A 7-Year Study of 1,278 Patients with Maxillofacial Trauma and Cerebrospinal Fluid Leak

Abstract

Background A number of patients with facial fractures have cerebrospinal fluid (CSF) leak that may result in meningitis and other central nervous system complications. Commonly, CSF leak occurs following trauma, but the etiology and pattern of this disorder are different from region to region. This study aims to evaluate the distribution of CSF leak in patients with maxillofacial fractures in Isfahan province, Iran. Patients and Methods In this retrospective cross-sectional study, 1,287 medical files of patients admitted to a medical center with head and face injuries were evaluated during a 7-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010). Data was obtained using descriptive analysis. Results Of the 1,278 patients with head and maxillofacial fractures, 16 (1.25 %) males and one (0.07 %) female had CSF leak; all these cases had skull base fracture. Of these, 52.9 % had maxillary fracture, 23.5 % nasal fracture, 41.1 % orbital fracture, 11.7 % mandibular fracture, 23.5 % frontal fracture, and 41.1 % had more than one site of fracture. 58.8 % had rhinorrhea and 41.2 % otorrhea. Of all these patients with CSF leak, 8 (47 %), 2 (11.8 %), and 7 (41.2 %) cases were treated spontaneously, using lumbar drain placement, and by surgical intervention, respectively. Conclusions Cerebrospinal fluid leak was observed most frequently in patients with fracture in the zygomatic and maxillary bone, and mostly exhibited itself as rhinorrhea and/or otorrhea. All cases with CSF leak had skull base fracture as well. However, post-traumatic CSF leaks are uncommon and are generally treated without surgical intervention (59 %). Distribution of CSF leak varies from one region to another and knowing this fact helps to manage the injury and prevent the complications.

Craniomaxillofacial Trauma in Dogs—Part II: Association Between Fracture Location, Morphology and Etiology

“…Importantly, our study showed that in cases of symphyseal separation, the cribriform plate is also fractured, which is highly relevant for treatment recommendations and prognosis. Although many human CMF trauma patients with CSF leaks heal without additional surgical intervention (14,15), intensive monitoring for meningitis and other sequelae should be considered. It is reasonable to assume that similar recommendations are warranted in dogs.…”

Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report

“…It has been reported that intracranial hypotension following CSF leakage is associated with head injury. [7,13] Therefore, in the current case, we performed a lumbar puncture for CT myelography to detect the points of CSF leakage using a radioscopic examination apparatus, but it was a dry tap. Although we could not perform CT myelography, we suspected that a dry tap could support the idea of a CSF leak.…”

Analysis and Clinical Importance of Skull Base Fractures in Adult Patients with Traumatic Brain Injury

“…[ 11 ] With recent surge of HI in spite of better and strict implementation of traffic rules, there is a need to reassess BSF pattern, incidence and pattern of CSF leak and meningitis and management protocol in head trauma patients, especially in this part of the world as most of the recent literature is from the western world. [ 12 13 14 15 16 ]…”