Incidence of Cervical Spine Injuries in Pediatric Craniomaxillofacial Trauma Patients
Helen Xun, BS, Joseph Lopez, MD, MBA, Halley Darrach, BS, Bart Kachniarz, MD, Richard J. Redett, MD, Paul Manson, MD, Amir Dorafshar, M.B.Ch.B.
Johns Hopkins School of Medicine, Baltimore, MD, USA.
Craniomaxillofacial (CMF) fractures are accepted as injuries at high risk for concomitant cervical spine injuries (CSI). In adult studies, the incidence of CSI concurrent with CMF factures has been reported to be as high as 24%, thus supporting imaging studies to detect CSI in all adult patients with CMF fractures. Presently, there is a paucity of studies investigating the relationship between craniomaxillofacial (CMF) fractures and CSI in the pediatric population. The purpose of this study was to investigate the frequency of CSI after CMF trauma at a level-1, pediatric, tertiary, trauma center.
A retrospective cohort review of all pediatric patients (ages 0-15) who presented to the Johns Hopkins Hospital from 1990-2010 with CMF fractures were examined for concurrent CSI injuries. Patient charts were reviewed for mechanism of injury, dentition stage, type of CSI, location of CMF fractures, and overall outcome were collated for each of the patients.
A total of 2966 pediatric patients were identified with CMF fractures, and 5 were identified with concomitant CSIs (0.2%). The frequency of CSI in CMF fracture patients with deciduous, mixed, and permanent dentition was 0%, 0.307%, and 0.441%, respectively. Of the five identified cases, four had concomitant middle- and upper-third cranial skeletal fractures.
The frequency of CSIs in children with CMF fractures is significantly lower (0.169%) than the reported ranges in adults (3.69-24%). The lack of CSI in deciduous CMF fracture patients could be explained by the anatomic differences between pediatric and adult cervical spines and supports conservative imaging for children in this age group. A continued index of suspicion for CSI in pediatric craniomaxillofacial patients should be practiced to reduce the sequelae of unrecognized cervical spine injuries. However, the low frequency of CSI injuries in children with deciduous dentition supports conservative imaging measures in this population.
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