Management and outcome of pediatric skull base fractures.
OBJECTIVE
The management of skull base fractures in the pediatric age group continues to be a major challenge even for experienced multidisciplinary teams. This retrospective study was undertaken at a tertiary care academic hospital to evaluate the management and outcome of pediatric skull base fractures.


METHODS
Retrospective analysis covering a period of 13.5 years (from 1996 to 2009) and 63 patients (mean age 10.7 years; range 1-18 years) was performed.


RESULTS
A road traffic accident was the most frequent etiological factor (38%). The most common skull base fracture type was temporal bone fracture (64%). Longitudinal temporal fractures were observed in 45% and transversal in 23% of these patients; in 10 cases (25%) the fracture was comminuted or mixed type. A fracture involving the spheno-ethmoidal complex was the second most common type of basilar skull fracture (41%) followed by fracture through the orbital bone (35%). Forty-three percent of the patients had a concomitant intracranial injury. Early neurological deficits were diagnosed in 21 patients (33%) and 10 patients (16%) had permanent neurological deficits. One patient died after 1 week of intensive care treatment. Fifty-four patients (86%) were discharged home and 8 patients (13%) were discharged for further rehabilitation. Glasgow Coma Scale score of 8 or lower correlated with moderate to poor outcome.


CONCLUSIONS
We conclude that skull base fracture is a rare injury in childhood. Mortality is uncommon, but this trauma is commonly associated with intracranial injury. Early neurological deficits are caused by traumatic brain injury and were observed in one-third of the patients. However, only less than one-sixth suffered from permanent neurological or neuropsychiatric disorders.
Perheentupa
Ulla
U
Department of Otolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Finland. ulla.perheentupa@utu.fi
Kinnunen
Ilpo
I
Grénman
Reidar
R
Aitasalo
Kalle
K
Mäkitie
Antti A
AA
D000046:Academic Medical Centers; D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001766:Blindness / Q000453:epidemiology; D001925:Brain Damage, Chronic / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology; D002558:Cerebrospinal Fluid Otorrhea / Q000453:epidemiology / Q000601:surgery; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005147:Facial Bones / Q000293:injuries; D005387:Finland / Q000453:epidemiology; D015600:Glasgow Coma Scale; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D019291:Skull Base / Q000293:injuries*; D012887:Skull Fractures / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000453:epidemiology