[Fronto-basal fractures in the child]. / Frontobasale Frakturen beim Kind.

The particularities and the authors' management of frontobasal fractures in children are discussed on the basis of cases treated at the authors' department during the last five years. Fifteen children aged between four and 16 years (mean eight years) made up 14.5% of all frontobasal fractures. The causes of the injury were equally divided between falls from a height of at least 2 m and traffic accidents. All children except one were treated immediately after the accident. The exception was a child with an accident two and a half years before operation and two episodes of late onset meningitis. The diagnoses were mainly made with the help of high resolution computer-tomographies, which permitted a correct localization of the fractures site. The exact course of the fracture was recognized correctly in seven of eleven cases. Each case was managed in interdisciplinary fashion together with the neurosurgeon and the general surgeon. If nonoperative management was chosen, a computer-tomography about six weeks after the injury had to demonstrate the return to normal appearance of the paranasal sinus. If a dural tear was ascertained, a repair with a rhinosurgical approach was favored and, thereby, a definite closure was obtained in seven out of nine cases. One case was primarily managed by a combined rhino- and neurosurgical approach, while two cases were reoperated neurosurgically because of persistent cerebrospinal fluid leakage after the rhinosurgical repair. No other postoperative complications, such as meningitis or a third operation, were encountered. The authors believe that these favorable results were obtained because of individual management of each case by an interdisciplinary team working closely together.