Traumatismes craniofaciaux

Abstract

Cranio-facial traumas associate concomitant traumatic injuries of face and skull, particularly the anterior cranial base. Their severity is potentially lethal due to the possible lesions of the brain tissues and dura mater. They also have a major impact on some functions such as vision, olfaction, mastication, and may affect the aesthetic of the head. Various mechanisms are involved and the numerous classifications that have been proposed reflect their complexity. Different tissues and major elements of the face and skull can be concerned. The trauma can be central, lateral or both, illustrating its violence; it may be associated with visceral and orthopedic lesions that aggravate the prognosis. Management must be immediate, from the accident’s scene. Clinical neurological and maxillo-facial examination, using modern CT scan and MRI allows the lesion’s inventory. Complications are mainly represented by presence, persistence or recurrence of a cerebrospinal fluid (CSF) leakage with post-traumatic meningitis risk. Nevertheless, nowadays these CSF leaks are easily visualized and safely treated by transnasal endoscopic techniques. Early single-stage repair of complex craniofacial trauma includes bony repair methods with rigid fixation and uses grafts when massive comminutions or tissue’s lost occurs. Damaged dura must also be repaired. Frontal sinus state depends on involvement of the anterior table, the posterior table, the floor and the naso-frontal duct. This kind of traumas requires a close co-operation between maxillo-facial surgeons, neuro-surgeons, and ENT specialists to manage a one-stage definitive primary treatment with which ophthalmologists and anesthesiologists are associated.