[Treatment of craniofacial fractures]

In the facial fractures, a large number of these patients also sustain a head injury. Neurosurgical care should be the first choice when an intracranial injury is associated. In such situation, suitable timing of the reduction of the facial fractures would be often missed and this would result in functional disturbance and deformities of the face. The present report concerns the early definitive treatment of the extensive craniofacial fractures. Operative procedure and its result are presented. We have surgically treated 100 cases with facial fractures during the past 7 years. Sixty-nine percent of these cases were injured in traffic accidents. The most common site, accounting for 72%, was the middle third of the face. Open reductions and internal fixations were performed within 10 days following the injury in all cases. Among 100 cases, 28 had associated intracranial injuries. Most of these cases were accompanied with frontobasal or zygomatic fractures. Twenty-four cases underwent craniotomy for acute intracranial hematomas, brain contusions, CSF rhinorrhea or optic nerve injuries. In 21 out of 24 cases, primary reconstruction of the fracture were performed at the time of craniotomy. Whether a primary reconstruction was available or not was determined according to the patient's general condition and the severity of the associated intracranial injury. In the extensive frontobasal injury, it is of the utmost importance to have a water-tight dural closure. Fractures involving the sinus were treated by exenteration of the sinus without packing to establish the pathway to the nasal cavity.(ABSTRACT TRUNCATED AT 250 WORDS)