Immediate Single-Stage Reconstruction of Complex Frontofaciobasal Injuries

Objectives: To determine if immediate (within 6 hours) single-stage repair of complex craniofacial injuries could be accomplished with acceptable appearance, morbidity, and mortality.

Patients and Methods: Twenty-six patients (19 men, 7 women), with ages ranging from 8–58 years and Glasgow Coma Scale scores of 5 to 15, had a combined single-stage repair within 6 hours of their admission after resuscitation. All patients had accurate CT-3D. Bicoronal skin flap was used for maximum exposure for frontal sinus exenteration, dural repair, cortical debridement, calvarial reconstruction, and titanium mesh placement. Dural grafts were necessary in 22 of 26 patients (85%), and supplementary bone grafting was required in 19 of 26 patients (73%), of which 6 patients (23%) had iliac bone grafts, whereas split calvarial grafts were used in 12 patients (46%) and a full thickness calvarial graft was used in 1 case (3.8%).

Results: Neurosurgical outcome at both early and late evaluation was judged as good in 22 of 26 patients (85%), moderate in 3 of the 26 (11%), and poor in 1 of the 26 (3.8%). Cosmetic surgical outcome at early evaluation showed 17 of 26 (65%) to be excellent, 4 of 26 (15.5%) to be good, 4 patients (15.5%) to be fair, and 1 patient (3.8%) to be poor. At late reevaluation, the fair had improved to good with only one additional reconstructive procedure, and the poor had improved to fair with another surgery. Complications occurred in 3 patients (11%): one case (3.8%) had tension pneumocephaly and meningitis, one case (3.8%) had delayed cerebrospinal fluid leak with recurrent attacks of meningitis, and one case had maxillary sinus infection (3.8%) secondary to frontomaxillary fistula associated with wound infection and hardware exposure. These results compare favorably with historical data in which an overall infection rate for a staged repair would be 12.5 to 17.7%.

Conclusion: The immediate single-stage repair of complex craniofacial injuries can be performed with an acceptable rate of morbidity and mortality, a decreased need for reoperation, and an improved cosmetic and functional outcome.