Maxillofacial Osseous Reconstruction in One-stage Operation Combined with Craniotomy for Moderate Craniocerebral Injury_West China Medical Journal

Authors：

 WANGJuan ¹ , WANGJun-hong ² , ZHAOJi-yuan ³ ,  LIRui-chun ¹

1. Department of Neurosurgery, the First A liated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P. R. China;
2. Huxian Hospital of Xi'an, Xi'an, Shaanxi 710300, P. R. China;
3. Department of Otolaryngology, the First A liated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P. R. China;

Corresponding author：

LIRui-chun, Email: lrckhz@126.com

Keywords：

Craniocerebral injury; Maxillofacial reconstruction; Leakage of cerebrospinal fluid

DOI：

10.7507/1002-0179.20150534

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Objective To explore the value of maxillofacial osseous reconstruction in one-stage operation combined with craniotomy for moderate craniocerebral injury. Methods A retrospective study was conducted by analyzing the clinical and radiographic results of 13 patients treated between January 2008 and February 2015. Among them, 7 patients admitted into the hospital between January 2008 and December 2009 were regarded as the control group. Among the 7 patients, 5 were males and 2 were females, aged between 22 and 66 years old, averaging (44.3±15.9) years old. The patients of the control group underwent craniotomy within 24 hours after admission, and accepted the second stage operation for maxillofacial reconstruction 3 to 5 weeks later. The other 6 patients including 4 males and 2 females aged between 27 and 57 years old, averaging (40.2±10.7) years old, admitted into the hospital between January 2010 and February 2015 were designated into the observation group. They underwent maxillofacial osseous reconstruction in one-stage operation combined with craniotomy within 24 hours after admission. The treatment effect, leakage of cerebrospinal fluid, intracranial infection and average length of stay were analyzed and compared. Results In the control group, there were 5 cases of cerebrospinal rhinorrhea preoperatively, and all were cured after craniotomy. During the second stage operation for maxillofacial reconstruction, bone callus and scar tissue presented in all cases and poor reconstruction occurred to 3 cases. After reconstruction, cerebrospinal rhinorrhea recurred in 2 cases. The average length of stay was (43.4±4.5) days. For the observation group there were 3 cases of cerebrospinal rhinorrhea preoperatively, and one of them remained after the operation and cured 7 days later. The average length of stay was (22.7±2.7) days. None of the 13 patients suffered intracranial infection. Conclusion Maxillofacial osseous reconstruction should be considered in one-stage operation combined with craniotomy for moderate craniocerebral injury

Citation： WANGJuan, WANGJun-hong, ZHAOJi-yuan, LIRui-chun. Maxillofacial Osseous Reconstruction in One-stage Operation Combined with Craniotomy for Moderate Craniocerebral Injury. West China Medical Journal, 2015, 30(10): 1857-1861. doi: 10.7507/1002-0179.20150534 Copy

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11.	Huempfner-Hierl H, Schaller A, Hierl T. Maxillofacial fractures and craniocerebral injuries-stress propagation from face to neurocranium in a finite element analysis[J]. Scand J Trauma Resusc Emerg Med, 2015, 23:35.
12.	Stam LH, Wolvius EB, Schubert W, et al. Natural course of orbital roof fractures[J]. Craniomaxillofac Trauma Reconstr, 2014, 7(4):294-297.
13.	李逸松, 田卫东, 李声伟, 等. 颌面创伤3958例回顾[J]. 中华口腔医学杂志, 2006, 41(7):385-387.
14.	丁国伟, 周正炎. 面中部骨折的治疗(附87例临床总结)[J]. 口腔颌面外科杂志, 1995, 5(1):6-10.
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1. Teasdale G, Jennet B. Assessment of coma and impaired consciousness:a practical scale[J]. Lancet, 1974, 2(7872):81-84.
2. 胡锦, 姚海军, 刘永, 等. 华东六省一市颅脑创伤合并颅面损伤住院患者调查[J]. 中华神经外科疾病研究杂志, 2009, 8(1):47-52.
3. 梁亮, 梁新强, 陈慧溪, 等. 中型颅脑损伤患者临床特点分析[J]. 北方药学, 2014, 11(7):132-133.
4. Rassovsky Y, Levi Y, Agranov E, et al. Predicting long-term outcome following traumatic brain injury (TBI)[J]. J Clin Exp Neuropsychol, 2015, 37(4):354-366.
5. 陈炼, 吕超. 单纯性中型颅脑损伤的临床特征与预后分析[J]. 中国临床神经外科杂志, 2012, 10(10):634-635.
6. Mulligan RP, Friedman JA, Mahabir RC. A nationwide review of the associations among cervical spine injuries, head injuries, and facial fractures[J]. J Trauma, 2010, 68(3):587-592.
7. Bellamy JL, Mundinger GS, Flores JM, et al. Facial Fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma:an analysis[J]. J Craniofac Surg, 2013, 24(6):1922-1926.
8. Salentijn EG, Peerdeman SM, Boffano P, et al. A ten-year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam. Incidence and aetiology[J]. J Cranio-Maxillofac Surg, 2014, 42(6):705-710.
9. Salentijn EG, Collin JD, Boffano P, et al. A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam:complications and treatment[J]. J Cranio-Maxillo-facial Surg, 2014, 42(6):1717-1722.
10. 刘斌, 张健强, 李岩峰. 颌面骨折合并中型颅脑损伤37例早期救治分析[J]. 人民军医, 2009, 52(8):530.
11. Huempfner-Hierl H, Schaller A, Hierl T. Maxillofacial fractures and craniocerebral injuries-stress propagation from face to neurocranium in a finite element analysis[J]. Scand J Trauma Resusc Emerg Med, 2015, 23:35.
12. Stam LH, Wolvius EB, Schubert W, et al. Natural course of orbital roof fractures[J]. Craniomaxillofac Trauma Reconstr, 2014, 7(4):294-297.
13. 李逸松, 田卫东, 李声伟, 等. 颌面创伤3958例回顾[J]. 中华口腔医学杂志, 2006, 41(7):385-387.
14. 丁国伟, 周正炎. 面中部骨折的治疗(附87例临床总结)[J]. 口腔颌面外科杂志, 1995, 5(1):6-10.
15. Louis PJ. Maxillofacial Reconstruction[J]. Oral Maxillofac Surg Clin, 2013, 25(2):105-340.

West China Medical Journal

Maxillofacial Osseous Reconstruction in One-stage Operation Combined with Craniotomy for Moderate Craniocerebral Injury

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