FRONTAL BASILAR TRAUMA - CLASSIFICATION AND TREATMENT

We report our experience with 14 consecutive cases of frontal basilar trauma occurring in children and adolescents aged 18 months to 18 year s (mean 9.5 years). Brain parenchymal injury resulting in functional d eficit occurred in 5 patients (36 percent), 2 patients suffered bilate ral blindness, and 1 suffered unilateral loss of vision. A classificat ion system and treatment algorithm based on the clinical fracture patt ern seen by computed tomography are introduced. Type I, central, is co nfined to the upper nasoethmoidal complex, central frontal bone, and m edial third of the superior orbital rims. Type II, unilateral, involve s the entire supraorbital rim and the upper lateral orbital wall, exte nding into the squamosa of the temporal bone and ipsilateral frontal b one. Type III, bilateral, involves fractures of the upper nasal ethmoi dal complex, bilateral supraorbital and upper lateral orbital wall fra ctures, and bilateral frontal bone fractures. This classification was utilized to plan elective orbital and cranial osteotomies, similar to those used for frontal orbital advancement at the time of acute fractu re repair. Frontal orbital osteotomies were used to access the anterio r cranial fossa, orbital apices, and nasofrontal ducts and to obtain a n intact bony template for side-table reassembly of the fracture fragm ents. There was no significant operative morbidity, one late cerebrosp inal fluid leak, and no infections. Reoperation was necessary in four patients (29 percent) for aesthetic indications.