Management of Craniofacial Polytrauma Complicated by Cerebrospinal Rhinorrhea

Objective: The aim of the investigation was to reveal the characteristics of the management of penetrating craniofacial injury against the background of polytrauma, and develop the algorithm of preoperative examination and treatment of concomitant craniofacial polytrauma complicated by cerebrospinal fluid rhinorrhea based on the use of modern neuroimaging techniques. Material and Methods: A total of 637 patients with major concomitant injuries underwent treatment in Nizhny Novgorod Regional Trauma Center from 2010 to 2012. Overall 85 patients (13.34%) had concomitant cerebral and facial skeleton injuries, among them there were 62 (9.7%) cases with cerebrospinal fluid rhinorrhea revealed on admission. Results: Concomitant injury of brain and bones of the facial skeleton in polytrauma was found in 13.3% of patients with polytrauma;9.7% cases were found to have penetrating craniofacial injuries. Relying on the experience obtained, we suggested the algorithm of preoperative assessment and planning of surgical management of craniofacial injury complicated by cerebrospinal fluid rhinorrhea using modern neuroimaging techniques based on the assessment of a patient's condition. Conclusions: The use of the algorithm in everyday practice in patients with penetrating craniofacial injury and polytrauma enables to improve the diagnosis and objectify the time optimal for surgical management of cerebrospinal fluid rhinorrhea, reduce the lethality up to 8%, and the morbidity of inflammatory complications up to 4.8%.