Subcranial management of 395 combined frontobasal-midface fractures

In severe craniofacial injuries, the involvement of the skull base with concomitant major dural tears is significantly high. Our methods and treatment plan are controversial compared with the conventional procedure: primary urgent neurosurgical exploration and repair with deferral of maxillofacial reconstruction. To avoid the disadvantages of the transfrontal intracranial management of the skull base, we modified the transethmoidal approach so as to enable the subcranial exposure of all the anterior fossa planes, including the sellar-sphenoidal region. The advantages rendered by this method are the feasibility of an early one-stage craniofacial reconstruction and avoiding retraction of the frontal lobes and damage to the olfactory filaments. The reduction of pseudohypertelorism, the decompression of the optic nerve, and the meticulous reconstruction of the midface and skull base are performed in one session and are regarded as one entity. The results of the surgical management of 395 craniofacial injuries and the low rate of complications emphasize the advantages of the methods described in this article.