MS03 BRAIN INJURIES

Abstract

Blast injuries to the head and neck comprise various combinations of primary blast injury to the brain with brain swelling and all types of intracranial haemorrhage; open wounds with multiple metal and bone fragments in the brain; head and neck, cervical and facial vascular injury; skull base fractures with CSF leak; pharyngo‐laryngeal injury, acute airway compromise; facial and scalp burns, scalp defects; orbit and eye injuries; profound shock and multiple other systemic injuries. The principles of management include early tracheostomy, vigorous replacement of blood loss and correction of coagulopathy, nasal and wound packing, neck exploration and repair of carotid artery injury, early generous craniectomy, haematoma evacuation, removal of accessible fragments and debridement of devitalized cerebral tissue, ventriculostomy, duroplasty, and use of broad spectrum antibiotics. Repair of ocular injury or eye removal is often deferred. CT is required for planning the extent of the neurosurgery and CT angiography is useful when cervical vascular injury is suspected. The timing and extent of the neurosurgery must be balanced against the relative priorities of the other injuries and the state of physiological compromise. The surgery for these injuries is generally more extensive compared with what is described in the literature for penetrating brain injury from previous wars. The management of these complex head and neck injuries should be conducted by a multidisciplinary team of head and neck (ENT) surgeon, neurosurgeon, ophthalmologist, oral and maxillo‐facial surgeon and plastic/burns surgeon.