[Frontobasal fractures in children]

Abstract

In 1987, four children between 5 and 13 years of age with severe frontobasal trauma and dural tears were treated operatively. A CSF rhinorrhea was manifest clinically in only two cases. In addition high-resolution computerised tomography was essential in diagnosis and planning of the operation. In each of the cases an intracranial pneumatocele indicating dural laceration was shown. The fractures were confirmed during surgery in: Case 1. The roof of the ethmoid sinus and the roof of the orbit. Case 2. Both the sphenoid sinuses. Case 3. The roof of the ethmoid sinus and the posterior wall of the frontal sinus. Case 4. The roof of the ethmoidal sinus and the posterior wall of the frontal sinus. The ontogenetically oldest part of the paranasal sinuses in the floor of the anterior cranial fossa forming the anterior part of the roof of the ethmoid bone is the site of predilection for fractures, even in children. The anterior cranial fossa was exposed in each case through a paranasal subfrontal access, in the first case combined with a frontal craniotomy by a neurosurgeon, because of the fracture of the roof of the orbit. In the second case the dural injury had to be closed at a second neurosurgical operation, because of a recurrence of the CSF leak. The third and fourth cases were treated by nasal surgery alone.