- •Dedication
- •Citation
- •Preface
- •Contents
- •1 Anatomy of the Craniofacial Region
- •1.1 Anterior Skull Base
- •1.1.1 Cribriform Plate/Crista Galli
- •1.1.2 Fossa Olfactoria
- •1.1.3 Roof of the Orbit
- •1.1.4 Dura
- •1.1.5 Arterial Supply: Skull Base/Dura
- •1.2 Paranasal Sinuses
- •1.2.1 Frontal Sinus
- •1.2.2 Ethmoid
- •1.2.3 Sphenoid
- •1.3 Midface Skeleton
- •1.4 Subcranial and Midface Skeleton
- •References
- •2 Radiology of Craniofacial Fractures
- •2.1 Conventional X-Rays
- •2.2 Computed Tomography
- •2.3 Magnetic Resonance Imaging (MRI)
- •2.4 Ultrasonography
- •2.5 Diagnostic Algorithm
- •2.5.1 General Considerations
- •2.5.2 Craniocerebral Trauma
- •2.5.2.1 The Initial CT After Trauma
- •2.5.3 Skull Base Fractures
- •2.5.4 Midface Fractures
- •References
- •3 Classification of Craniofacial Fractures
- •3.1 Frontobasal: Frontofacial Fractures
- •3.1.1.1 Type 1
- •3.1.1.2 Type 2
- •3.1.1.3 Type 3
- •3.1.1.4 Type 4
- •3.2 Midface Fractures
- •3.2.1 Standard Classifications
- •3.2.2 Central Midface Fractures
- •3.2.3 Centrolateral Midface Fractures
- •3.2.4 Skull Base and Fracture Levels in the Region of the Septum
- •3.2.5 Lateral Midface Fractures
- •3.2.6 Midface: Combined Fractures
- •3.2.8 Cranio-Frontal Fractures
- •3.3. Craniofacial Fractures
- •3.3.1 Skull Base-Related Classification
- •3.3.2 Subcranial Facial Fractures
- •3.3.3 Craniofacial Fractures
- •3.3.4 Central Cranio-Frontal Fractures
- •3.3.5 Lateral Cranio-Orbital Fractures
- •References
- •4 Mechanisms of Craniofacial Fractures
- •4.1 Fractures of the Skull Base
- •4.1.1 Burst Fractures
- •4.1.2 Bending Fractures
- •4.2 Frontofacial: Frontobasal Fractures
- •4.2.1 Fracture Mechanism
- •4.3 Midfacial: Frontobasal Fractures
- •4.3.1 Trauma Factors
- •4.3.2 Impact Forces and Vectors
- •4.3.3.1 Degrees of Absorption
- •4.3.4 Impact Surface
- •4.3.4.1 Small Impact Surface
- •4.3.4.2 Large Impact Surface
- •4.3.5 Position of the Skull
- •4.3.5.1 Proclination
- •4.3.5.2 Reclination
- •References
- •5.1 Epidemiology
- •5.2.1 Frequency
- •5.2.2 Localization
- •5.3 Midface: Skull Base Fractures
- •5.3.2 Dural Injuries
- •5.3.2.1 Frequency
- •5.3.2.2 Localization
- •5.4 Cranio-Fronto-Ethmoidal Fractures
- •5.4.1 Frontal Sinus: Midface Fractures
- •5.5 Distribution According to Age
- •5.6 Distribution According to Gender
- •5.7 Associated Injuries
- •5.7.2 Eye Injuries
- •5.7.3 Facial Soft-Tissue Injuries
- •5.8 Special Fractures and Complications
- •5.8.1 Penetrating Injuries
- •5.8.3 Complicating Effects
- •5.8.3.1 Nose: Nasal Septum – Nasolacrimal Duct
- •5.8.3.2 Orbit
- •5.8.3.3 Ethmoid
- •References
- •6 Craniofacial Fracture Symptoms
- •6.1.1.1 Liquorrhea
- •Fistulas
- •Multiplicity
- •Time of Manifestation
- •Clinical Evidence of Liquorrhea
- •Chemical Liquor Diagnostic
- •Glucose-Protein Test
- •Immunological Liquor Diagnostic
- •Beta-2 Transferrin Determination
- •Beta-Trace Protein
- •Liquor Marking Methods
- •6.1.1.2 Pneumatocephalus
- •6.1.1.3 Meningitis
- •6.1.2.1 Lesions of the Cranial Nerves
- •Olfactory Nerves
- •Oculomotor Nerve
- •Trochlear Nerve
- •Abducent Nerve
- •Optic Nerve
- •Loss of Vision in Midface Fractures
- •Location of Optic Nerve Lesions
- •Clinical Appearance
- •Primary CT Signs
- •Secondary CT Signs
- •Additional Injuries
- •Operating Indications/Decompression
- •Decompression of the Orbital Cavity
- •Decompression of the Optic Canal
- •Therapy/Prognosis
- •6.1.2.2 Injuries at the Cranio-Orbital Junction
- •Frequency
- •Superior Orbital Fissure Syndrome (SOFS)
- •The Complete SOFS
- •Incomplete SOFS
- •Hemorrhagic Compression Syndrome (HCS)
- •Orbital Apex Syndrome (OAS)
- •Clivus Syndrome
- •6.1.2.3 Vascular Injuries in Skull Base Trauma
- •Cavernous Sinus Syndrome
- •Thrombosis of the Superior Ophthalmic Vein
- •6.1.3.2 Hemorrhage in the Skull Base Region
- •Basal Mucosal Hemorrhage
- •Hemorrhage in Frontal Skull Base Fractures
- •6.3.1.1 Emphysema
- •Orbital Emphysema
- •6.2 Midface Injuries (Clinical Signs)
- •6.2.1 Central Midface Fractures without Abnormal Occlusion (NOE Fractures)
- •6.2.2 Central Midface Fractures with Abnormal Occlusion (Le Fort I and II)
- •6.2.4 Lateral Midface Fractures
- •6.3 Orbital Injuries
- •6.3.1 Orbital Soft-Tissue Injuries
- •6.3.1.1 Minor Eye Injury
- •6.3.1.2 Nonperforating Injury of the Globe
- •6.3.1.3 Perforating Injury of the Globe (2%)
- •6.3.2 Orbital Wall Fractures
- •6.3.2.1 Fracture Frequency
- •6.3.3 Fracture Localization
- •6.3.3.1 Orbital Floor Fractures
- •6.3.3.2 Medial Orbital Wall Fractures
- •6.3.3.4 Multiple Wall Fractures
- •6.3.4 Fracture Signs
- •6.3.4.1 Clinical Manifestations
- •6.3.4.2 Change in Globe Position
- •6.3.4.3 Enophthalmus
- •6.3.4.4 Exophthalmus
- •6.3.4.5 Vertical Displacement of the Globe
- •6.3.4.7 Retraction Syndrome
- •6.3.4.8 Disturbances of Eye Motility
- •References
- •7.1 Intracranial Injuries
- •7.2 Management of Skull Base and Dural Injury
- •7.2.1 Skullbase Fractures with CSF Leakage
- •7.2.2 Skullbase Fractures with CSF Leak without Severe TBI
- •7.2.3 Skullbase Fractures with CSF Leak with Severe TBI
- •7.2.4.1 Skullbase Fractures with Spontaneously Ceased CSF Leakage
- •References
- •8 Surgical Repair of Craniofacial Fractures
- •8.1 Indications for Surgery
- •8.1.2 Semi-Elective Surgery for Frontobasal and Midface Fractures
- •8.1.3 No Surgical Indication
- •8.2 Surgical Timing
- •8.2.1 Evaluation
- •8.2.1.1 Neurosurgical Aspects
- •8.2.1.2 Maxillofacial Surgical Aspects
- •8.2.2 Surgical Timing
- •8.2.2.3 Elective Primary Treatment
- •8.2.2.4 Delayed Primary Treatment
- •8.2.2.5 Secondary Treatment
- •8.3 Surgical Approaches
- •8.3.1 Strategy for Interdisciplinary Approach (Decision Criteria)
- •8.3.1.2 Approach Strategy: Transfacial-Frontoorbital or Transfrontal-Subcranial
- •8.4.1 Indications
- •8.4.2.1 Coronal Approach
- •8.4.2.2 Osteoplastic Craniotomy
- •8.4.2.3 Skull Base Exposition
- •Technical Aspects
- •Technical Aspects
- •8.5 Transfrontal-Subcranial Approach
- •8.5.1 Indications
- •8.5.2 Surgical Principle
- •8.5.3 Subcranial Surgical Technique
- •8.6 Transfacial Approach
- •8.6.1 Indications
- •8.6.2 Surgical Principle
- •8.6.4.1 Frontal Sinus
- •8.6.4.2 Ethmoid/Cribriform Plate
- •8.6.4.3 Sphenoid
- •8.7 Endonasal-Endoscopical Approach
- •8.7.2 Sphenoid Fractures
- •References
- •9.1 Principles of Dural Reconstruction
- •9.2 Dural Substitutes
- •9.2.1 Autogenous Grafts
- •9.2.2 Allogeneic Transplants
- •9.2.2.1 Lyophilized Dura
- •9.2.2.2 Collagenous Compounds
- •9.3 Principles of Skull Base Reconstruction
- •9.3.1 Debridement of the Ethmoid Cells
- •9.3.3 Skull Base Repair
- •9.3.3.1 Extradural Skull Base Repair
- •9.3.3.2 Intradural Skull Base Occlusion
- •9.4 Skull Base Treatment/Own Statistics
- •References
- •10 Bone Grafts
- •10.1 Indications
- •10.1.1 Midface
- •10.2 Autogenous Bone Grafts
- •10.2.1 Split Calvarial Grafts
- •10.2.2 Bone Dust/Bone Chips
- •10.2.3 Autogenous Grafts from the Iliac Crest
- •References
- •11 Osteosynthesis of Craniofacial Fractures
- •11.1 Biomechanics: Facial Skeleton
- •11.3 Osteosynthesis of the Midface
- •11.3.1 Plating Systems
- •11.3.2 Miniplates: Microplates
- •11.3.3 Screw Systems
- •11.4 Surgical Procedure: Osteosynthesis of the Midface
- •11.4.1 Different Plate Sizes: Indication
- •11.4.2 Fracture-Related Osteosynthesis
- •11.4.2.1 Surgical Approaches
- •11.4.2.2 Lateral Midface Fractures
- •11.4.2.4 Complex Midfacial Fractures
- •11.5.1 Mesh-Systems
- •11.5.2 Indications and Advantages
- •References
- •References
- •12.1 Craniofacial Fractures
- •12.1.1 Concept of Reconstruction
- •12.1.5 Own Procedure: Statistics
- •12.2 NOE Fractures
- •12.3.1 Concept of Reconstruction
- •12.4 Zygomatico-Orbito-Cranial Fractures
- •12.5 Craniofrontal Fractures (CCF)
- •12.5.1 Concept of Reconstruction
- •12.5.6 Fractures of the Frontal Sinus with Comminution of the Infundibulum
- •12.6 Own Statistics
- •13.1 Infections and Abscesses
- •13.2 Osteomyelitis
- •13.3 Recurrent Liquorrhea
- •13.4 Hematoma: Central Edema
- •13.5 Subdural Hygroma
- •13.6 Frontal Sinus: Complications
- •13.7 Functional Neurological Deficits
- •13.8 Meningitis
- •13.9 Facial Contour Irregularities
- •13.10 Conclusion
- •References
- •14.1.1 Autogenous Grafts
- •14.1.1.1 Split Calvarial Grafts
- •14.1.1.2 Cartilage Grafts
- •14.1.3.1 Synthetic Calcium Phosphates
- •14.1.3.2 Synthetic Polymers
- •14.1.4 Titanium-Mesh
- •References
- •15.1 Overall Objective
- •15.2 Patient-Related Conditions
- •15.2.1 Size and Location of the Defect
- •15.2.1.1 Examples
- •15.2.2 General Health Status
- •15.2.3 Neurological Status
- •15.2.4 Patient’s Wish
- •15.2.5 Treatment Plan
- •15.2.6 Technical Aspects
- •15.3 New Developments
- •15.3 1.1 The SLM process
- •15.3.2 PEEK-Implants
- •15.3.3 Outlook
- •References
- •Index
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3 Classification of Craniofacial Fractures |
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Fig. 3.29 Comminuted cranio-orbito-facial fracture (COF) with polyfragmentation of the left frontotemporal bone, orbital roof and frontotemporal base of the skull
References
Baker NJ, Evans BT, Neil-Dwyer G, Langn DA (2003). Frontal sinus fractures, In: P Ward-Booth, BL Eppley, R Schmelzeisen (eds), Maxillofacial trauma and aesthetic facial reconstruction. Churchill Livingstone: Edinburgh, pp 63–74.
Becker R, Austermann K (1981). Frakturen des Gesichtsschädels, In: Schwenzer, G Grimm (eds), Zahn-Mund-Kieferheilkunde (vol II). Thieme: Stuttgart.
Boenninghaus HG (1974). Traumatologie der Rhinobasis und endokranielle Komplikationen, In: HH Naumann (ed), Kopfund Halschirurgie (vol II/2). Thieme: Stuttgart.
Bowerman JE (1985). Fractures of the middle third of the facial skeleton, In: NL Rowe, JL Williams (eds) Maxillofacial injuries (vol I). Churchill Livingstone: Edinburgh, pp 363–435.
Bull HG, Ganzer U, Gruentzig J, Schirmer M (1989). Trauma tologie des Hirnund Gesichtsschädels. Urban und Schwarzen berg: München.
Denecke HJ, Denecke MU, Draf E, Ey W (1992). Die Operationen an den Nasennebenhölen und der angrenzenden Schädelbasis. Springer: Berlin.
Donald PJ (1998). Surgery of the skull base. Lippincott-Raven: Philadelphia.
Ernst A, Herzog M, Saidl RO (2004). Traumatologie des Kopf- Hals-Bereiches. Thieme: Stuttgart.
Escher F (1969). Clinic, classification and treatment of the frontobasal fractures. Almquist and Wiksell: Stockholm.
Escher F (1971). Klassifikation der offenen frontobasalen. Frakturen Mschr Ohrenheilk 105: 144–145.
Escher F (1973). The trauma of the basis of the skull in the view of oto-rhino-laryngology: A survey over three decenniums. HNO 21, 5: 129–144.
References |
53 |
|
|
Ewers R, Wild K, Wild M, Ensilidis G (1995). Traumatologie, In: JE Hausamen, E Machtens, J Reuther (eds) Mund-, Kieferund Gesichtschirurgie. Springer: Berlin, pp 211–298.
Fonseca RJ, Walker RV (1991). Oral and maxillofacial trauma (vol 1). Saunders: Philadelphia.
GodbersenGS,KügelgenC(1998).KlassifikationvonStirnhöhlen wandfrakturen, In: R Schmelzle (ed), Schädelbasischirurgie. Al-Budoor: Damaskus, pp 22–27.
Gross CL (1984). Pathophysiology and evaluation of frontoethmoid fractures. In: RH Mathog (ed), Maxillofacial trauma. Williams and Wilkins: Baltimore.
Gruss JS (1982). Fronto-naso-orbital trauma. Clin Plast Surg 9, 4: 577–589.
Gruss JS (1985). Naso-ethmoid-orbital fractures: Classification and role of primary bone grafting. Plast Reconstr Surg 75, 3: 303–317.
Gruss JS, Pollock RA, Phillips JH, Antonyshyn O (1989). Combined injuries of the cranium and face. Br J Plast Surg 42, 4: 385–398.
Habal MB, Ariyan S (eds) (1989). Facial fractures. BC Decker: Philadelphia.
Hammer B (1995). Orbital fractures, diagnosis, operative treatment, secondary corrections. Hogrefe and Huber: Seattle.
Hammer B, Prein J (1998). Naso-orbital-ethmoid fractures. In: J Prein (ed), Manual of internal fixation in the craniofacial skeleton. Springer: Berlin, pp 127–132.
Hardt N, Sgier F, Gottsauner A (1992). Techniken der Rekon struktion kraniofazialer Frakturen und Defekte. In: HF Sailer, N Hardt (eds), Schweiz. Kieferund Gesichts Chir 3: 49–54 F. Wüst, Küsnacht.
Hausamen JE, Schmidseder R (1975). Involvement of the anterior skull base in fractures of the mid-face. Fortschr Kiefer Gesichtschir 19: 134–136.
Hausamen JE, Schmelzeisen R (1996). Traumatologie der Schädelbasis. Einhorn Presse: Reinbek.
Hoffman HT, Krause, CJ (1991). Traumatic injuries to the frontal sinus. In: RJ Fonseca, RV Walker (eds), Oral and maxillofacial trauma (vol 1). Saunders: Philadelphia, pp 576–599.
Holt GR, Holt HJ (1985). Nasoethmoid complex injuries. Otolaryng Clin North Am 18: 87–98.
Hybels RL (1977). Posterior table fractures of the frontal sinus. Clinical aspects. Laryngoscope 87: 1740–1745.
Ioannides C, Freihofer HP, Vrieus J, Friens J (1993). Fractures of the frontal sinus: A rationale of treatment. Br J Plast Surg 46, 3: 208–214.
Jackson et al. (1986). Classifikation and treatment of orbitozygomatic and orbito-frontoethmoid fractures. The place of bone grafting and plate fixation. Ann Plast Surg 16: 77–81.
Joss U, Piffko J, Meyer U (2001). Behandlung von frontobasalen Traumen und Polytraumen. Mund Kiefer Gesichtschir 5: 86–93.
Krafft T, Spitzer WJ, Farmand M, Laumer R, Seyer H (1991). Results of combination neurosurgical and orofacial surgery of fronto-maxillary fractures. Fortschr Kiefer Gesichtschir 36: 54–56.
Le Fort R (1901). Etude expérimentale sur les fractures de la machoire superior. Rev Chir 23: 208–227, 360–379, 479–507.
Lew D, Sinn DP (1991). Diagnosis and treatment of midface fractures. In: RJ Fonseca, RV Walker,(eds) Oral and maxillofacial trauma (vol 1). Saunders: Philadelphia, pp 515–542.
Machtens E (1987). Diagnostik und Behandlungsablauf aus Sicht der Mund-, Kieferund Gesichtschirurgen. Fortschr Kiefer Gesichtschir 32: 221–223.
Manson PN (1986). Some thoughts on the classification and treatment of Le Fort fractures. Ann Plast Surg 17, 5: 356–363.
Manson PN (1998). Craniofacial fractures. In: J Prein (ed), Manual of internal fixation in the craniofacial skeleton. Springer: Berlin, pp 95–154.
Markowitz BL, Manson PN, Sargent L, Vander Kolk CA, Yaremchuk M, Glassman D et al. (1991). Management of the medial canthal tendon in nasoethmoid orbital fractures: The importance of the central fragment in classification and treatment. Plast Reconstr Surg 87, 5: 843–853.
Mathog RH (1992). Atlas of craniofacial trauma. Saunders: Philadelphia.
Mathog RH (1984). Maxillofacial trauma. Williams and Wilkins: Baltimore.
Mathog RH, Arden RL, Marks SC (1995). Trauma of the nose and paranasal sinuses. Thieme: Stuttgart.
Matras H, Kuderna H (1980). Combined craniofacial fractures. J Maxillofac Surg 8: 52–59.
Mc Mahon JD, Koppel DA, Devlin M, Moos KF (2003). Maxillary and panfacial fractures, In: P Ward-Booth, L Eppley, R Schmelzeisen (eds), Maxillofacial trauma and aesthetic facial reconstruction. Churchill Livingstone: Edinburgh, pp 153–167.
Meleca RJ, Mathog RH (1995). Diagnosis and treatment of nasoorbital fractures. In: RH Mathog, RL Arden, SC Marks (eds), Trauma of the nose and paranasal sinuses. Thieme: Stuttgart, pp 65–98.
MesserklingerW,NaumannHH(1995).ChirurgiedesNasenneben höhlensystems. In: HH Naumann, ER Kastenbauer, ME Tardy (eds), Kopf und Halschirurgie (vol 1/II). Thieme: Stuttgart.
Oberascher G (1993). Diagnosis of cerebrospinal rhinorrhea. Eur Arch Otorhinolaryngol Suppl 1: 347–362.
Paskert JP, Manson PN, liff NT (1988). Nasoethmoidal and orbital fractures. Clin Plast Surg 15, 2: 209–223.
Prein J (ed) (1998). Manual of internal fixation in the craniofacial skeleton. Springer: Berlin.
Probst C (1971). Frontobasale Verletzungen - Pathogenetische, diagnostische und therapeutische Probleme aus neurochirurgischer Sicht. Huber: Bern.
Raveh J, Laedrach K, Vuillemin T, Zingg M (1992). Management of combined fronto-naso-orbital/skull base fractures and telecanthus in 355 cases. Arch Otolaryngol Head Neck Surg 118, 6: 605–614.
Raveh J, Vuillemin T, Sutter F (1988). Subcranial management of 395combinedfrontobasal-midfacefractures.ArchOtolaryngol Head Neck Surg 114, 10: 1114–1122.
Riefkohl R, Georgiade G, Georgiade N (1985). Facial fractures. In: R Wilkins, S Rengachary,(eds) Neurosurgery. McGrawHill: New York.
Rowe NL, Williams JL (1985). Maxillofacial injuries (vol II). Churchill Livingstone: Edinburgh.
Schilli W, Joos U (1991). Treatment of panfacial fractures. Fortschr Kiefer Gesichtschir 36: 36–38.
Schneider O, Richter HP (1993). Die Besonderheiten in der Diagnostik und Behandlung offener Schädel-Hirn-Verlet zungen, einschliesslch der Basisfrakturen. Unfallchirurg 90: 591–594.
54 |
3 Classification of Craniofacial Fractures |
|
|
Schroeder HG (1993). Frontobasal fractures. Systematic and symptomatic aspects. Eur Arch Otorhinolaryngol Suppl 1: 275–285.
Schwab W (1995). Atlas der Kopf-Hals-Chirurgie. Kohlhammer: Stuttgart.
Schwenzer N, Ehrenfeld M (2002). Spezielle Chirurgie (vol 3). Thieme: Stuttgart.
Schwenzer N, Pfeifer G (eds) (1991). Traumatologie des Mittelgesichts. Fortschr Kiefer Gesichtschir 36. Thieme: Stuttgart.
Stoll W (1993). Surgical management of frontobasal injuries (including the orbits) by ENT surgeons. Eur Arch Otorhi nolaryngol Suppl 1: 287–307.
Vuillemin T, Lädrach K, Raveh J (1998). Craniofacial surgery. Advantages of subcranial procedures in craniofacial surgery. Schweiz Monatsschr Zahnmed 98, 8: 859–869.
Weerda H (1995). Traumatologie der Frontobasis und Umgebung, einschliesslich der endokraniellen Komplikationen. In: HH Naumann, ER Kastenbauer, ME Tardy,(eds) Kopfund Halschirurgie (vol 1): Gesicht, Nase und Gesichtsschädel. Thieme: Stuttgart.
Werda H, Siegert R (1992). Verletzungen der Nase, der Nasennebenhöhlen und des Gesichtsschädels. In: HH Naumann, J Helms, C Heberhold, ER Kastenbauer (eds), Oto- rhino-laryngologie (vol II). Thieme: Stuttgart, pp 294–311.
Wolfe SA, Baker S (1993). Facial fractures. Thieme: Stuttgart.
