Immediate Single-Stage Reconstruction of Complex Frontofaciobasal Injuries: Part II

Objectives: The purpose of this article was overcoming the shortage of the first part, better selection the candidates appropriate for this technique, improving the functional outcome of this kind of severe complex trauma.

Patients and Methods: In this series, 24 new patients (16 men, 8 women) were added to our previous group (26 patients) with age range from 10–55 years, with Glasgow Coma Scale scores of 5 to 13, all had a combined single-stage repair of their complex craniofacial injuries within 6 hours of their admission. We added some modifications to our standard technique: a precise CT-3D, ICP monitoring, supporting the dural repair/graft by dural patch and glue, the radiological and aesthetic outcome were evaluated by independent radiologist and plastic surgeon. The second group was operated at Prince Salman Military Hospital between November 2010 and September 2013.

Results: Neurosurgical outcome at early evaluation was judged as good in 22 of 24 patients (92%), moderate in 1 of the 24 (4%) and poor in 1 of the 24 (4%). At late evaluation, 20 cases (83%) regained their consciousness without any cognitive deficit. One case (4%) remained in neurovegetative status. Cosmetic surgical outcome at early evaluation showed 18 of 24 (75%) were excellent, 3 patients (12.5%) were good, 2 patients (8.5%) were fair, and one patient (4%) was poor. At late evaluation, the fair had improved to good with scar management and the poor had improved to fair with two successive plastic procedures. Complications included two patients (8.5%) with CSF leak. One was managed conservatively and the second was operated transcranially with intra and extra dural grafting. However, there was no intra or extra cranial significant infection

Conclusion: We achieved an improvement in neurological and aesthetic outcome by precise understanding of CT-3D of this complex injury, attempt to get possible manual mirror image reconstruction, peri-operative ICP monitoring, adequate sealing the dura using supporting materials, active radiological and plastic participation