is evidence that spontaneous scar tissue only provides an insufficient barrier against recurrent leakage and infection (Probst 1971; Probst und Tomaschett 1990).

Spontaneously “healed” frontal rhinorrhea is reported to be followed by late meningitis and even brain abscess in 20–60% of cases (Paillas et al. 1967).

Older reports claim 24% morbidity and even 16% mortality with spontaneously healed CSF rhinorrhea (Lewin 1966, 1974). This is a strong argument in favor of surgical repair (Kästner et al. 1998).

7.2.4.2  Frontobasal Fracture with Suspected

CSF Leakage

Frontobasal fractures without manifest CSF leakage may still be associated with a dural injury. Herniation of brain tissue, swelling of the nasal mucosa or blood clot may temporarily block CSF flow (Probst 1986; Fonseca and Walker 1991; Fonseca 2000). In significant frontobasal fractures with radiographic evidence of bone fragment dislocation, surgical repair should be considered even in the absence of manifest CSF rhinorrhea to avoid late complications, particularly meningitis (Watson 1967; Probst 1986; Schick et al. 1997).

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