The Characteristics of Management of Concomitant Craniofacial Injury Complicated by Cerebrospinal Fluid Rhinorrhea
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 trauma complicated by cerebrospinal fluid rhinorrhea based on the use of modern neuroimaging techniques.
Materials and Methods. 637 sufferers with major concomitant injuries underwent treatment in Nizhny Novgorod Regional Traumatology Centre from 2010 to 2012. 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. Mean age of those suffered from craniofacial injury was 31.2±13.9 years (min — 16; max — 88). The severity of injuries according to ISS (Injury Severity Score) was 35.15±17.40 scores (min — 9; max — 77).
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 neuro-imaging techniques based on the assessment of a patient’s condition. 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 pyoinflammatory complications — up to 4.8%.
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