| Abstract: |
Background: Craniofacial reconstruction became more challenging, with increasing incidences of trauma and advancement in craniofacial and neurosurgical techniques. Successful outcome of craniofacial reconstruction depends on understanding the complex anatomy and biomechanics of this area.Objectives: The aim of the work is to evaluate advantages and disadvantages of different modalities of craniofacial reconstruction.Patients and methods: This study has been done in Zagazig University Hospitals on 45 patients in the period from July 2003 to March 2006. All patients had a craniofacial deformity and/or defect. Every patients had been evaluated by full history taking, clinical examination, radiological evaluation, endoscopic examination of nose and nasopharynx and medical photography or video recording.Results: The most common cause of craniofacial lesion is accidental trauma specially motor vehicle accident, this renews the importance to strictly adjust, respect, and control traffic rules and prepare and observe the roads and motor vehicle and safety measures. Associated injuries with craniofacial lesions are proved to be high and must be suspected in all cases of panfacial fractures and many cases of middle facial third lesions. So, general examination of the patient is mandatory specially neurologically orbital, and orthopedic and consultation. Condylar reconstruction is so difficult and imperfect results must be suspected. So, preservation of the condyle must be always attempted and further study on condylar reconstruction is highly recommended. Iliac bone graft is appeared to be very helpful in craniofacial reconstruction and significant resorption was not detected. Donor site morbidity had not occurred. Shorter operative time is gained if another surgical team takes the graft while working on the craniofacial area. After frontal bone reconstruction, well drained frontal sinus is usually obtained even without the help of frontonasal stent. So, there is no need to obliterate the frontal sinus. In displaced fractures of the middle facial third, early open reduction and internal fixation is the preferred option and allow satisfactory control on cosmesis and functions of this area, but still Naso-Orbital Ethmoidal (NOE) injury is one of the most difficult areas to be repaired and requires to be properly diagnosed, to properly repair the MCAL and augment the nasal dorsum. Early interference is necessary for good results. Lacrimal drainage system is better to be assessed preoperatively and if still affected, postoperative DR is done in a second sitting. Early traumatic enophthalmos can be repaired with good results, but delayed traumatic enophthalmos is a sophisticated problem, difficult to be treated. So, careful attention to details is required especially proper repositioning of the zygomaticomaxillary complex by osteotomies, repair of the medial orbital wall, exploration and repair of orbital floor, especially posterior part and soft tissue repositioning. However, the most common complication is still imperfect outcome even after extensive reconstructive surgeries. Planned osteotomy in transfacial approach to skull base is very helpful and allows ideal reconstruction. Management of fibrous dysplasia is controversy. Partial removal is not appeared to be a wise option as recurrence and residue is the role. Another options (as radical excision and autografting) may be recommended by other study.Conclusion: Endoscopic endonasal CSF leak repair is a very effective method. It minimizes the incidence of complications and it is considered the treatment of choice in any CSF fistula (< 1 cm defect). However, long series is recommended.
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