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Management of Large Dural Defect with CSF Leak in Hypertelorism Correction
S M Balaji1, C V Shankar Ganesh2, Preetha Balaji1
1Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
The Rationale:
Dural tear is a serious complication during hypertelorism corrective surgeries. Identifying the tear and managing requires considerable expertise. Managing large dural tears correctly is necessary to prevent cerebrospinal fluid (CSF)-related complications in craniofacial surgery.
Patient Concerns:
The patient presented with hypertelorism as a part of the Tessier Cleft 0 and sought to correct the widely placed eyes.
Diagnosis:
Large critical-sized dural tear during modified box osteotomy surgery.
Treatment:
Besides successful modified box osteotomy surgery, the critical-sized dural tear was managed with fascia lata and fibrin glue.
Outcomes:
There was no CSF leak or related complication postsurgically indicating successful sealing and healing of the dural tear.
Take-Away Lessons:
The synergistic mechanism by which fascia lata graft and fibrin glue help to hermetically seal the critical-sized defect, especially when there are variable amounts of hydrostatic-hydrodynamic forces of CSF exerting pressure on the patched area, is discussed.
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