Paranasal Sinus Fractures in Pediatric Head Trauma: A Retrospective CT-Based Analysis of Pattern Distribution, Mechanism Correlation and Associated Intracranial Injury

Background/Objectives: Pediatric paranasal sinus fractures are often reported within broader craniofacial trauma series. This retrospective cross-sectional descriptive study focused on fracture distribution across the four sinus groups, injury mechanisms, initial management, and associated traumatic intracranial hemorrhage. Methods: Written head CT reports and clinical records from a pediatric emergency hospital in Romania were reviewed retrospectively for 2021–2025. Thirty-eight patients with documented sinus fractures were included. Sinus involvement was coded by anatomical group, with bilateral involvement counted once per group. Traumatic intracranial hemorrhage was defined as hemorrhage documented on the index CT. Analyses were descriptive. Results: Median age was 13 years; 25 patients (65.8%) were male. Maxillary fractures occurred in 31/38 patients (81.6%), frontal fractures in 13 (34.2%), ethmoid fractures in 12 (31.6%), and sphenoid fractures in four patients (10.5%). Eighteen patients had isolated maxillary fractures, three had isolated frontal fractures, and 17 (44.7%) had multisinus fractures. Motor vehicle accidents accounted for 19 injuries (50.0%). Traumatic intracranial hemorrhage was documented in 10 patients (26.3%), including two of seven with posterior table involvement. Eight hemorrhage cases lacked posterior table fractures. Twenty patients received conservative management, 10 underwent other operative interventions, and eight were transferred; no sinus-specific operation was documented at the study institution. Among the 30 non-transferred patients, median hospital stay was six days. Conclusions: Maxillary involvement predominated in this selected pediatric sinus-fracture cohort. Traumatic intracranial hemorrhage occurred with both isolated and multisinus fractures and was usually documented without posterior table involvement. Report-based ascertainment, exclusions with unknown fracture status, and unavailable post-transfer outcomes limit interpretation. These findings support further descriptive investigation in larger cohorts with standardized image review.