Olfaction After Frontobasal Trauma With and Without Surgery

Abstract

Cerebrospinal fluid (CSF) rhinorrhea, a certain sign of an open frontobasal fracture, represents an absolute indication for surgical repair (Boenninghaus, 1960; Dietz, 1970; Escher, 1973; Kley, 1966; Kuhlendahl, 1966). To avoid an infection of the en-docranium the fistula of the dura has to be closed. In addition, the paranasal sinuses have to be cleared up to prevent a rhinogen secondary infection (Pirsig, 1975; Voss, 1936). In principle, two operative techniques may be used for this purpose: The intracranial intradural approach to the base of the skull, used by the neurosurgeon (Fig. 1), and the extracranial rhinosurgical approach through the upper paranasal sinuses (Fig. 2). The intracranial approach has not only the disadvantage of being a major surgical procedure (Burian, 1972), but also does not permit the observation of the CSF-flow into the nose nor paranasal sinuses, particularly in the case of minute fistulae in the sphenoidal area (Kuhlendahl, 1966). This approach, in addition, often entails the risk of damaging the olfactory nerve fibres (Thumfart, 1977). In order to evaluate the protection of smell by the rhinosurgical technique of frontobasal reconstruction, two groups of patients were compared with regard to results of their olfactory examinations: One group before and after rhinosurgical closure of dural defects, and a second group after frontobasal skull trauma without any surgery.