[Primary optic nerve decompression in mid-face fractures].

In severe craniofacial-frontobasal injuries the optic nerve is quite often damaged. We report the findings and the visual outcome in 21 patients with severe mid-face fractures, who underwent primary optic nerve decompression after showing an afferent pupillary defect. During the subcranial exploration and the optic nerve decompression, fractures of the optic canal were found in 13 cases; a dislocated bone fragment could be removed in 6 patients. 9 eyes remained blind, but another 9 eyes regained good final visual acuity between 0.5 and 1.0. We conclude that fractures of the optic canal and dislocated bone fragments are often causes of optic nerve damage in mid-face injuries. The primary subcranial decompression of the optic nerve is a safe method to prevent secondary damage.