Raveh J, Vuillemin T, Sutter F
Department of Maxillofacial Surgery, University of Berne, Switzerland.
Arch Otolaryngol Head Neck Surg. 1988 Oct;114(10):1114-22. doi: 10.1001/archotol.1988.01860220048022.
In severe craniofacial injuries, the involvement of the skull base with concomitant major dural tears is significantly high. Our methods and treatment plan are controversial compared with the conventional procedure: primary urgent neurosurgical exploration and repair with deferral of maxillofacial reconstruction. To avoid the disadvantages of the transfrontal intracranial management of the skull base, we modified the transethmoidal approach so as to enable the subcranial exposure of all the anterior fossa planes, including the sellar-sphenoidal region. The advantages rendered by this method are the feasibility of an early one-stage craniofacial reconstruction and avoiding retraction of the frontal lobes and damage to the olfactory filaments. The reduction of pseudohypertelorism, the decompression of the optic nerve, and the meticulous reconstruction of the midface and skull base are performed in one session and are regarded as one entity. The results of the surgical management of 395 craniofacial injuries and the low rate of complications emphasize the advantages of the methods described in this article.
在严重的颅面部损伤中，颅底受累并伴有硬脑膜大撕裂的情况显著增多。与传统手术方法（即先行紧急神经外科探查与修复，推迟颌面重建）相比，我们的方法和治疗方案存在争议。为避免经额部颅内处理颅底的弊端，我们改良了经筛窦入路，以便能够在颅下暴露前颅窝的所有层面，包括鞍区 - 蝶骨区域。该方法的优点包括早期一期颅面重建的可行性，以及避免额叶回缩和嗅丝损伤。在一次手术中完成假性眶距增宽的矫正、视神经减压以及中面部和颅底的精细重建，并将其视为一个整体。395例颅面部损伤的手术治疗结果及低并发症发生率凸显了本文所述方法的优势。
