comparison with skull base fractures associated with a cranio-cerebral trauma.

Frequency of skull base fractures in isolated cranio-cerebral trauma and skull base fractures in complex midface fractures

5.3.1  Involvement of the Skull Base

in High Midface Fractures

The involvement of the skull base in subcranial midface fractures varies, depending on the type of midface fracture and the severity of the injury. In 25–46% of Le Fort II and Le Fort III fractures, further skull base fractures can be expected (Waller 1977; Vajda et al. 1987; Neidhardt 2002).

With reference to the Le Fort classifications, the frequency of skull base fractures in subcranial midface fractures can be subdivided as follows:

Lucerne (1980–2005), 73% had additional injuries to the frontofacial skeleton. Of these injuries, 67% were termed craniofacial and 33% subcranial fractures.

In the severe craniofacial fracture group, fractures of the skull base occurred in 45% of the cases [comminuted cranio-midface fractures (CCMFs)]; 22% of the casualties were termed panfacial fractures (PFs).

In the subgroup with subcranial fractures, skull base fractures were seen in 21% of the patients [comminuted upper midface fractures (CUMFs)] and in 12% comminuted midface fractures were diagnosed [comminuted midface fractures (CMFs)] (Hardt et al. 1990; Neidhardt 2002).

Involvement of the frontobasal compartment in subcranial and craniofacial fractures (Neidhardt 2002)

Skull base fractures in midface fractures (Le Fort type fracture) (Neidhardt 2002)

According to our own data, midface fractures of the central compartment of the midface are related to skull base fractures in up to 62% of the cases. Centrolateral midface fractures occur in 25%; lateral midface fractures in 13% (Hardt et al. 1990; Neidhardt 2002).

These results are similar to the data published by Raveh and Vuillemin in 1988, who found an involvement of the skull base in 54% in central midface fractures and 12% in lateral midface fractures.

Skull base fractures in subcranial midface fractures (Neidhardt 2002)

Skull base injuries predominate in complex craniofacial traumas (Hardt et al. 1990). Out of 268 elective serious midface injuries presented to the Department of Oral and Maxillofacial Surgery of the Kantonsspital

5.3.2  Dural Injuries

5.3.2.1  Frequency

The frequency of simultaneous dural injuries in midface fractures varies, depending on the severity and extension of the osseous lesions.

According to the literature, between 41 and 70% of the craniofacial fractures are associated with dural injuries [Manson et al. 1987 (50–70%); Vajda et al. 1987 (41%); Hausamen and Schmidseder 1975 (44%); Raveh and Vuillemin 1988 (70%); Neidhardt 2002 (56%)].

In 18–31%, typical subcranial midface fractures are associated with simultaneous dural injuries [Waller 1977(25%); Manson et al. 1987 (26%); Vajda et al. 1987 (18%); Brachvogel et al. 1991 (31%); Neidhardt 2002 (20%)] and 31% of the casualties with craniofrontal fractures [CFFs, including cranio-orbital fractures (COFs)] suffer from dural lacerations (Neidhardt 2002).

Frequency of dural injuries in complex craniofacial, craniofrontal, and subcranial midface fractures (Neidhardt 2002)