8.2.2  Surgical Timing

The concept of early interdisciplinary treatment of maxillofacial and frontobasal injuries has been broadly accepted and applied in clinical practice (Gruss et al. 1985; Machtens 1987; Raveh and Vuillemin 1988; Gruss and Phillips 1989; Perrott 1991; Hardt et al. 1992; Evans et al. 1996; Lee et al. 1998; Joss et al. 2001).

8.2.2.1  Immediate Treatment (Phase 1)

(Piek and Jantzen 2000)

Neurosurgical emergencies are craniofacial injuries combined with life-threatening injuries, particularly intracranial hemorrhage. In the majority of cases, a two-step approach will be appropriate, with the neurosurgical decompression being the immediate intervention and craniofacial surgery following stabilization and recovery (Zink and Samii 1991; Schneider and Richter 1993; Lehmann et al. 1998).

Maxillofacial surgical emergencies are significant uncontrolled hemorrhages from the skull base, significant soft tissue damage with tissue avulsion, open multifragmented maxillofacial and mandibular fractures, as well as optic nerve compression. The initial maxillofacial intervention may be confined to hemostasis and primary closure of soft tissues wounds (Fig. 8.1).

8.2.2.2  Primary Treatment (Phase 2)

(Piek and Jantzen 2000)

Urgency, surgical timing and planning are determined by the individual extent of the injury and the extent of primary and secondary traumatic brain injury.

Open maxillofacial fractures should be operated within 6–8 h of injury (Metelmann et al. 1991):

•if there is only a moderate traumatic brain injury [Glasgow Coma Scale (GCS) > 8],

•if the patient remains stable upon GCS monitoring,

•if the control computed tomography (CT) scan shows no worsening