Maxillofaziale Frakturen im Kindesalter

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

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