Severe TBI with complex craniofacial fractures followed by cranioorbitar reconstruction

Abstract

Young age is associated with better outcome in patients with severe traumatic brain injury (TBI). Still the reported mortality rate in patients that present in profound coma Glasgow Coma Scale (GCS) -3 pts is very high, even approaching 100% in the presence of fixed and dilated pupils in some series. We report a case of a 25 years old patient with a severe TBI in a car crush and presented in severe coma with a bilateral frontal and right temporal brain laceration with extended posttraumatic subarachnoid hemorrhage and a complex cominutive right frontal, maxillary and zygomatic fracture corresponding to Le Fort III fracture. After a difficult postoperative course with complications of tracheostomy like candidosis and bronchopneumony, then after a slowly progressive recovery, the patient was hemiparetic and with a persistent right 3rd nerve paresis at 6 weeks after the traumatic event, but was able to speak and to ambulate with assistance. Given the large bony defect that remained, a frontal and facial bony reconstruction was made by an interdisciplinary team using titanium plates and screws. Considering the excellent results in this case we advocate that young patients who suffered severe TBI even if they present in a very bad neurological shape should be given access to the best treatment.