RESUMEN
This radiologic work aimed to display the alteration in the superior orbital fissure (SOF) morphology in the pediatric population with advancing age. This pediatric examination consisted of computed tomography images of 180 subjects (90 males/90 females) aged 1-18 years. The length (SOF-L) and width (SOF-W) of SOF were measured, and its shape was noted. SOF-L and SOF-W were measured as 16.04 ± 2.34 mm and 5.35 ± 1.01 mm, respectively. SOF-L was similar in infancy and early childhood periods, but then decreased up to postpubescent period. This measurement increased significantly in postpubescent period. SOF-W did not show important change from infancy period up to postpubescent period. After that, it increased significantly in postpubescent period. Seven configurations regarding SOF shape were observed: the straight type in 20.8% out of 360 SOFs, eight-shaped type in 12.2%, key-shaped type in 14%, racket-shaped type in 18.6%, narrow type in 7.2%, triangular type in 14.7%, and curved type in 12.5%. SOF shape was not affected by sex (p = 0.150) and side (p = 0.919). Linear functions were calculated as y = 16.310-0.028 × age for SOF-L, and as y = 4.886 + 0.048 × age for SOF-W. SOF-L showed an irregular pattern of first decreasing and then increasing, during the transition from 1 year to 18 years. SOF-W displayed an irregular pattern of increasing with advancing ages in children. Our linear functions representing the growth pattern of SOF in children may be useful to estimate SOF size.
RESUMEN
OBJECTIVES: Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI. METHODS: We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups. RESULTS: Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention. CONCLUSION: Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.