Pediatrik Faysal Travma Yönetimi
Özet
Çocuk yaş grubunda fasyal travmalar, yüksek morbidite ve mortalite riski taşımakla birlikte ileri dereceli yüz kırıklarının görülme oranı yetişkinlere kıyasla daha düşüktür. Pediatrik fasyal travma yönetimi prensipleri, çocuklardaki hızlı yara iyileşmesi ve artmış osteojenik aktivite nedeniyle daha konservatif bir yaklaşım gerektirir; bu doğrultuda erken redüksiyon ve kısa süreli immobilizasyon temel alınır. Müdahale sürecinde ilk öncelik havayolunun güvenliğe alınmasıdır ve özellikle karmaşık kırıklarda entübasyon ihtiyacı doğabilmektedir. Tanı aşamasında kemik yapıların detaylı incelenmesi için üç boyutlu Bilgisayarlı Tomografi (BT) ilk tercih edilen görüntüleme yöntemidir. Yüz kırıkları arasında çocuklarda en sık nazal kemik fraktürlerine rastlanırken, bunu orbital ve daha nadir olarak mandibula kırıkları izler. Kırıkların tedavisinde öncelikle kapalı veya minimal açık teknikler tercih edilir; maloklüzyon veya dislokasyon oluşturmayan durumlarda sadece sıvı diyet ve gözlem yeterli olurken, deplase ve karmaşık kırıklarda açık redüksiyon ile internal fiksasyon yöntemlerine başvurulur. Cerrahi operasyonlarda titanyum veya diş tomurcuklarına zarar vermeyecek şekilde konumlandırılan emilebilir plaklar kullanılır. Sonuç olarak, çocukların gelişimsel özellikleri nedeniyle yaş gruplarına göre kırık tipleri değişkenlik gösterdiğinden, komplikasyonların önlenmesi ve anatomik rekonstrüksiyonun başarıyla sağlanması için multidisipliner bir ekip çalışması zorunludur.
In the pediatric age group, facial traumas carry a high risk of morbidity and mortality, although the incidence of advanced facial fractures is lower compared to adults. The principles of pediatric facial trauma management require a more conservative approach due to rapid wound healing and increased osteogenic activity in children; accordingly, early reduction and short-term immobilization are fundamental. The first priority in the intervention process is ensuring airway security, and intubation may be required, particularly in complex fractures. In the diagnostic phase, three-dimensional Computed Tomography (CT) is the preferred imaging method for a detailed evaluation of bone structures. Among facial fractures, nasal bone fractures are most commonly observed in children, followed by orbital and, more rarely, mandibular fractures. In treatment, closed or minimal open techniques are primarily preferred; while observation and a liquid diet are sufficient in cases without malocclusion or dislocation, open reduction and internal fixation methods are utilized for displaced and complex fractures. Titanium or resorbable plates are used in surgical operations, positioned carefully to avoid damage to tooth buds. Consequently, since fracture types vary by age group due to the developmental characteristics of children, a multidisciplinary team approach is essential to prevent complications and successfully achieve correct anatomical reconstruction.
Referanslar
Ryan ML, Thorson CM, Otero CA, et al. Pediatric facial trauma: A review of guidelines for assessment, evaluation, and management in the emergency department. [Online] Journal of Craniofacial Surgery. 2011. doi:10.1097/SCS.0b013e31821c0d52
Haug RH, Foss J. Maxillofacial injuries in the pediatric patient. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2000;90(2). doi:10.1067/moe.2000.107974
Hatef DA, Cole PD, Hollier LH. Contemporary management of pediatric facial trauma. [Online] Current Opinion in Otolaryngology and Head and Neck Surgery. 2009. doi:10.1097/MOO.0b013e32832d95a0
Oji C. Fractures of the facial skeleton in children: A survey of patients under the age of 11 years. Journal of Cranio-Maxillo-Facial Surgery. 1998;26(5). doi:10.1016/S1010-5182(98)80062-0
Messinger A, Radkowski MA, Greenwald MJ, et al. Orbital roof fractures in the pediatric population. Plastic and Reconstructive Surgery. 1989;84(2). doi:10.1097/00006534-198908000-00003
Transfer S, Injury B. Recommendations for the Safe Transfer of Patients with Brain Injury 2006. 2006;(May).
Moore R. Head and neck surgery?otolaryngology, 3rd ed, vols I & II, by Byron J. Bailey, Lippincott Williams & Wilkins, Philadelphia, 2001, 2485 pp. Head & Neck. 2003;25(4). doi:10.1002/hed.10227
Alcalá-Galiano A, Arribas-García IJ, Martin-Pérez MA, et al. Pediatric facial fractures: Children are not just small adults. Radiographics. 2008;28(2). doi:10.1148/rg.282075060
Gotcher JE, Livesay KW. Management of complex facial fractures. The Journal of the Tennessee Dental Association. 2002;82(3).
Costa Ferreira P, Amarante JM, Natividade Silva P, et al. Retrospective study of 1251 maxillofacial fractures in children and adolescents. [Online] Plastic and Reconstructive Surgery. 2005. doi:10.1097/01.PRS.0000160268.20294.FD
Koltai PJ, Rabkin D, Hoehn J. Rigid fixation of facial fractures in children. The Journal of cranio-maxillofacial trauma. 1995;1(2).
MacLennan WD. Consideration of 180 cases of typical fractures of the mandibular condylar process. British Journal of Plastic Surgery. 1949;5(2). doi:10.1016/S0007-1226(49)80020-8
Nguyen DC, Shahzad F, Snyder-Warwick A, et al. Transcaruncular Approach for Treatment of Medial Wall and Large Orbital Blowout Fractures. Craniomaxillofacial Trauma & Reconstruction. 2016;9(1). doi:10.1055/s-0035-1563390
Wright RJ, Murakami CS, Ambro BT. Pediatric nasal injuries and management. Facial Plastic Surgery. 2011;27(5). doi:10.1055/s-0031-1288931
Hoffmann JF. An Algorithm for the Initial Management of Nasal Trauma. Facial Plastic Surgery. 2015;31(3). doi:10.1055/s-0035-1555618
Jul M, Sjöstedt S, Grønhøj C, et al. Evaluation and management of paediatric nasal fractures. Ugeskrift for laeger. 2019;181(17).
Desrosiers AE, Thaller SR. Pediatric nasal fractures: Evaluation and management. Journal of Craniofacial Surgery. 2011;22(4). doi:10.1097/SCS.0b013e31821c932d
Nguyen M, Koshy J, Hollier L. Pearls of Nasoorbitoethmoid Trauma Management. Seminars in Plastic Surgery. 2010;24(04). doi:10.1055/s-0030-1269767
Zimmermann CE, Troulis MJ, Kaban LB. Pediatric facial fractures: Recent advances in prevention, diagnosis and management. [Online] International Journal of Oral and Maxillofacial Surgery. 2006. doi:10.1016/j.ijom.2005.09.014
Goth S, Sawatari Y, Peleg M. Management of pediatric mandible fractures. [Online] Journal of Craniofacial Surgery. 2012. doi:10.1097/SCS.0b013e318240c8ab
Maniglia AJ, Kline SN. Maxillofacial trauma in the pediatric age group. Otolaryngologic Clinics of North America. 1983;16(3). doi:10.1016/s0030-6665(20)32055-7
Siy RW, Brown RH, Koshy JC, et al. General management considerations in pediatric facial fractures. Journal of Craniofacial Surgery. 2011;22(4). doi:10.1097/SCS.0b013e31821c0cf9
Wheeler J, Phillips J. Pediatric Facial Fractures and Potential Long-Term Growth Disturbances. Craniomaxillofacial Trauma & Reconstruction. 2011;4(1). doi:10.1055/s-0031-1272901
Holland AJA, Broome C, Steinberg A, et al. Facial fractures in children. Pediatric Emergency Care. 2001;17(3). doi:10.1097/00006565-200106000-00002
Boyette JR. Facial fractures in children. [Online] Otolaryngologic Clinics of North America. 2014. doi:10.1016/j.otc.2014.06.008
Hopper RA, Salemy S, Sze RW. Diagnosis of midface fractures with CT: What the surgeon needs to know. [Online] Radiographics. 2006. doi:10.1148/rg.263045710
Andrew TW, Morbia R, Lorenz HP. Pediatric Facial Trauma. [Online] Clinics in Plastic Surgery. 2019. doi:10.1016/j.cps.2018.11.008
Criden MR, Ellis FJ. Linear nondisplaced orbital fractures with muscle entrapment. Journal of AAPOS. 2007;11(2). doi:10.1016/j.jaapos.2006.08.022
