[1-stage procedure in the reconstruction of frontobasal middle face fractures. Modifications and treatment modalities].

This paper deals with the management of 269 patients with frontobasal fractures of which 143 were treated operatively. The close interrelation between midface and base of skull and our operative modifications are discussed. The advantages and importance of the transethmoidal approach to the base of the skull is most adventageous for reconstruction of the midface pillars. Specially for comminuted fractures, avoiding complications such as pseudohypertelorism, telecanthus and frontobasal disturbances. This also enables an accurate reposition to be made with minimal use of foreign materials such as wire ligatures and miniplates. The operation should be performed by the same surgeon in a single sitting thus combining the transethmoidal approach with the midface reconstruction. The reduction of the rate of CSF recurrent leaking to only 3,5% is ascribed to these methods.