Complications of anterior craniofacial resection

Background. The complications associated with anterior craniofacial resecti ons for benign and malignant tumors were reviewed in 104 patients treated b etween January 1981 and June 1996. Methods. information regarding patient characteristics, histologic type, hi story of prior therapy, extent of the disease, extent of surgical procedure , and type of reconstruction were entered in a microcomputer database. To b etter understand and stage postoperative complications, we divided them int o early (<14 days) and late (>14 days) according to the time of presentatio n, into major and minor depending on the morbidity potential of complicatio n, and into local and systemic ones. Comparison between risk factors associ ated with complications was made using chi-square analysis with Yates' corr ection for continuity. Survival analysis was performed using the Kaplan-Mei er product limit method. Results. There were 8 (7.6%) postoperative deaths, with only 1 occurring fr om systemic complications. Complications occurred in 53 (48.6%) patients. L ocal major complications occurred in 49 (45%) patients, local minor in 29 ( 26.6%), and systemic in II (10%). Early complications occurred in 40 (38.5% ) patients and late complications in 13 (12.5%) patients. These complicatio ns developed during a period ranging from I day to 5 months. More than one complication occurred in a number of patients. Bacterial contamination lead ing to local septic complications was the principal cause of morbidity, acc ounting for 54.7% (29/53) of complications. Major complications included me ningitis in 8 patients associated with cerebrospinal fluid leak in 7, cereb ral abscess in 2, sepsis in 1, and subdural hemorrhage in 1, all of which r esulted in death except for one case. The extent of the craniofacial resect ion (p =.011) was the most important factor associated with major complicat ions. Invasion of the dura and the type of reconstruction of the anterior s kull base were the most important factors related to cerebrospinal fluid le akage (p =.048 and p =.032) and meningitis (p =.011). Conclusion. Contemporary surgical approaches and methods of reconstruction have enabled skull base surgeons to extend their cranial base resections an d increase the B-year survival rates of patients. Nevertheless, significant complications persist. Knowledge and high index of suspicion together with early recognition of these complications are essential for effective manag ement of patients undergoing craniofacial resection. The factors related to major complications found in this study stressed the need to develop more effective methods to prevent contamination of intracranial structures. (C) 1999 John Wiley & Sons, Inc.