Saint Petersburg: Expert Medical Care Rendered to Patients with Associated Craniofacial Trauma

A.A. Limberg

(Center of Associated Craniofacial Trauma, Aleksandrovskaya Municipal Multifield Hospital of Emergency Care,
Saint Petersburg)

Up-to-date and adequate specialized treatment of associated craniofacial traumas (the International Classification) is of great importance for a clinical course and outcome of traumatic disease in casualties with polytrauma. Our experience (1980-2002) has proved necessity of early (during the first 72 hours after trauma) and profound examination and specialized treatment under conditions of a municipal multifield hospital of emergency care with compulsory joint participation of neurosurgeons, craniofacial surgeons, neuroophthalmologists, ophthalmic surgeons, neurootologists, working in one and the same unit. In case of necessity specialists from other departments can be involved, as well.

Time, elapsing between the moment of trauma and expert care, is a decisive factor, determining outcomes of craniofacial trauma. A choice of treatment tactics should be individual and depends on a character and severity of injuries. The analysis of 4368 casualties (1998-2002) shows, that craniocerebral trauma was present in 100% of cases; 56% of them had brain contusions, fractures of the skull base. Other injuries were as follows: fractures of walls of accessory sinuses - 100% of cases; an orbit wall -98% (25% of these cases had traumas of its deep-lying structures); eye injuries - 86%; injuries of soft tissues of a head and face - 98%; fractures of facial bones - 88% (they were multiple in 75% of patients); injuries of the locomotor system - 17.5%; thoracic and abdominal injuries - 10.2%.

Presence of acute disorders of respiration and bleeding demands urgent resuscitation measures or surgical intervention in case of necessity. Urgent operations are indicated in injuries of abdominal organs, wounds of an eyeball, severe craniocerebral traumas, accompanied by brain compression. Fractures of bones of the skull fornix and base without brain compression, associated with fractures of facial bones, orbit walls and paranasal sinuses demand emergency treatment as well. It should include examination and debridement of sinuses, reposition and fixation of bones fragments of the cerebral and visceral cranium. Preserved mobility of the latter supports and enhances bleeding and liquorrhea and promotes development of inflammatory complications and aspiration pneumonias. Fractures of long spongy bones, pelvic bones and spine are indications for quick immobilization of bone fragments. All casualties require adequate gas exchange, timely and full replacement of blood loss, preventive antibacterial therapy with use of different broad-spectrum antibiotics, starting immediately after admission. Outpatient treatment in a hospital department of craniofacial trauma during 6 months occupies a very important place in full-value care and rehabilitation of patients after their discharge. According to our experience, 28% of discharged cases demanded continuation of staged stationary treatment. Elaborated algorithms of examination and treatment of such casualties improve outcomes, reduce disability duration and, in the long run, minimize treatment cost.