Updates in the Management of Complex Craniofacial Injuries

Complex craniofacial injuries (CFI) are induced by high-energy mechanisms of injury, resulting in the simultaneous breaking of many bones, bony displacement and often comminution, soft tissue lacerations or avulsions, and visceral consequences. They can be defined as facial injuries with a CFI score equal to or above 10. In the emergency setting, severe facial injuries can affect the patency of the airway and hemodynamic instability, so essential Damage Control procedures must be well known. These patients often have associated injuries, which can constitute real-life saving priorities. Among these, certainly the most frequent are traumatic brain injuries and cervical spine injuries. This type of patient generally requires long-lasting surgery, with a lack of a solid anatomical reference for reconstruction, a few weeks of hospitalization, and several days in ICU. The definitive treatment of complex craniofacial injuries, therefore, requires high technical skill, but mainly a solid organization of the reconstructive planning and multidisciplinary coordination of priorities and treatment sequences. Technologies and the heavy manipulation of images are nowadays indispensable tools, for a correct diagnosis and personalized surgical planning, and for increasing the level of safety and accuracy of the results. Concurrent skull base fractures and gunshot injuries represent the most complex expressions of severe craniofacial injuries, in which specific definitive treatment protocols are required for proper management.