Skull base and maxillofacial fractures: Two centre study with correlation of clinical findings with a comprehensive craniofacial classification system

Bächli, Heidi; Leiggener, Christoph; Gawelin, Petter; Audigé, Laurent; Enblad, Per; Zeilhofer, Hans‐Florian; Hirsch, Jan‐Michaél; Buitrago-Téllez, C.

doi:10.1016/j.jcms.2009.01.008

Cited by 25 publications

(19 citation statements)

References 23 publications

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“…If the post-traumatic rhinorrhoea tends to persist, or if the leak is spontaneous, surgical repair is indicated since spontaneous healing is rare in these conditions. The severity of the trauma and the presence of associated problems can influence the timing of the surgical intervention (Bächli et al, 2009). There is no doubt that intra-operative leaks should be addressed immediately (Stankiewicz, 1991;Anand et al, 1995;Nachtigal et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus

Muscatello

Lenzi

Dallan

et al. 2010

Journal of Cranio-Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus

Muscatello

Lenzi

Dallan

et al. 2010

Journal of Cranio-Maxillofacial Surgery

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“…All bone grafts, plates, and mesh used to correct the facial deformity were each considered equally as 1 implant because any preferential weighting would have introduced further bias to the calculation. Although some previous studies have investigated correlations with physiologic parameters and surgical complications, 11,12,16 these data could not be reliably assessed retrospectively and would be better suited for prospective analyses.…”

Section: Discussionmentioning

confidence: 99%

A New System for Severity Scoring of Facial Fractures

Catapano

Fialkov

Binhammer

et al. 2010

Journal of Craniofacial Surgery

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Facial fractures are often the result of high-velocity trauma, causing skeletal disruption affecting multiple anatomic sites to varying degrees. Although several widely accepted classification systems exist, these are mostly region-specific and differ in the classification criteria used, making it impossible to uniformly and comprehensively document facial fracture patterns. Furthermore, a widely accepted system that is able to provide a final summary measure of fracture severity does not exist, making it difficult to investigate the epidemiologic data surrounding facial fracture severity. In this study, a comprehensive method for panfacial fracture documentation and severity measurement is proposed and validated through a retrospective analysis of 63 patients operated on for acute facial fracture. The severity scale was validated through statistical analysis of correlation with surrogate markers of severity (operating room procedure time and number of implants). Spearman correlation coefficients were calculated, and a statistically significant correlation was found between severity score and both number of implants and operating room procedure time (R = 0.92790 and R = 0.68157, respectively). Intraclass correlation coefficients were calculated to assess intrarater and interrater reliabilities of the severity scale and were found to be high (0.97 and 0.99, respectively). This severity scale provides a valuable, validated research tool for the investigation of facial fracture severity across patient populations, allowing for systematic evaluation of facial fracture outcomes, cost-benefit analysis, and objective analysis of the effect of specific interventions.

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“…It provides a sensitivity of 88% for the visualization of the bony defects responsible for CSF leak [3] and also allows for fracture classification used for operative planning and risk assessment [1,15,16,22]. Based on an analysis of 48 patients, Sakas et al [22] introduced a fast and effective classification showing direct correlation of fracture location close to the midline (Type I and II) and size (large>1 cm) with complication risks.…”

Section: Diagnosticsmentioning

confidence: 99%

A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures: detailed clinical and radiological follow-up

et al. 2011

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Detailed outcome data for the management of anterior skull base fractures associated with cerebrospinal fluid (CSF) leakage is lacking. We present detailed follow-up data of a single-center study using a predetermined algorithm for the management of CSF leakage secondary to traumatic fractures. A number of 138 consecutive patients were included in the analysis; all patients underwent high-resolution computed tomography (CT) scanning at time of admission with β(2)-transferrin testing used to confirm CSF leakage. Patients with acute surgical indications were operated as emergent; leaks were repaired at the time of initial surgery in patients with intracranial pressure < 15 cm H(2)O. The remainder of the study population was managed conservatively including use of prophylactic antibiotics; lumbar drainage (LD) catheters were placed in those patients with leakage persisting beyond 48 h. Leaks lasting longer than 5 days underwent microsurgical repair using an intradural bicoronal approach. One-year follow-up assessment included evaluation of neurological status, Glasgow Outcome Scale (GOS), and repeat head CT. Twenty eight patients (26.9%) underwent emergent surgery, 15 of whom had simultaneous CSF leak repair, whereas 76 patients (73.1%) underwent delayed CSF leak repair between days 5 and 14. Postoperative meningitis rate was low (1.9%). Postoperative CSF leak (1.9%) was managed by intradural or transnasal endoscopic operation. Comparable rates of anosmia and frontal lobe hypodensities were seen in the surgical and conservatively managed subgroups. The presented algorithm, utilizing prophylactic antibiotics, trial of LD, acute and/or delayed intradural microsurgery, yields favorable outcomes. Large randomized controlled trials are needed to better define the role of prophylactic antibiotics and to better characterize the optimal timing and approach of surgical repair.

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Skull base and maxillofacial fractures: Two centre study with correlation of clinical findings with a comprehensive craniofacial classification system

Cited by 25 publications

References 23 publications

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus

A New System for Severity Scoring of Facial Fractures

A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures: detailed clinical and radiological follow-up

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