Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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27-AUGUST-2009 RAGHAD NABEEL ABULATTA 15 MONTHS
SEVERE HEAD INJURY WITH CRUSHED ANTERIOR FOSSA AND ETHMOIDO-NASAL REGION.
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The patient suffered RTA
26-August-2009 with loss of consciousness and
was transferred to the ICU of Shmaisani
hospital. The respiratory drive was acceptable,
but she has cut wound in the forehead through
which lacerated brain was coming out and there
was wide-based longitudinal fracture involving
the left anterior , middle fossa and dividing
the pyramid into two parts and continuing to the
occipital bone from the left. There was
severe ecchymosis of both eyes more the left
with the medial wall of the right orbit shifted
to the left and the medial wall of the left
orbit shifted laterally of the medial axis. The
ethmoid structures were shifted to the left and
the nasal bone and xanthus burst and shifted to
the left. There was massive bleeding with CSF
from the left ear and both nostrils. There was
fracture of the right femur mid-shaft.
The patient had left sided
hemiparesis with GCS 12/15. Hb was 6.8 mg/dL.
Infusion of blood and FFP was initiated and
continued until the Hb became 11.8.
A left frontal approach was
used and using the deformed fracture in the
frontal bone in the right side, a bony flap was
created over the frontal area from the left. The
lacerated brain was coming from the mediobasal
frontal lobes. The dura over the convexital part
of the frontal lobes was intact and pulsating
The shifted parts of the
medial walls of the orbital walls were
repositioned, so that they got accepted
position. The flail parts of the xanthus
and nasal bones were returned back and using
nylon were approximated to their counterpart of
the normal bone. After that the lacerated
brain material stopped to leak out. The bony
flap returned back and it was more perfect than
during its creation.
Routine closure of the
wound and smooth
and the patient sent to
the ICU without
The patient has longitudinal
fracture extending from the right supratrochlear
area of the frontal bone down to the right
anterior fossa and right middle fossa and
cutting the pyramid into two parts and reaching
the occipital bone.
This degree of trauma is
usually a fatal one, but the presence of a wide
gap in the fractured bone, it could allow
sufficient drainage of the CSF and blood and
lacerated brain material for in time evacuation,
permitting the survival of such a case. The age
of the patient also playing an integral role in
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .