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FR.04.04
Reconstruction of the orbital roof in traumatic head injuries – an interdisciplinary challenge
Kartik G. Krishnan1 , Constantin Landes2 , Robert Sader2 , Volker Seifert1 Departments of 1Neurosurgery and 2Maxillofacial Surgery, Johann Wolfgang Goethe University,
Frankfurt
Introduction: Frontobasal and orbital fractures have three unique and reproducible patterns based on
vector, location, and force: type 1- isolated-linear (only cranial base), type 2- vertical-linear (base and vault)
and type 3- comminuted (base, vault, frontolateral) . Surgically addressing displacing orbital roof fractures
have specific time limitations, owing to severe long-term sequelae . However, frontobasis exploration is
not indicated during the acute stage of brain injury, owing to edema and neurological complications . In
such cases delayed subacute reconstruction is the method of choice, optimally in conjuction with midface
reconstruction, which is a part and parcel of such injuries . Here we present our interdisciplinary approach
to these rare cases .
Methods: 18 cases with type 2 and 3 fractures associated with dural tear and brain contusion of the frontal
base were treated in an interdisciplinary manner between the 14th and 21st day after initial injury . Bilateral
subfrontal approach was employed in all cases to explore the frontal base and the orbital rooves . Frontal
base reconstruction was performed using pedicled pericranial flaps and the orbital rooves were reconstructed
using microplate and screw systems .
Results: Adequate morphological frontal base and orbital reconstruction and orbital decompression was
achieved in all cases . Functional neurological rehabilitation of patients depended on the extent of initial brain
injury in par with empirical results .
Conclusion: Owing to acute brain edema after initial head injury, the timing of exploration, decompression
and frontal base & orbital reconstruction should be chosen carefully depending on the clinical status of the
patient: in this series a latency of 14 to 21 days seemed adequate . Timely structural reconstruction will
prevent long-term sequelae in patients with type 2 & 3 fractures of the frontal base and the orbit .
FR.04.05
Eine osteotomiefreie Technik zur Korrektur des anophthalmischen Enophthalmus
Martin Rücker
Medizinische Hochschule Hannover, Klinik für Mund-, Kiefer- und Gesichtschirurgie
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