ORIGINAL ARTICLES   

Rivista Italiana di Chirurgia Maxillo-Facciale 2003 April;14(1):17-21

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Combined neurosurgical and maxillo-facial approach to cranio-facial trauma: a series of 16 cases

Faccioli G. ¹, Fraccari E. ¹, Cristofori L. ², Baldin C. ¹

¹ Maxillofacial Surgery Division General Hospital, Verona, Italy 2 Division of Emergency Neurosurgery and Neurological Intensive Care General Hospital, Verona, Italy

Craniofacial trau­ma ­has tra­di­tion­al­ly ­been treat­ed ­through sequen­tial sur­gery. The ­first ­step ­was neu­ro­sur­gi­cal ­and con­sist­ed of intra­cra­ni­al hae­mat­o­ma evac­u­a­tion, ­repair of ­dural lac­er­a­tions, reduc­tion of dis­lo­cat­ed frac­tures of ­the ­skull ­and if nec­es­sary ­soft tis­sue debride­ment in ­the max­il­lo-­facial ­region. Facial frac­tures ­were usu­al­ly treat­ed ­after 10-14 ­days, ­while fron­tal con­tour ­defects ­were ­repaired ­after 6-12 ­months. The ­intent ­was to ­reduce ­the ­risk of ner­vous ­system infec­tion ­and of ­long-­term neu­ro­log­i­cal dam­age ­due to pro­longed anaesthe­sia. However, it is ­now con­sid­ered pref­er­able to ­treat com­plex cra­ni­o­fa­cial trau­ma ­with a com­bined neu­ro­sur­gi­cal ­and max­il­lo-­facial ­approach, in ­order to ­obtain func­tion­al ­and aes­thet­ic ­results in a sin­gle ­step. The advan­tage of decreas­ing ­the num­ber of sur­gi­cal oper­a­tions is ­dual: it reduc­es bio­log­i­cal ­cost ­and med­i­cal expens­es. In ­our ­series of 16 ­patients ­there ­were no cas­es of infec­tion or of neu­ro­log­i­cal or car­di­o­vas­cu­lar dam­age ­due to gen­er­al anaesthe­sia. On ­the ­basis of ­our sur­gi­cal ­results, we ­believe ­that ­the com­bined neu­ro­sur­gi­cal ­and max­il­lo-­facial ­approach ­can pro­vide ade­quate ­and defin­i­tive sur­gi­cal treat­ment ­for ­severe cra­ni­o­fa­cial trau­ma, ­both ­from ­the aes­thet­ic ­and ­from ­the func­tion­al stand­point.