Presentation
Kicked and trampled by a horse.
Patient Data
Brain:
Complex, open, comminuted and severely displaced fracture of the right frontal bone with the fracture fragment perpendicular to the adjacent skull. Associated small volume extra-axial haemorrhage.
Facial:
The open comminuted right frontal bone fracture extends into the right zygoma and the roof and floor of the right frontal sinus.
There is extensive, moderately displaced and comminuted fractures through the right orbital roof, right orbital floor, and medial and lateral walls of the right orbit. The infraorbital foramen is also involved.
The right globe, optic nerve and extraocular muscles are intact.
Comminuted fracture involving the anterior, lateral and medial walls of the right maxillary sinus is also present. Associated haemorrahge into the right frontal, maxillary and ethmoid sinuses.
Case Discussion
This case demonstrates complex craniofacial fractures secondary to blunt trauma.
The patient underwent extensive craniofacial surgery with right frontal decompressive craniectomy, evacuation of extradural haematoma, right frontal sinus/nasofrontal outflow tract cranialisation and open reduction/internal fixation of multiple facial fractures by a combined maxillofacial and neurosurgical team.
The patient was eventually discharged home with a complete neurological recovery, preservation of visual acuity and satisfactory cosmetic outcome. They will undergo a right frontal cranioplasty in the future to complete the reconstruction process.
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