Fractures of the middle third of the face and cerebrospinal fluid rhinorrhoea.

The incidence of cerebrospinal fluid (CSF) rhinorrhoea in patients with facial fractures is about 25%. Although the management of facial fractures is well documented, its timing and role in the presence of CSF leak is still open to debate. This study evaluates facial manipulation in 89 facial fractures associated with CSF rhinorrhoea, with a mean follow-up of 4 years. The facial fractures were reduced in 26 patients (29%) and the CSF fistula was repaired in 75 (84%). Twenty-three (25.8%) had both facial manipulation and dural repair with no deaths, post operative infection, failure or recurrence of CSF leak. On the other hand, when facial manipulation or dural repair was performed alone, the CSF rhinorrhoea either persisted or recurred in a significant number of patients requiring further intervention. Although this is a retrospective analysis of patients treated over several years and, there has been a change in the methods of investigation and treatment of these patients, one can conclude that manipulation of facial fractures and surgical dural repair can be carried out at the same sitting without increasing the surgical morbidity and mortality.