Early Single-Stage Repair of Complex Craniofacial Trauma

Benzil, Deborah L.; Robotti, Elisabetta; Dagi, T. Forcht; Sullivan, Patrick K.; Bevivino, Jack; Knuckey, Neville W.

doi:10.1227/00006123-199202000-00003

Cited by 43 publications

(18 citation statements)

References 25 publications

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“…[20] However, early single stage repair of craniofacial trauma was carried out in 12 of the craniofacial trauma victims due to massive disruption of facial bones and CSF rhinorrhea. The earlier studies have also concluded that such intervention can be undertaken with an acceptable rate of morbidity and mortality, a decreased need for re-operation and improved cosmetic and functional outcome.…”

Section: Discussionmentioning

confidence: 99%

Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute

Bajwa

Kaur

Singh

et al. 2012

Natl J Maxillofac Surg

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Background and Objectives:Maxillofacial trauma is commonly associated with other injuries, predominantly head injuries. The predictors of outcome in such concomitant injuries have been studied the least. The present study aims at the evaluation of types of injury, management and outcome of patients sustaining maxillofacial trauma and concomitant cranial injuries.Materials and Methods:A retrospective study was carried out in the department of anesthesiology and intensive care. A case series of 129 patients was evaluated who were admitted in ICU (Intensive Care Unit) with maxillofacial trauma and head injuries. The data was then compiled systematically and analyzed using SPSS windows and value of P < 0.05 was considered significant and P < 0.001 as highly significant.Results:Among the 129 patients, majority of them had roadside accidents (RSA > 90%) and male gender predominance with male to female ratio of 5: 1. Fracture maxilla and nasal bones were the most commonly encountered injuries (51.93%) followed by mandibular fractures (39.53%) and fracture of zygomatic bones (28.68%). Eighty five patients (65.90%) required mechanical ventilation, tracheostomy was needed in 29 (22.48%) patients and 81 (62.8%) patients were operated for head injuries as well. Majority of the victims were aged between 15 and 40 years.Conclusions:Maxillofacial trauma and cranial injuries are common among young males and so is the nature of injuries, that is, RSA. Besides facial injuries, head injuries are important determinant of outcome in such patients. Timely resuscitation and surgical interventions at specialized centers are of prime importance as far as a better prognosis is concerned in such injuries.

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Section: Discussionmentioning

confidence: 99%

Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute

Bajwa

Kaur

Singh

et al. 2012

Natl J Maxillofac Surg

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“…4,18 However, the repair of large defects using free grafts may result in rates of postoperative CSF leaks of up to 40%. 14,18,20 Classic repair of the anterior skull base uses an anteriorly based pericranial flap as the primary means to repair anterior cranial floor defects due to multiple etiologies.…”

Section: Discussion Pericranial Flap Designmentioning

confidence: 99%

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Safavi–Abbasi

Komune

Archer

et al. 2016

JNS

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OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.

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“…We now perform early extradural repair of CSF fistulas without delay also in these patients and have not observed neurological worsening in any of the cases. This policy has clear advantages over delayed repair of dural fistulas: first, the probability of intracranial infections is decreased by shortening the interval between trauma and repair of the fistula; second, it allows early single-staged repair in patients with associated complex craniofacial injuries, therefore decreasing the need for reoperation and improving the cosmetic and functional outcome [4,17,26]. Using the transfrontal sinus approach, we consider the extradural procedure as the method of choice for closure of dural defects.…”

Section: Discussionmentioning

confidence: 99%

Osteoplastic frontal sinusotomy and extradural microsurgical repair of frontobasal cerebrospinal fluid fistulas

et al. 1996

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SummaryThe choice of the surgical approach and operative technique for the management of cerebrospinal fluid (CSF) fistulas of the anterior cranial fossa are still a controversially discussed topic. Although "extracranial" approaches through the paranasal sinuses are becoming increasingly more popular among otolaryngologists and maxillo-facial surgeons, most neurosurgeons traditionally prefer the "intracranial" repair of CSF fistulas by a craniotomy.We present an approach through the frontal sinus for the repair of dural defects behind the posterior wall of the frontal sinus and at the floor of the anterior cranial fossa. The operative procedure comprises the following main steps: l) exposure of the anterior wall of the frontal sinus by a bicoronal incision; 2) excision of the anterior wall without frontal burr holes; 3) bilateral removal of the posterior wall of the fronal sinus; 4) extradural inspection of the dura behind the fi'ontal sinus and above the cribriform plate, ethmoidal roof, and orbital roof bilaterally; 5) closure of dural tears by direct suture and a periosteal graft; 6) reinsertion of the anterior wall of the frontal sinus and fixation with titanium micro plates.Twenty-five patients operated upon using this technique are described. The aetiology of the frontobasal lesion was traumatic in 23, and an ethmoid carcinoma in two. In all patients, the dural fistulas were successfully repaired during the initial procedure. One patient died from sudden circulatory arrest after an uneventful postoperative course of nine days. Otherwise, there were no postoperative complications.This technique affords atraumatic extradural inspection and repair of dural fistulas bilaterally behind the frontal sinus, and above the cribriform plate and the ethmoidal and orbital roofs with none or minimal brain retraction. It therefore allows early repair of CSF fistulas also in patients with severe brain injury. Although we consider the extradural closure of fistulas the method of choice, this approach also allows for a combined extradural-intradural procedure, thus enabling the surgeon to treat associated intradural pathologies, such as traumatic lesions or tumours of the frontal cranial base.

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Early Single-Stage Repair of Complex Craniofacial Trauma

Cited by 43 publications

References 25 publications

Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute

Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Osteoplastic frontal sinusotomy and extradural microsurgical repair of frontobasal cerebrospinal fluid fistulas

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