Prevention & Management of Complications in Craniofacial Surgery Involving the Anterior Cranial Base

ABSTRACT

Despite its obvious advantages craniofacial surgery still remains a high-risk procedure with major complications. The purpose of this article is to review craniofacial surgery involving the anterior cranial base performed at Severance hospital from 1986 to 2000, focusing on complications and their management. The cases reviewed included not only craniofacial anomalies, but also curative procedures for trauma and tumor resection. This article retrospectively analyzed 136 procedures performed in 126 patients. Patients were classified into 5 groups on a clinical basis : craniosynostosis, craniofacial synostosis syndrome, orbital hypertelorism, tumor, and trauma. There were 58 complications in 36 patients. Complications were most frequent in group 2(craniofacial synostosis syndrome) which showed a complication rate of 50%, followed in order by orbital hypertelorism, trauma, craniosynostosis, and tumor. There were two deaths, and the mortality rate was 1.5% and the complication rate was 26%. Complications were divided into surgical and medical ones. The majority of surgical complications had serious morbidity potential and infection was most frequent. Medical complications were largely minor, with postoperative pneumonia being most common. Infection-related complications were frequently life-threatening and shown to have decisive influence on postoperative results. We therefore propose the following guide lines for the prevention and management of infection-related complications: 1) extensive antibiotics, 2) atraumatic dural dissection around crista gali, 3) water-tight closure of anterior cranial base defect with well vascularized flap, 4) secure bony fixation with minimal miniplate usage, 5) early detection of infection and continuous intracranial irrigation, 6) surgical skill, 7) short operative time.