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Both of large groups, lateral and central facial skull fractures, are further divided into isolated fractures of particular localisation (zygomatic arc, orbital floor fractures etc.) and compound fractures of varying degrees. 33 patients aged 5 to 14 years with fractures of the orbital floor (blow-out fractures) were followed up for 3 months to 9 years. Advances in the primary surgery have contributed to an improvement in the treatment of defects. The present investigation confirms the view that blow-out fractures with diplopia and prolaps in childhood require early surgical treatment.

89 patients with fractures of the orbital floor - both in isolation (blow-out fractures) and combined with a complex fracture of the midregion of the face - were followed up for an average of 5 years. Particular attention was paid to the quantitative evaluation of binocular fusion, diplopia and enophthalmos. Comparison of operated and conservatively treated patients with blow-out fractures led to the following conclusions with regard to indications for surgery: 1. It is not justified to regard either surgery or its postponement pending developments as obligatory in all cases. 2. Surgery is indicated by clinical, orthoptic and roentgenological findings as follows: a) In case of enophthalmos or roentgenological demonstration of prolapse, surgery is indicated independent of diplopia. b) Diplopia outside the main field of view does not, in general, necessitate surgery. c) If there is diplopia within the main field of view, surgery is indicated. It is generally accepted that orbital-floor fractures associated with complex mid-face fractures require early surgical treatment. The present investigation confirms this view.

Over a period of 15 years the author operated on 205 patients with traumatic frontobasal CSF fistulas. In one third of these cases, exploration had to take place within 24 hours because of cerebral compression or a direct open injury. Craniotomy enables the surgeon to repair the concomitant neurosurgical lesions frequently found (57%) as well as the often multiple (56%) or bilateral (35.3%) fistulas. As regards surgical technique, the important points are: protection of the brain thanks to the use of magnification, the best possible approach, lumbar puncture during surgery to relieve pressure, sufficient cerebral debridement and in the paranasal sinuses, reliable closure of the fistula (duraplasty and sometimes additional plastic closure of the bony defect), and consideration of the latest findings of neuroanaesthesia, endocrinology etc. Nearly two-thirds of the patients operated were able to resume work completely.