Introduction: Concomitant cranial and facial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults.
Object: evaluation of the early versus delayed management of these combined craniofacial fractures
Methods: Fifty-five patients ranging in age from 5 to 62 years with combined craniofacial fractures were included. Data regarding age, gender, aetiology, pattern of injuries, anatomic site and pattern of facial fractures, associated cranial injuries and systemic injuries, treatment details and complications were analyzed. Conservative treatment was indicated in 7 patients while the remaining 48 patients underwent surgical intervention and classified into two groups: group 1:35 patients received early (less than two weeks) one-step surgical treatment of their fractures and group II: 13 patients received late surgery (more than 2 weeks after the trauma).
Results Majority of patients had mild head injury and managed conservatively. Regarding the intracranial procedures: elevation of depressed fractures with dural repair was needed in 39 patients; primary dural closure was done in 31 patients, while 8 patients needed pericranial graft. Evacuation of intracranial hematomas was performed in 8 patients. Maxillofacial procedures consisted of exenteration of the sinus in 33 patients, cranialization of the sinuses in 5 patients. The nasofrontal duct was identified and packed with muscle grafts in 36 patients. In 9 patients there was a large bone defect which repaired by bone grafts. In 39 patients bone fragments and/or bone grafts were fixed by miniplates only or by miniplates and wires.
Conclusion: early single-stage repair of complex craniofacial injuries can be performed with an acceptable rate of morbidity and mortality. Many advantages are reported for the early surgical repair such as prevention of infection, better cosmetic and functional results and reduce hospital stay.