Pediatric emergency medicine trisk 3301 3301
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result in brain injury. On examination, by grasping the maxilla at the level of the
central incisors, the clinician may be able to appreciate crepitus or mobility when
traction is applied. Clear rhinorrhea in the setting of midface trauma may be a
sign of a cerebrospinal fluid (CSF) leak and warrants neurosurgical consultation.
All patients suspected of having a midface fracture require CT imaging to
determine whether surgical reduction is necessary.
Frontal Bone Fractures
CLINICAL PEARLS AND PITFALLS
Clear rhinorrhea or leakage of clear fluid from a forehead laceration
should raise suspicion for fracture of the posterior wall of the frontal
sinus with dural tear and CSF leak.
Clinical Considerations
Fractures of the frontal bone are rare in young children because the frontal
sinuses do not develop until 8 years of age. Injury to the frontal sinus may reveal
a palpable or visible depression if the anterior wall of the sinus has been
compressed. Displaced fractures of the anterior wall of the frontal sinus require
surgical elevation. In patients with severe frontal sinus fractures associated with
forehead lacerations, a fracture of the posterior wall of the sinus and dural tear
may allow CSF to leak from the wound. Leakage of clear fluid from the wound,
or clear rhinorrhea, should raise suspicion for such a leak and warrant CT
imaging and neurosurgical consultation.
SOFT TISSUE INJURIES
Lacerations
Goals of Treatment
The goal of laceration repair is to achieve hemostasis and provide an optimal
cosmetic result.
CLINICAL PEARLS AND PITFALLS
