Characteristics of cervical spine injury in pediatric patients with facial fractures

Jordan N. Halsey, Ian C. Hoppe, Andrew A. Marano, Anthony M. Kordahi, Edward S. Lee, Mark Granick

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Overview: Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. Methods: A retrospective review from 2000 to 2012 of all facial fractures in patients <18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected. Results: During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90%) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70%) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge. Conclusions: In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly used for facial fracture treatment. Special caution should be used when examining patients with a depressed Glasgow Coma Scale or in those with upper midface fractures.

Original languageEnglish (US)
Pages (from-to)109-111
Number of pages3
JournalJournal of Craniofacial Surgery
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Spine
Pediatrics
Wounds and Injuries
Skeleton
Glasgow Coma Scale
Zygoma
Palate
Trauma Centers
Orbit
Operating Rooms
Neurologic Manifestations
Decompression
Mandible
Upper Extremity
Immobilization
Nervous System
Demography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Otorhinolaryngology

Cite this

Halsey, Jordan N. ; Hoppe, Ian C. ; Marano, Andrew A. ; Kordahi, Anthony M. ; Lee, Edward S. ; Granick, Mark. / Characteristics of cervical spine injury in pediatric patients with facial fractures. In: Journal of Craniofacial Surgery. 2016 ; Vol. 27, No. 1. pp. 109-111.
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abstract = "Overview: Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. Methods: A retrospective review from 2000 to 2012 of all facial fractures in patients <18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected. Results: During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90{\%}) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70{\%}) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge. Conclusions: In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly used for facial fracture treatment. Special caution should be used when examining patients with a depressed Glasgow Coma Scale or in those with upper midface fractures.",
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Characteristics of cervical spine injury in pediatric patients with facial fractures. / Halsey, Jordan N.; Hoppe, Ian C.; Marano, Andrew A.; Kordahi, Anthony M.; Lee, Edward S.; Granick, Mark.

In: Journal of Craniofacial Surgery, Vol. 27, No. 1, 01.01.2016, p. 109-111.

Research output: Contribution to journalArticle

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