture mechanism, diagnosis, treatment, and possible complications were analyzed. Data of 224children were grouped into 107cases with nose fractures, 104cases with skull fractures, 9patients with temporal bone fractures, 4patients with rhinobasal fractures, and 2cases with fractures of the orbital floor. Among patients with nose fractures, the average age was 10.9years (64% males), among patients with skull fractures 1.0year (64% males), and in children with skull base fractures 6.0years (85% males). Falls were the most frequent genesis (63%), followed by car accidents, collisions (25%), and violence (10%). Patients with skull fractures underwent sonography in 94% of cases; in 87% the fracture was verified. Patients with nose fractures underwent x‑ray in 92% of cases, or sonography only in 8%; 95% of patients with nose fractures underwent operative repositioning. Typical fracture signs (i.e., hemotympanum, ophthalmic symptoms) or signs of central nervous system involvement (i.e., nausea, amnesia) occurred in 12 of 13children with skull base fractures, and CT was performed in all these cases (none of whom developed acerebrospinal fluid leak). The imaging modality should be selected based on the clinically suspected diagnosis and the course. Most fractures can be sufficiently treated without any permanent sequelae, except for nose fractures, which frequently require operative repositioning.