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Uncomplicated midfacial fractures represent a frequent and typical injury of soccer-players in oral and maxillofacial surgery. The treatment of these fractures in professional players requires special treatment modalities, especially concerning quick rehabilitation. The examples of a nasal bone fracture, a malar bone fracture and a zygomatic arch fracture in 3 professional soccer players demonstrate the therapeutic principles of these most common uncomplicated midfacial fractures. In this context the fabrication of individual facial masks is presented, which allow an improved postoperative protection and therefore an earlier participation of the player in training and matches.

This article presents the examination of 78 accidents in horseback riding, referring to their origin and kind of injury. It was found that 76% of all injuries did not occur during the active phase of riding, but in the time just before and right after it. Children without any experience in horseback riding were most susceptible to injuries. Referring to lesions occurring before and after the active phase, the longer extremity was predominantly involved (40%); furthermore, the skull was injured in 18% and the hand in 14% of all lesions. During the active phase of horseback riding, skull injuries increased to 34%. Thoracic and spinal lesions occurred in 15% each. The frequency of all lesions shows a reversed proportional dependence on the amount of experience in this sport. Severity of the accidents increases significantly with increasing demand on performance. In consideration of these studies the thesis can be advanced that coordinated prevention directly before and after the active riding phase can decrease the frequency of all accidents and especially the involvement of the lower extremity and the skull.

4 soccer accidents, causing the rare case of impression fracture of the frontal sinus, are introduced as soccer-specific lesions, which are caused by head-to-head collisions, being due to heading-maneuvers. Mostly the right frontal sinus was hurt. The indication for an operation is the obvious dislocation of the osseous fragments. Primary intentions for an intervention are the precise reconstruction of the anterior wall of the frontal sinus because of esthetic reasons and a permanent drainage in order to avoid late complications as for instance mucopyoceles, if the infundibulum has been damaged. The therapy of choice is the osteoplastic frontal sinus operation, using a bicoronary incision.

In the department of Oral and Maxillofacial Surgery, Kiel, 120 individual skull models have been fabricated from 1986 to 1992. The purpose of this study is to compare the results of the 3-D-operation simulation with those of the operation planning based on clinical, radiological and cast analyses. 62 models, used for simulation of skeletal reconstructions, osteotomies and transplantation of bone, have been analysed. In 38 cases the previous operation planning could be proved by the model operation. 24 operation simulations, including secondary reconstructions of the midface and the mandible, asymmetric craniofacial anomalies and large transplants of bone, lead to more exact results as the planning without a model. We therefore regard these types of operations as good indications for 3-D-model operation planning.

Over a 12 year period 56 patients presented for secondary corrections of the periorbital region after trauma. Corrections after isolated fracture of the zygoma improved the final result in 75% of the cases. Further correction seems useless. After midface fractures 85% became acceptable or good results. Tertiary corrections are usefull. The results after front-basal fractures were comparable. Twenty percent of the secondary canthopexies had to be revised once more. The final result was at least acceptable in all cases. Not all secondary nose-corrections lead directly to success, however, after further corrections only 5 percent remained unacceptable. Finally, overall good results were established in 60 percent and in another 20 percent at least an acceptable result could be reached.

Nowadays, free revascularized myocutaneous and osteomyocutaneous flaps are available as grafts of high biological value, which allow functional and esthetic rehabilitation after tumor resection and trauma. The use of these flaps however must be considered carefully, since these techniques require a good general physical condition of the patient for extensive surgery and a considerable operation time. Therefore we consider these flaps as adequate solely in cases of poor recipient site conditions after previous irradiation or chronic infection, in cases of extensive scar formation and in large bone and soft tissue defects. In these cases revascularized grafts from the iliac crest have proven to be useful in mandibular reconstruction while scapular grafts has been useful in restorations of the midface.

Small calvarial defects may be recontoured by Gore-Tex membranes or by micro burr hole covering plates in combination with bone dust. In extended defects the best primary and secondary results are obtained with splitted calvarium grafts due to their stabilizing and esthetic features. Micromeshes prevent contour disturbances in the contact zone of the transplants.

90 patients were followed-up, in whom 110 cartilage grafts of bovine origin (Chondroplast) had been inserted. Nose and orbit (46 and/or 32 cartilage grafts) were the most frequent implantation sites. In three out of those 90 patients incorporation of the grafts was eventful. In two out of those three complication finally resulted in a loss of the graft. When following-up in 57 patients whether the grafts had kept their shape we found out that the cartilage grafts had still kept their shape quite well after three and a half years in 50 patients.

From 1986 to 1992 in the Department of Oral and Maxillofacial Surgery in Innsbruck, in 102 patients with a congenital or acquired deformity of the face, 128 augmentations with Hydroxylapatite granules (in 36 cases) or with Ethylenoxid-sterilised lyophilised cartilage (in 92 cases) have been performed. Hydroxylapatite granules, filled in a Vicryl-tube and implanted subperiosteal solely, proved to be at well tolerated material and consistently in form. In different areas of the face implanted Ethylenoxid-sterilised lyophilised cartilage showed no loss of substance up to now.

During an 8-year period, fifteen patients with subacute or chronic epidural haematoma were seen among 110 treated cases of extradural haematoma corresponding to a frequency of 13.6%. Increasing headache, nausea, vomiting, mild drowsiness and cranial nerve palsy were the symptoms resulting in the correct diagnosis in most cases. Clinical and pathological findings are described, and the factors influencing the course of events are discussed. The most important factors are cerebral atrophy, age, source of bleeding and location. By means of early CT (computed tomography) diagnosis of haematoma, fatal outcome could be prevented in most of the cases.

Between 1.1.1990 and 30.9.1991 32 neuro-traumatological operations were carried out. With 22 patients the intracranial pressure probe was used. With 11 injured persons the ICP (intracranial pressure) values were unchanged. Within this group a computer tomography of the skull around the fifth postoperative day was indicated. Unlike this group, injured persons without a monitoring of intracranial pressure had to undergo a computer tomography on the first postoperative day. After craniotomies, measurements of the intracranial pressure should be carried out as in case of severe head injuries. In this way expansive intracranial changes which occur postoperatively can immediately be seen and diagnosed or treated. On the other hand, if the intracranial pressure values are unchanged, postoperative computed tomography may be carried out later i.e. after the vulnerable phase. Further advantages result from monitoring the patients in the intensive care unit.

The classification of anterior fossa fractures with their sequelae: cerebrospinal fluid (CSF) rhinorrhea, pneumocephalus, or meningitis is presented. This classification is based on five selection criteria which are discussed in this paper. This classification resulted in the table of indications for operative treatment, according to which the appropriate time for operation in urgent cases is immediately, in cases with absolute indication 5 to 6 days after the injury, in long-lasting CSF rhinorrhea or pneumocephalus 10 days after the onset, in intermittent or delayed rhinorrhea and/or pneumocephalus as soon as these signs occur, and in cases of meningitis soon after recovery. This study is based on the analysis of 52 consecutive surgically treated cases, collected from 1984 up to December 1989.

In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17%. In this paper the operative experience with 22 cases of penetrating head injuries is discussed. In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier. 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely. There were no signs of suppurative complications in superficial wounds or in the brain. 4 patients died due to their severe brain damage with multiple contusional lesions. Postoperative complications were as follows: one patient suffered extradural and one patient subdural rebleeding. Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered. The revision was done successfully using the "Sulmycin Implant". Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant".

17 cases of operated Posterior Fossa Epidural Hematomas (PFEDH) of traumatic origin are reported. Clinical and neuroradiological findings are presented and discussed. Authors emphasize the importance of CT scan in determining a more precise diagnosis and the related improvement in the morbidity (13%) and mortality (12%) rates.

Cerebrospinal fluid leakage is one of the central problems facing neurosurgeons, both due to its occasional difficulty in management and to the catastrophical significance of ensuing infection. An important tool emerging in the surgical management of CSF leakage is fibrin sealant, the natural coagulation product. Thirteen cases of CSF leakage, due to meningomyelocele, posttraumatic, and secondary to tumor, that were managed surgically with fibrin sealant are presented. Several of the cases were successfully operated upon following failure of conventional surgical techniques. Additional uses of fibrin sealant in neurosurgery are discussed.

In 32 patients with fractures of different localisation the transverse CT layers were compared with three-dimensional reconstructions. Evaluation showed that three-dimensional CT can better visualize complicated anatomical conditions especially if there are dislocated fragments in the facial part of the skull and in the trunk of the body. Hence, 3-D CT is a valuable complement to axial CT which, however, remains the basis of the findings. Misinterpretations are possible of the reconstructions are used alone because of the lack if visualization of the lesions of the soft parts that accompany fractures and because there may be pseudoforamina at thin osseous lamellae.

300 patients with traumatic frontobasal CSF-fistulae were treated neurosurgically from 1967 to 1989. CT was introduced in 1980, allowing a definitive detection of intracranial lesions including appraisal of cerebral edema, direct detection of fistulae (metrizamide-CT) and of brain hernias and far better imaging of osseous lesions, also of fine structures, such as a better apprasial of paranasal sinus pathology. Classical radiology is, however, still indispensable for imaging certain fracture types and localization of a pneumocranium. Computer Tomography allows an improvement of postoperative results, influencing indication, timing of operation, such as surgical approach.

The transsphenoidal gunshot injury of the head is a subgroup of the temporal gunshot injury, generally with a bad prognosis quoad vitam. Important neural and vascular structures could be damaged by penetration of the missile. In our case the important structures were "missed" exactly and the patient survived without severe neurological deficits. With this case anatomical considerations of the transsphenoidal gunshot injury are made.

A prospective four-year-study of 945 fractures of the facial skeleton is presented. Details of facial trauma were collected in patients referred from the Bradford and Airedale Districts of West Yorkshire, England, an area with a population slightly in excess of half a million. Statistical analysis shows variations from previously published papers, the male to female ratio being under 2.6:1, with an average of 1.15 fractures per patient. A relatively high incidence of sports fractures is reported but the number of industrial accidents is surprisingly low. The majority of patients seen were in their third decade, the mean age being just over 25 years. The analysis also reveals that a high percentage of fractures were treated conservatively.

Within 5 years (1973--1977) 171 facial fractures were treated surgically at the University ENT-Clinic Marburg. 115 cases (67,3%) showed a fracture of the orbital floor, either an isolated fracture of the orbital floor (24 cases) or combined with fractures of the orbital rim in combination with midfacial lesions of the central type (42 cases) or of the lateral type (49 cases). After analysing the mechanism of those fractures the main symptoms and the most important diagnostic investigations (x-ray tomograms, synoptometric investigations, forced-duction-test) are shown. By two examples the results of the prae- and postoperative synoptometric investigations are explained. Those investigations enable a more exact diagnosis in all types of orbital fractures and demonstrate exactly the postoperative functional results.