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Complex craniofacial trauma - a case report

Tina Traykova, Miroslav Stoykov, Pavel Georgiev, Karen Dzhabalyan, Tsvetan Tonchev


Introduction: Complex craniofacial trauma is a life threatening condition due to the complications that may occur. Injury mechanisms such as vehicle accidents, contact sports injures and assaults are a common cause.

Materials and methods: A 36-year-old male was referred to the Department of Oral and maxillofacial surgery at St. Marina University Hospital on the occasion of a vehicle accident. After full diagnostic work-up including computed tomography of head and neck, paraclinical examinations and consulta­tion with a neurosurgeon, ophthalmologist, anaesthesiologist and otorhinolaryngologist the patient was diagnosed with Le Fort III fracture, naso-orbital-ethmoid comminuted fracture and fracture of the anterior and middle cranial fossa. The treatment consisted of open reduction and internal fixa­tion with submental intubation for management of the airways.

Results: On the computed tomography image bilateral fractures were visible, with multifragment­ed fractures of the nasal bones and the maxillary process. Multifragmented fractures of the anterior lateral wall and posterior lateral wall of the both maxillary sinuses were present as well. A minimal­ly dislocated multi fragmented fracture of the left temporal bone was localized in the area. Impaired integrity of the left eyeball was diagnosed. The ophthalmologist concluded that eye evisceration can be done further in time. The neurosurgeon established pink exudation with the appearance of a cere­brospinal fluid from the right nostril. Uneventful submental intubation has led to successful surgery with no following complications. The contour of the middle facial floor and the correct occlusion of the teeth have been restored.

Conclusion: Despite the fact that the person was diagnosed with Le Fort III fracture, naso-orbital-ethmoid comminuted fracture, fracture of the anterior and middle cranial fossa and amaurosis in the left eye satisfactory functional and aesthetic results and improvement of the patient`s quality of life can be achieved.


craniofacial region; fracture; computed tomography image; maxillary sinus; submental intubation



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