Traumatologie des Gesichtsschädels im Kindesalter

Zusammenfassung

Frakturen des Gesichtsschädels sind im Kindesalter aufgrund anatomischer Besonderheiten und unterschiedlicher Kausalitäten deutlich seltener als im Erwachsenenalter. Die Versorgung von sich im Wachstum befindlichen Gesichtsschädelknochen stellt den behandelnden Arzt oft vor eine große Herausforderung und setzt eine genaue Kenntnis der kindlichen Anatomie voraus. Oft bleiben mögliche spätere Wachstumsstörungen aufgrund des initialen Traumas, aber auch durch den chirurgischen Eingriff selbst schwer abzuschätzen. Kleine Patientenkollektive und die Notwendigkeit langfristiger Nachuntersuchungen erschweren zusätzlich evidenzbasierte Aussagen.

Abstract

Associated injuries are a common feature in pediatric facial fractures, which reinforce the importance of a complete initial assessment of a child with facial trauma.

Particular kinds of fracture tend to occur at specific anatomic sites in children, with the severity and extent of the fracture varying according tot he patient’s age and the stage of skeletal development. The frequency of severe fractures increases with age, as does the frequency of surgically treated fractures. Maxillofacial surgical intervention is indicated only for the repair of severely displaced fractures that are likely to cause functional impairment, esthetic deformity, or both. The effect of treatment on long-term growth and development must be the cornerstone when choosing the optimal therapeutic option. While internal fixation is routinely used for adult facial trauma patients, the application of these surgical techniques in children is controversial as subperiosteal dissection might disturb the growth of the bone.

Kernaussagen

• Frakturen des Gesichtsschädels im Kindesalter sind selten und sind häufig im Rahmen von schweren Traumata mit weiteren Begleitverletzungen verbunden.

• Die jeweilige Phase des Gesichtswachstums und die Entwicklung bestimmt oft das Frakturmuster bzw. den Frakturtyp in der jeweiligen Altersgruppe.

• Prinzipiell sollte die gewählte Therapie möglichst konservativ sein und wenn ein chirurgisches Vorgehen unvermeidbar ist, sollte dies so minimalinvasiv wie möglich sein, um spätere Wachstumsstörungen zu vermeiden.

• Einklemmungen von extraokulären Augenmuskeln bei Frakturen des Orbitabodens sind häufiger im Kindesalter und erfordern eine unmittelbare chirurgische Intervention.

• Die meisten Frakturen des Unterkiefers lassen sich mit weicher Kost oder mittels geschlossener Reposition therapieren.

• Ein Langzeit-Follow-up ist notwendig, um mögliche Wachstumsstörungen frühzeitig erkennen.

Schlüsselwörter

pädiatrische Frakturen - Unterkieferfrakturen - Gesichtsschädel - Mittelgesichtsfrakturen - Orbitabodenfrakturen - Schädelentwicklung

Key words

pediatric facial trauma - internal Fixation - Maxillofacial trauma - orbital fractures - mandible fractures - facial growth

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