Ossification of a Post-traumatic Low Frontal Subcutaneous Hematoma Treated Via Trans-eyebrow Approach: A Clinical Case

Abstract

Background: Post-traumatic hematomas can be subcutaneous or subperiosteal, with the latter being rare outside the neonatal period. These hematomas typically resorb spontaneously but can occasionally ossify. Ossification is extremely rare and may occur in the context of carcinosis. Case Presentation: We report a case of a 13-year-old child who sustained a head injury in November 2022. The injury occurred when the child was accidentally struck on the head by a neighbor while watching a football match. The initial symptoms included a painful swelling in the right periorbital region, rated 8/10 on the visual analogue scale, with no loss of consciousness. The pain resolved within two weeks without treatment, but the swelling persisted and progressively increased in size. Six months later, the swelling was treated with warm water massage and local ointments. Due to the persistence of the mass, the patient was referred to neurosurgery. Examination revealed a hard, bony swelling in the right fronto-naso-orbital region. A CT scan showed a calcified formation measuring 20x36x41 mm, confirmed after surgery by trans eyebrow approach. Discussion: Post-traumatic orbitofrontonasal swellings result from lesions of the vessels, either subcutaneous, muscular, or subperiosteal, likely with an associated hematoma. These hematomas generally evolve towards resorption. However, in rare cases, unresorbed hematomas may calcify after 11 months. This phenomenon is often associated with subperiosteal hematomas. The case presented highlights the rare progression of a subperiosteal hematoma to ossification, emphasizing the need for careful monitoring and timely intervention. Conclusion: This case underscores the importance of monitoring post-traumatic hematomas for potential complications such as calcification, even in pediatric patients. Early recognition and appropriate management are crucial to prevent long-term sequelae.