Frontal sinus fractures in children.

OBJECTIVE: To review the epidemiologic characteristics, clinical course, and management of pediatric patients with frontal sinus fractures.

METHODS: Retrospective review of 120 patients with maxillofacial fractures who presented to a tertiary children's hospital from 1998 to 2003 revealed 11 patients with frontal sinus fractures.

RESULTS: The study group included 9 males and 2 females with a mean age of 9.7 (range 4-14) years. The most common mechanisms of injury were unrestrained motor vehicle accident and all-terrain vehicle accident. All patients suffered concomitant orbital fractures. Other maxillofacial fractures included sphenoid (4), naso-orbitoethmoid (3), midface (2), and mandible (1). Seven (63.6%) patients sustained significant intracranial injuries including intraparenchymal hemorrhage, expanding pneumocephalus, and subdural hematoma. The average age of patients with intracranial injury was younger than those without intracranial injury (8.1 vs. 12.8 years, P = .025). Four patients had a total of six sites of cerebrospinal fluid (CSF) leak. The most common sites of dural injury were the cribriform area (4) and frontal region (2). All patients with CSF leaks had significant intracranial injuries and required bifrontal craniotomy.

CONCLUSIONS: Pediatric frontal sinus fractures are likely to involve other maxillofacial injuries, particularly involving the orbit. Frontal sinus fractures in children are associated with increased risk of serious intracranial injury and CSF leak when compared with adults. The most common site of dural injury was the cribriform area. A multidisciplinary approach is necessary to manage concomitant injuries, obtain separation of the sinonasal tract from intracranial contents, and to restore cosmesis to the brow.