Craniofacial injuries and osteomeningeal ruptures. When should the anterior fossa be approached

A retrospective analysis was carried out of 142 cases of craniofacial traumas divided into 5 types according to the Fain classification. The incidence of cerebrospinal fistula of fronto-basal skull is very high in types III and IV traumas (60% of the cases). It is less important in type II2 traumas representing severe naso-orbital lesions (40% of the cases). It is only of 20% in type II1 traumas (Lefort II and III). Uncontrollable rhinorrhea and late meningitis are mainly due to types II and IV traumas. From these findings surgical indications and technique of the approach of the fronto basal skull are discussed.