*3.8.2 Corticoids*

In this case, the neurosurgeon may prevent administering these compounds due to cerebral trauma. But for other lesions at the level of the viscerocranium, corticoids are beneficent reducing facial swelling and edema along the cranial nerve

#### **Figure 6.**

*Combined fracture of nasal vault and septum with CSF leak on the left side—clinical aspect, CT scan revealing fracture lines through the nasal septum and left nasal bone, also the endoscopic aspect of the CSF leak in a case with accidental fall from the same level.*

**93**

after the trauma [41].

*and final aspect at the end of the surgical procedure.*

*3.8.4 Gastric secretion modulators*

*3.8.3 Analgesics*

**Figure 8.**

**Figure 7.**

*imaging.*

*Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics…*

endings and preventing major functional deficits completely assessed many days

*A complex fracture involving the nasal vault, orbit, and ethmoid bone—CT scan with 3D reconstruction, surgical aspects of the coronal approach, and closing the fracture with titanium plates mounted in a Y pattern* 

*A complex fracture involving the nasal vault, orbit, and ethmoid in axial section and 3D reconstruction* 

Such situations are facial palsy with inner ear lesions or eyesight impairment due to indirect compression or elongation of the optic nerve. Sometimes efficient

Painkillers from various classes may be used ranging from paracetamol to nonsteroids and opioids or morphine if the patient is transferred to ICU with the help

These compounds are proton pump inhibitors used to diminish the impact of traumatic stress and because of lack of oral food intake in the first 24 hours, but also to control the interactions between corticoids and analgesic compounds [44].

corticoid regimens can even reduce the need for surgical treatment [42].

and continuous adjustment of the anesthesia and pain specialist [43].

*DOI: http://dx.doi.org/10.5772/intechopen.92862*

*Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics… DOI: http://dx.doi.org/10.5772/intechopen.92862*

#### **Figure 7.**

*Trauma and Emergency Surgery - The Role of Damage Control Surgery*

synthesis materials are mandatory [36].

before osteosynthesis [37].

*3.8.1 Antibiotics*

barrier [39].

*3.8.2 Corticoids*

allows a functional aftercare [38].

**3.8 Medical treatment in cranial-facial trauma**

• **Rigid fixation—**rigid fixation will produce a three-dimensional stability of the fracture site, promoting primary fracture healing. The healing is extremely susceptible to mechanical influences. Mobility at the fracture site is one of the main causes of healing disturbances, and stability is considered the best

• **Preservation of blood supply—**it is achieved by gentle handling and reduction of bone and soft tissue and by careful cold irrigation during the drilling phase, which must be performed at low rotation less than 1500 rpm to prevent the overheating of the bone structures. Good-quality instruments and osteo-

• **Anatomical reduction/repositioning—**one must achieve anatomical correct repositioning of all midfacial bones. The height, width, and projection must be reestablished. The fracture lines must be surgically exposed and reduced

• **Early mobilization—**early mobilization of the operated area and the patient

The treatment scheme should include third-generation cephalosporins, along with metronidazole due to oral bacteria contamination. This association of antibiotics has many advantages: it covers the spectrum of gram-positive bacteria encountered in ENT practice and also anaerobic bacteria and penetrates the blood–brain

These should be administered for at least 48 hours during nasal packing but better for 5–7 days including surgery and up to 14 days in cases with nasal CSF leaks. Meropenem or carbapenems after discussing with the neurosurgeon in cases with brain lesions or following local treatment protocols are also associated [40].

In this case, the neurosurgeon may prevent administering these compounds due

*Combined fracture of nasal vault and septum with CSF leak on the left side—clinical aspect, CT scan revealing fracture lines through the nasal septum and left nasal bone, also the endoscopic aspect of the CSF leak in a case* 

to cerebral trauma. But for other lesions at the level of the viscerocranium, corticoids are beneficent reducing facial swelling and edema along the cranial nerve

protection against fracture site contamination and malunion [35].

**92**

**Figure 6.**

*with accidental fall from the same level.*

*A complex fracture involving the nasal vault, orbit, and ethmoid in axial section and 3D reconstruction imaging.*

#### **Figure 8.**

*A complex fracture involving the nasal vault, orbit, and ethmoid bone—CT scan with 3D reconstruction, surgical aspects of the coronal approach, and closing the fracture with titanium plates mounted in a Y pattern and final aspect at the end of the surgical procedure.*

endings and preventing major functional deficits completely assessed many days after the trauma [41].

Such situations are facial palsy with inner ear lesions or eyesight impairment due to indirect compression or elongation of the optic nerve. Sometimes efficient corticoid regimens can even reduce the need for surgical treatment [42].

#### *3.8.3 Analgesics*

Painkillers from various classes may be used ranging from paracetamol to nonsteroids and opioids or morphine if the patient is transferred to ICU with the help and continuous adjustment of the anesthesia and pain specialist [43].

#### *3.8.4 Gastric secretion modulators*

These compounds are proton pump inhibitors used to diminish the impact of traumatic stress and because of lack of oral food intake in the first 24 hours, but also to control the interactions between corticoids and analgesic compounds [44].

Other treatments in managing midfacial trauma include the following:


#### **3.9 Indication of surgical treatment in craniofacial trauma**

Surgical treatment should focus on functional and esthetic deficits. Regarding early intervention in facial trauma, neurosurgeons consider the risks greater than the benefits. Therefore, surgery in these cases should be scheduled within 4–7 days to enable remission of edema and patient stabilization [50].

An exception from this rule is nasal bone fractures which require reduction within the first 24–48 hours from the accident to prevent secondary skull base fractures. We emphasized previously that this is possible under general anesthesia along with solving other fractures within 4–5 days from trauma [51].

Given the presence of CSF leak, the surgery must be postponed, and surgical reduction of fractures is possible within 10 days without a major change of the outcome [52].
