Treatment of severe frontobasilar fractures in growing patients: a case series evaluation

Objective: The treatment of frontobasilar fractures is a demanding aspect of craniofacial fracture management. A sequel of inadequate or improper fracture management presents cosmetic and functional problems which are very difficult to correct. The aim of this manuscript was to examine a group of growing patients treated for frontobasilar fractures and provide clinicians a possible therapeutic option for the treatment of these challenging fractures. Methods: In this investigation, 12 patients under the age of 16 years treated for severe injuries to the frontobasilar region were included. Their records were reviewed to evaluate the clinical diagnosis, preoperative findings, hospital course, postoperative results, and long-term follow-up. Preoperative and postoperative CT scans were performed in all children treated. Postoperative complications were reviewed in detail. Surgical procedures were evaluated for type and location of fixation. All complications and treatments were recorded. Results: Three of the patients presented with a cerebrospinal fluid (CSF) leak and required pericranial flaps. Only 3 patients underwent removal of plates and screws due to palpability in 1 patient, loose hardware in 1 patient, and limited disturbance on growth in the rest patient. Seven patients underwent open reduction and internal fixation with resorbable plates, 4 patients with titanium plates, and 1 patient with a combination. Follow-up ranged from 6 months to 5 years. No patients with a preoperative CSF leak developed any recurrence of the leak. Conclusion: According to basic craniofacial principles, reducing and stabilizing the fractures should reconstruct the anterior cranial base. However, the treatment of paediatric maxillofacial trauma requires the evaluation of several factors. The facial skeleton of a child is constantly evolving and its growth depends on the balance of basal bone and soft tissues.