Severe Craniofacial Trauma With Bilateral Epidural Hematomas and Complex Skull Base and Midface Fractures Managed With Early Multidisciplinary Damage Control Surgery and Immediate Osteosynthesis: A Case Report.

Severe traumatic brain injury (TBI) associated with complex craniofacial fractures represents a life-threatening condition, requiring prompt, multidisciplinary management. Early intervention and timely access to surgical resources are critical factors influencing outcomes. A 23-year-old male sustained a high-energy motorcycle accident without helmet use. On admission, the Glasgow Coma Scale (GCS) score was 13, followed by neurological deterioration. Cranial computed tomography (CT) demonstrated bilateral epidural hematomas, subdural hematoma, subarachnoid hemorrhage, and extensive craniofacial fractures, including Le Fort II and naso-orbito-ethmoidal (NOE) type III fractures, with skull base involvement. The patient underwent emergent, combined neurosurgical and maxillofacial damage control surgery, followed by early definitive reconstruction using osteosynthesis systems available in an emergency setting. Favorable clinical evolution was observed, achieving a GCS score of 15 at discharge without neurological deficits. Early (<24 hours) multidisciplinary damage control surgery, combined with immediate availability of osteosynthesis materials, may significantly improve neurological and functional outcomes in patients with severe craniofacial trauma.