Craniofacial trauma due to grass cutter: A case report

Abstract

Removal, irrigation, and reconstruction of the damaged parts are performed for open cranial injuries. These procedures are highly dependent on the cause and effect of the injuries. Herein, we report a case of neuroendoscopic surgery performed for the craniofacial injury caused by a grass cutter. A 60‒year‒old male accidentally collapsed while operating the grass cutter and suffered from left facial injury due to a direct cut by an engine‒driven cutting blade. His level of consciousness on emergency admission was GCS E3V5M6. The facial incised wound extending from the left forehead to the zygomatic bone was 15 cm long and 4 cm deep. His left eyeball was also injured. Head computed tomography (CT) revealed linear bone fracture along the open wound, left frontal lobar contusion, and pneumocephalus. Emergency surgery was performed by neurosurgeons, ophthalmologists, and plastic surgeons. Craniectomy of 3 cm width was performed on the frontal bone utilizing the open incised wound. Rigid neuroendoscope was inserted through the damaged dural opening. Under observation by a rigid neuroendoscope, contusional hematoma and fractured bony pieces were removed. The damaged dura mater of the frontal cranial base was peeled off, trimmed, and sutured. After the peeling off of the frontal sinus mucosa, the frontal sinus was filled with periosteum. Cranioplasty was performed using a titanium plate. Neither wound infection nor spinal fluid leakage followed. The patient was discharged on day 16. In conclusion, the neuroendoscopic procedure was useful in the restoration of injured deep dura mater and skull base from the limited surgical opening.