[Craniofacial fractures]

Results of early combined maxillo-facial and neurosurgical treatment of 53 craniofacial fractures are referred. The fracture location was in 31 cases central midfrontal, 10 lateral supraorbital and 12 combined central and lateral fractures. 35 fractures interested the floor and the posterior wall of frontal sinus, lacerating the underlying dura and cortical tissue. In 19 fractures orbital displacement was present. The key points in the management of these patients are: 1) Early (within 1 to 5 days) and one stage neurosurgical-maxillofacial procedure. Immediate intervention is indicated only in case of evolutive neurological lesions; 2) wide exposition of all the injuries through bicoronal incision and bone flap; 3) assessment of fractures pattern and amount of bone loss; 4) reconstruction of craniofacial frame with osteosynthesis and autologous bone grafts (35 cases iliac crest, 7 split calvarial graft); 5) interosseous wiring is used in sutured mosaic, small bone fragments and intraoperative temporary fixation; miniplates are used for rigid fixation of craniofacial pillars; 6) for optimal cosmetic result reconstruction of supraorbital ridge, nasoglabellar region and zygomatic arch is essential; 7) fractures involving the sinus floor, posterior wall and the nasofrontal duct result in direct communication between the nose and intracranial cavity with high risk of infection and mucocele formation. Cranialization of the sinus removing the posterior wall and all the mucosa is mandatory. The nasofrontal duct, the floor and sinus dead space are obliterated with autologous bone chips. Osteoneogenesis occurred in all the cases.