Summary:
The paper presents the results of treatment of 165 patients with frontobasal injury who were hospitalized
in our clinic from 1 January 1989 to 31 December 2002. The classic conservative treatment of frontobasal
trauma involves bed rest for 3 weeks, followed by consideration of surgery. This treatment strategy is still
being applied by some neurosurgeons. In cases of concomitant craniofacial surgery, the procedure consisted
of three phases. The first period included craniotomy, revision of intracranial space, repair of dural
tears, brain damage and bleeding. The second phase, 7 to 10 days later, included treatment of orbitofacial
trauma. If needed, corrective plastic surgery was performed in 6 to 12 months. Our treatment strategy is
early repair within 48 hours of injury. The aim is to take advantage of this time interval in order to repair
dural tear in the anterior fossa and restore the anatomical relations of the skull before the development of
traumatic brain edema, which minimizes the operative field. For concomitant facial injuries, we indicate
early single-stage repair by a team including a neurosurgeon and a maxillary surgeon. In our patient group,
22 patients developed intracranial cerebral inflammations, 17 meningitis and 5 abscess. In the group treated
with the traditional conservative approach 14 (45.1 %) patients developed meningitis. With the early
repair approach, 1 (0.9 %) case of meningitis occurred. Five (18 %) cases of abscess developed in the postponed
surgery patients. In our opinion, early and single-stage repair allows definitive treatment of dural
tears and represents the only prevention of intracranial inflammatory complications. This procedure substantially
decreases time spent in hospital, reduces the amount of operative procedures, accelerates healing,
improves the final esthetic effect and reduces the possibility of complications that arise in such intricate regions
in two-stage surgeries.
Key words:
frontobasal trauma, craniofacial trauma, early single-stage repair
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