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The cranium (skull) is the skeletal structure of the head that supports the face and protects the brain. It is subdivided into the facial bones and the brain case, or cranial vault. The facial bones underlie the facial structures, form the nasal cavity, enclose the eyeballs, and support the teeth of the upper and lower jaws.
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Trauma of the midface.

Thomas S Kühnel1, Torsten E Reichert2

  • 1Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany.

GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery
|January 16, 2016
PubMed
Summary

Midface fractures, often caused by traffic accidents, require interdisciplinary care. Advances in endoscopic surgery and new techniques like cone beam imaging improve outcomes for complex facial trauma.

Keywords:
ESSmidface fracturesorbitrhinologytrauma

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Area of Science:

  • Traumatology
  • Otorhinolaryngology
  • Neurosurgery

Background:

  • Midface fractures present significant medical complexity, frequency, and socio-economic impact.
  • Traffic accidents are the primary cause, predominantly affecting adult males in their thirties.
  • Established treatment algorithms exist for nasal, maxillary, and zygomatic fractures, but frontal sinus and orbital apex injuries remain debated.

Purpose of the Study:

  • To review current diagnostic and surgical techniques for midface fractures.
  • To discuss advances in endoscopic approaches and evidence-based knowledge limitations.
  • To highlight new techniques in midface traumatology and skull base fracture repair.

Main Methods:

  • Review of current literature and treatment algorithms for midface fractures.
  • Focus on advances in endoscopic surgery for frontal sinus and skull base injuries.
  • Evaluation of novel techniques including intraoperative cone beam radiographs and titanium mesh implants.

Main Results:

  • Minimally invasive approaches are increasingly favored for frontal sinus fractures, with decreased use of obliteration and cranialization.
  • Endonasal endoscopic repair shows promising results for anterior skull base fractures with cerebrospinal fluid leaks.
  • Intraoperative cone beam radiographs and preshaped titanium mesh implants are key advancements in orbital reconstruction.

Conclusions:

  • Interdisciplinary approaches and modern techniques yield favorable results for most midface fractures.
  • Endoscopic surgery and innovative implants are transforming the management of complex midface and skull base trauma.
  • Critical evaluation of treatments like high-dose methylprednisolone for optic nerve injury is necessary.