gms | German Medical Science

Recent studies demonstrating a remarkable decline of perioperative mortality rates in elderly patients encourage us to direct even complex reconstructive cranio-maxillofacial procedures. Several risk factors have been identified including high co-morbidity, reduced general condition and emergency operations. Despite controversies, we recommend osteoplastic surgical techniques (e.g. split calvarian techniques, osteotomies and osteosynthesis) due to a limitless and preserved osseous regenerative capacity even at an advanced age.

In the last 32 months, 16 patients from 60 upwards suffering either from an anterior fossa fracture and / or, a complex comminuted depressed fracture of the frontal bone (9), a fronto-orbito-naso-ethmoidal fracture (1) or orbital tumour (5) underwent surgery. Surgical reconstruction of the cranial vault combined with split calvarian techniques or osteosynthetic procedures were performed in 10 patients. With the exception of one patient sustaining a fronto-orbito-naso-ethmoidal fracture without signs of rhinorrhea but reduced general condition (ASA IV) all patient were treated surgically.

Surgery was performed using conventional bone plating systems or the so-called minimal material osteosynthesis (MMO) a lag-screw only fixation technique developed in our departments. With the exception of one patient, whose treatment was complicated on the basis of skin flap necrosis, healing was uneventful (n = 9). No patient developed a CSF fistula post-operatively. Follow-up investigations imply CT scanning and plain roentgenograms 6 months after surgery. CT scans revealed an unchanged position of the osteosynthetic hardware and the bony flaps or fragments. No side effects e.g. loosening of screws, inflammation, and unpredictable osseous resorptional processes were observed.

Unlike long bones, surgeons need not fear osteoporotic phenomena in bones developed by intramembraneous ossification (neuro-/ viscerocranium). Bone quality, structure and density do not suffer dramatical changes even late in life. Therefore, age is not a limit for reconstructive cranio-maxillofacial surgery. In experienced hands and under consideration of basic principles of osteosynthesis and bone grafting and osteosynthetic techniques are safe and have a relatively modest risk.