The Management of Post-Traumatic Rhinorrhea: Experience at CHU Ibn Rochd Casablanca (2018–2022)

In this study conducted at the Ibn Rochd University Hospital in Casablanca, the management of post-traumatic rhinorrhea was evaluated over five years. The results showed that this condition was relatively rare, affecting around 7.73% of patients with craniofacial trauma. Patients were predominantly young men, and road traffic accidents were the leading cause of trauma. Rhinorrhea characteristics included anterior localization, bilaterality in over half of cases, and immediate onset in most situations. Patients were generally hemodynamically stable and hospitalized for less than a week. Treatments included medical approaches such as acetazolamide (DIAMOX) administration, antibiotic prophylaxis, and surgical interventions to close the osteomeningeal breach in some patients. Overall results were favorable, with a positive evolution observed in 64.28% of patients. Only one case of meningitis was reported. This study highlights the effectiveness of a multidisciplinary approach to the management of post-traumatic rhinorrhea, underlining the importance of early assessment and appropriate management. Further research is needed to deepen understanding of this condition and improve long-term outcomes for patients.

Introduction

Post-traumatic rhinorrhea is due to a communication between the subarachnoid space and the false nasal cavity following a traumatic osteomeningeal breach. Anterior-stage fractures, without often incriminating the latter, represent the most frequent type of skull base fracture. This communication exposes the patient to a high risk of neuromeningeal infection, which requires multidisciplinary management. This study will evaluate the management of these patients at the CHU Ibn Rochd [1]–[3].

Materials and Methods

The study consisted of a retrospective descriptive review of patient records from January 1, 2018, to December 31, 2022, hospitalized for rhinorrhea at the Ibnou Rochd Hospital, including patients with craniofacial trauma complicated by rhinorrhea. 28 patients were identified via hospitalization registers and records from the neurosurgery department, the neurosurgical emergency department, and the maxillofacial surgery department.

Results

Our study found rhinorrhea in 7.73% of patients with craniofacial trauma during the study period, with a predominance of males, a sex ratio of 13, and an average age of 34. 89.29% of patients were of urban origin, and the etiology of the trauma was public road accidents (PVA), with an increase in cases at weekends and during the summer season. 71.42% of patients were hospitalized for less than a week. % of patients were hospitalized for less than a week, and our study showed that 89.28% had no disturbance of consciousness and stable hemodynamics, with only 2 patients in the series requiring intensive care. 85.71% of rhinorrhea was anterior, bilateral in 53.57%, immediate in 57.14%, and delayed in only 7.14% (Table I).

Table I. Characteristics of Rhinorrhoea According to Type, Laterality, and Time of Onset

Rhinorrhoea	Type		Laterality		Time of onset
	Anterior	Posterior	Unilateral	Bilateral	Immediate	Delayed >24H	Delayed >24H
%	85.71%	14.29%	53.57%	46.43%	57.14%	35.71%	7.14%

75% of patients presented initial loss of consciousness, 17.86% intracranial hyperpressure syndrome, 3.57% otorrhea, 7.14% otorrhagia, 42.86% epistaxis, and 21.12% associated limb trauma. Cerebral tdm was performed in all patients and revealed a fracture of the anterior floor in 67.85%, a fracture of the orbit in 57.14%, and a fracture of the nasal bone in 50%. A cerebral lesion was found in 15.57% of cases, with cerebral contusions the most frequent in 28.57%. MRI was performed on only one patient.

Management consisted of medical and surgical aspects; treatment was always the rule in 78.57% of cases, with acetazolamide (DIAMOX), and antibiotic prophylaxis based on amoxicillin acid-clave was instituted in 89.28% of cases. Anti-epileptic treatment was performed to prevent comas in 25% of cases, and a lumbar puncture was performed in 14.18% of patients. Surgical treatment to close the osteomeningeal gap was performed in 35.71% of cases. 64.28% of patients had a favorable outcome, and only one patient (3.57%) developed meningitis.

Discussion

Post-traumatic rhinorrhea is a relatively rare phenomenon, as found in this study and previous research. According to various studies, hospitalization rates for this condition are generally low, ranging from 2% to 2.9%. This underlines the importance of in-depth research to understand this condition better and improve its management.

The results of the study showed a male predominance in cases of post-traumatic rhinorrhea, with a male-to-female ratio of 13:1. In addition, it was observed that affected patients were generally young, aged between 20 and 30. These specific demographics can help identify at-risk populations and implement appropriate preventive measures, such as awareness and road safety campaigns targeting young men.

In terms of mechanisms of trauma, public road accidents were the main cause of post-traumatic rhinorrhea, and an increase in cases was observed at weekends and during the summer months. This correlation can be attributed to the greater frequency of outdoor activities and travel during these periods, which increases the risk of head trauma. This information is valuable for reinforcing prevention and safety measures, focusing on periods of higher risk.

The study results also revealed that the majority of patients hospitalized for post-traumatic rhinorrhea had a hospital stay of less than a week. This indicates that management of this condition can be relatively rapid and that most patients did not present with significant disorders of consciousness or hemodynamic problems. However, it is important to note that some more severe cases require intensive care hospitalization, underlining the need for careful assessment and close monitoring of patients.

The characteristics of rhinorrhea, such as its anterior localization, bilaterality, and immediate onset, are consistent with what has been reported in other studies. This information can help healthcare professionals recognize and rapidly diagnose post-traumatic rhinorrhea in patients with head injuries, which is essential for appropriate management.

As far as medical and surgical management is concerned, it is encouraging to note that the majority of patients had a favorable outcome. Medical treatments, such as acetazolamide (DIAMOX) and antibiotic prophylaxis, were widely used. In addition, some patients received antiepileptic therapy, and in some cases, a depletive lumbar puncture was performed to prevent the risk of complications.

In around a third of cases, surgery was performed to close the osteomeningeal breach. This demonstrates the importance of a multidisciplinary approach in managing this pathology, involving specialists from different medical disciplines to ensure the best patient outcome.

In conclusion, this study has helped to improve knowledge of the management of post-traumatic rhinorrhea, highlighting the effectiveness of a multidisciplinary approach. The results highlighted this condition’s demographic, etiological, and clinical aspects, providing valuable information for identifying at-risk populations and optimizing prevention strategies. Further research is needed to deepen understanding of this pathology and to evaluate the efficacy of new therapeutic approaches, which could improve long-term outcomes for patients with post-traumatic rhinorrhea.

Post-traumatic rhinorrhea occurs after head trauma. It is characterized by a persistent nasal discharge that may be clear, cloudy, or tinged with blood. This condition is rare, with relatively low hospitalization rates found in different studies 2% Friedman [4], Gosal [5]. Affected patients are often young men aged 20 to 30 years [6]–[12]. Public road accidents in urban areas on public holidays are the primary mechanism in different studies [13]–[15]. Hospital stay varies from 5 to 13 days [16], [17].

A Glasgow score of over 13 was observed in the various studies, which is in line with the results of our series; hypo- or anosmia was a sign often found in 41.89% of cases [18]; rhinorrhoea was of immediate onset [13]–[20].

Conclusion

In conclusion, this retrospective descriptive study conducted at the Ibn Rochd University Hospital in Casablanca enabled us to assess the management of patients with post-traumatic rhinorrhea over five years. The results showed that post-traumatic rhinorrhea is relatively rare, affecting around 7.73% of patients with craniofacial trauma.

Data analysis showed a male predominance, with a ratio of 13 men to one woman, and the average age of the patients was 34. Road accidents were the main cause of trauma, with an increase in cases at weekends and during the summer months.

The majority of patients hospitalized for post-traumatic rhinorrhea were managed for less than a week, with no significant disorders of consciousness and hemodynamic stability. Only two patients in the series required intensive care hospitalization. Rhinorrhea characteristics included a predominance of anterior cases, bilaterality in more than half of cases, and immediate onset in most situations.

As for other clinical manifestations, the initial loss of consciousness was observed in 75% of patients, while symptoms such as otorrhea, otorrhagia, and epistaxis were reported in some patients. Imaging studies, such as brain CT scans, revealed fractures of the anterior floor, orbit, and nasal bone, as well as associated brain lesions.

Patient management was multidisciplinary, combining medical and surgical approaches. Medical treatment included acetazolamide (DIAMOX) and amoxicillin-clavulanic acid antibiotic prophylaxis. Some patients also received antiepileptic treatment, and in some cases, a depletive lumbar puncture was performed. Surgical osteomeningeal breach was closed in around a third of patients.

Overall results were encouraging, with a favorable outcome observed in 64.28% of patients. Only one case of meningitis was reported among the cohort studied, underlining the importance of early and appropriate management to reduce the risk of infectious complications.

In conclusion, the management of post-traumatic rhinorrhea at CHU Ibn Rochd in Casablanca demonstrated the effectiveness of a multidisciplinary approach, combining medical and surgical treatments. These results help to improve knowledge of this relatively rare condition and may guide future clinical practice to optimize outcomes for patients with post-traumatic rhinorrhea.