Download PDF
Kinder- und Jugendmedizin 2015; 15(02): 75-85
DOI: 10.1055/s-0038-1629259
Mund-, Kiefer- und Gesichtschirurgie
Schattauer GmbH

Maxillofaziale Frakturen im Kindesalter

Pediatric maxillofacial fractures
T. Hierl
1   Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Leipzig AöR
,
A. Hemprich
1   Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Leipzig AöR
,
H. Hümpfner-Hierl
1   Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Leipzig AöR
› Author Affiliations
Further Information

Publication History

Eingereicht am: 01 December 2014

angenommen am: 09 December 2014

Publication Date:
31 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Frakturen des Gesichtsschädels sind im Kindesalter relativ selten, Jungen sind dabei häufiger betroffen als Mädchen. Nasengerüstfrakturen stellen die häufigste Gruppe dar, gefolgt von Unterkiefer- und lateralen Mittelgesichtsfrakturen. Mit zunehmendem Alter steigt das Frakturrisiko, und das Ursa-chenspektrum verändert sich hierbei von Stürzen und Verkehrsunfällen hin zu Sportunfällen und Rohheitsdelikten. Mit dem Teen-ageralter verschiebt sich die Behandlung von eher konservativer zur operativen Behand-lung durch offene Reposition und interne Fixation. Eine Ausnahme bilden Orbitawandfrakturen, die bei einer Einklemmung von Orbitainhalt in jedem Kindesalter unverzüglich operiert werden müssen, um dauerhafte funktionelle Spätschäden zu verhindern. Weitere potenzielle Spätschäden betreffen vor allem das Wachstum von Nase und Unterkiefer und bedürfen einer operativen Korrektur nach Wachstumsabschluss. Hinsichtlich der bildgebenden Diagnostik ist die klassische Projektionsradiografie meist wenig aussagekräftig, sodass in begründeten Fällen eine dosisangepasste CT-Diagnostik das Mittel der Wahl darstellt.

Summary

Although pediatric maxillofacial fractures are comparatively rare, untreated or unnoticed fractures may lead to serious functional impairment. This concerns especially orbital, nasal and mandibular trauma. With increasing age, therapy changes from conservative to operative treatment with open reposition and internal fixation. There is also a shift in etiology from falls and motor vehicle accidents towards sports´ accidents and interpersonal violence. Boys suffer twice as much as girls due to different habits. In contrast to surgery in adults, orbital trap-door fractures with impingement of soft tissue contents are to be treated immediately to prevent permanent functional impairment. Regarding diagnostics, CT-scanning will often be the method of choice as plain radiography may be difficult to interpret. In cases of trauma-related growth disturbances (nasal, midface, mandible), corrective surgery after growth may be appropriate.

Schlüsselwörter

Traumatologie - Kindesalter - maxillofazial

Keywords

Traumatology - pediatric - maxillofacial
 

  • Literatur

  • 1 Aldelaimi TN, Khalil AA. Surgical management of pediatric mandibular trauma. J Craniofac Surg 2013; 24: 785-787.
    CrossrefPubMedGoogle Scholar
  • 2 Boyette JR. Facial fractures in children. Otolaryngol Clin N Am 2014; 47: 747-761.
    CrossrefPubMedGoogle Scholar
  • 3 Bruckmoser E, Undt G. Management and outcome of condylar fractures in children and adolescents: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114: 86-106.
    Google Scholar
  • 4 Costa Ferreira P, Barbossa J, Braga JM. et al. Pediatric facial fractures. A review of 2071 fractures. Ann Plast Surg; 2014
    Google Scholar
  • 5 Costello BJ, Rivera RD, Shand J, Mooney M. Growth and development considerations for craniomaxillofacial surgery. Oral Maxillofac Surg Clin N Am 2012; 24: 377-396.
    CrossrefPubMedGoogle Scholar
  • 6 Da Costa Nardis A, Pinho Costa SA, da Silva RA, Pardo Kaba SC. Patterns of paediatric facial fractures in a hospital of Sao Paulo, Brazil: a retrospective study of 3 years. J Craniomaxillofac Surg 2013; 41: 226-229.
    CrossrefPubMedGoogle Scholar
  • 7 Erdmann D, Follmar KE, DeBruijn M. et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg 2008; 60: 398-403.
    CrossrefPubMedGoogle Scholar
  • 8 Fernandez H, Osorio J, Russi MT. et al. Effects of internal rigid fixation on mandibular development in growing rabbits with mandibular fractures. J Oral Maxillofac Surg 2012; 70: 2368-2374.
    CrossrefPubMedGoogle Scholar
  • 9 Gassner R, Tuli T, Hächl O. et al. Craniomaxillofacial trauma in children: a review of 3385 cases with 6060 injuries in 10 years. J Oral Maxillofac Surg 2004; 62: 399-407.
    CrossrefPubMedGoogle Scholar
  • 10 Gerber B, Kiwanuka P, Dhariwal D. Orbital fractures in children: a review of outcomes. Br J oral Maxillofac Surg 2013; 51: 789-793.
    CrossrefPubMedGoogle Scholar
  • 11 Hogg NJV. Primary and secondary management of pediatric soft tissue injuries. Oral Maxillofacial SurgClin N Am 2012; 24: 365-375.
    Google Scholar
  • 12 Hoppe IC, Kordahi AM, Paik AM. et al. Pediatric facial fractures as a result of gunshot injuries: an expression of associated injuries and trends in management. J Craniofac Surg 2014; 25: 400-405.
    CrossrefPubMedGoogle Scholar
  • 13 Kassam K, Rahim I, Mills C. Paediatric orbital fractures: the importance of regular thorough eye assessment and apprpriate referral. Case Reports Em Med. 2013 http://dx.doi.org/10.1155/2013/376564.
    CrossrefPubMedGoogle Scholar
  • 14 Koenig WR, Olsson AB, Pensler JM. The fate of developing teeth in facial trauma: tooth buds in the line of mandibular fractures in children. Ann Plast Surg 1994; 32: 503-505.
    CrossrefPubMedGoogle Scholar
  • 15 Maqusi S, Morris DE, Patel PK. et al. Complications of pediatric facialfractures. J Craniofac Surg 2012; 23: 1023-1027.
    CrossrefPubMedGoogle Scholar
  • 16 Morris C, Kushner GM, Tiwana PS. Facial skeletal trauma in the growing patient. Oral Maxillofacial Surg Clin N Am 2012; 24: 351-364.
    CrossrefPubMedGoogle Scholar
  • 17 Mukherjee CG, Mukherjee U. Maxillofacial trauma in children. Int J Clin Ped Dent 2012; 5: 231-236.
    Google Scholar
  • 18 Posnick JC. Management of facial fractures in children and adolescents. Ann Plast Surg 1994; 33: 442-457.
    CrossrefPubMedGoogle Scholar
  • 19 Roudari BS, Psoter KJ, Vavilala MS. et al. CT use in hospitalized pediatric trauma patients: 15-year trends in a level I pediatric and adult trauma center. Radiology 2013; 267: 479-486.
    CrossrefPubMedGoogle Scholar
  • 20 Salentijn EG, van den Bergh B, Forouzanfar T. A ten-year analysis of midfacial fractures. J Craniomaxillofac Surg 2013; 41: 630-636.
    CrossrefPubMedGoogle Scholar
  • 21 Singh G, Mohammad S, Hariram USP. et al. Pediatric facial injuries: it´s management. Nat J Maxillofac Surg 2011; 2: 156-162.
    Google Scholar
  • 22 Sherick DG, Buchman SR, Patel PP. Pediatric facial fractures: a demographic analysis outside an urban environment. Ann Plast Surg 1997; 38: 578-585.
    CrossrefPubMedGoogle Scholar
  • 23 Shi J, Chen Z, Xu B. Causes and treatment of mandibular and condylar fractures in children and adolescents. A review of 104 cases. JAMA Otolaryngol Head Neck Surg 2014; 140: 203-207.
    CrossrefPubMedGoogle Scholar
  • 24 Thaller SR, Huang V. Midfacial fractures in the pediatric population. Ann Plast Surg 1992; 29: 348-352.
    CrossrefPubMedGoogle Scholar
  • 25 Thaller SR, Mabourakh S. Pediatric mandibular fractures. Ann Plast Surg 1991; 26: 511-513.
    CrossrefPubMedGoogle Scholar
  • 26 Totonchi A, Sweeney WM, Gosain AK. Distinguishing anatomic features of pediatric facial trauma. J Craniofac Surg 2012; 23: 793-798.
    CrossrefPubMedGoogle Scholar
  • 27 Yamamoto K, Matsusue Y, Horita S. et al. Maxillofacial fractures in children. J CraniofacSurg 2013; 24: 153-157.
    Google Scholar