Subcranial Approach for Management of Secondary Frontal Bone Deformity

Abstract

Secondary correction for aesthetic purposes can be more challenging as the fractured segments may be united in abnormal positions and would require osteotomy procedures before mobilizing the segments for reconstruction. Such maneuvers require adequate exposure and visibility. The subcranial approach is an effective alternate to classical approaches, which required frontal lobe retraction.

Conclusion

Subcranial approach is a viable alternative to posttraumatic deformity of frontal bone.

Contralateral traumatic carotid cavernous fistula after a craniomaxillofacial fracture

Introduction

Carotid-cavernous fistula is an abnormal communication between the internal carotid artery, the external carotid artery or any of their branches and the cavernous sinus. This condition may occur spontaneously or after craniofacial trauma; in this case the fistula takes place on the same side as the craniofacial fracture and becomes symptomatic within a few weeks. The diagnosis is clinical; it must be evoked before any post-traumatic proptosis. Treatment must be started quickly to avoid visual or even vital complications.

Case presentation

We report the case of a 19 years old male patient who was admitted to the maxillofacial surgery department for osteosynthesis of a fracture of the left orbital roof after a traffic accident. The three-month's examination noted a right pulsatile proptosis with redness and decrease of the visual acuity. The cerebral MRI was in favor of a right sided direct CCF, which was confirmed by the arteriographie. The patient responded very well to embolization.

Discussion

Craniofacial trauma is a major cause of carotid cavernous fistula. When a patient has ophthalmic manifestations of vascular complications, early detection of CCF is important for preserving visual acuity. The diagnosis is mainly clinical based on the ophthalmological symptoms. CT and MRI scans show the indirect signs of the fistula. There are several types of invasive and non-invasive treatments. The evolution of the fistula is generally favorable and recurrence is not very frequent.

Conclusion

This case report is a documentation on an exceptional case of posttraumatic direct CCF occurring on the contralateral side of the skull base fracture.

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Posttraumatic carotid-cavernous fistula in a rare complication of craniofacial trauma.

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Contralateral CCF to the fracture side is even more exceptional.

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CCF's complications can be both invalidating and life threatening.

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The prognosis depends on the etiology and the therapeutic delay.

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Before an exophthalmic and ocular redness, it is always necessary to think of a cavernous carotid fistula especially when there has been a recent trauma.