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Dilworth D, Johnston D, McAuley D, Gordon P. A trans-eyebrow zig-zag approach for frontal bone fractures ✰. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101972. [PMID: 39032646 DOI: 10.1016/j.jormas.2024.101972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Frontal bone fractures are amongst the most common facial fractures and surgical management, which has traditionally involved access via a coronal flap, can result in unsightly scarring, alopecia, paraesthesia, facial nerve weakness and temporal hollowing. Alternative approaches include use of endoscopically-assisted surgery, often through the eyebrow, which minimises the risk of unsightly scarring but may also sacrifice access in the process. In this technical note, we discuss a surgical technique for open reduction and internal fixation of fractures of the bone overlying the frontal sinus and supra-orbital rim, which the authors have not found in the literature, which involves the making of a "zig-zag" incision through the eyebrow in a trichophytic manner which reduces the risk of unsightly scarring whilst simultaneously allowing for sufficient surgical access to the fracture site.
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Affiliation(s)
- Daniel Dilworth
- Department of Oral and Maxillofacial Surgery, Ulster Hospital, Belfast, United Kingdom.
| | - David Johnston
- Department of Oral and Maxillofacial Surgery, Ulster Hospital, Belfast, United Kingdom
| | - Donal McAuley
- Department of Oral and Maxillofacial Surgery, Ulster Hospital, Belfast, United Kingdom
| | - Peter Gordon
- Department of Oral and Maxillofacial Surgery, Ulster Hospital, Belfast, United Kingdom
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Kaplan GO, Küçük KY, Kara M, Calis M, Tunçbilek G. Comparison of closed percutaneous screw reduction versus open reduction and internal fixation in the treatment of frontal sinus fractures: A retrospective study. J Craniomaxillofac Surg 2024; 52:743-747. [PMID: 38580560 DOI: 10.1016/j.jcms.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/01/2024] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
The aim of this study was to compare closed percutaneous screw reduction to traditional open reduction-internal fixation (OR-IF) for the treatment of anterior table fractures. Both groups were evaluated in terms of operative variables, complications, and treatment success. Of 32 patients included, 19 patients underwent OR-IF, while 13 underwent percutaneous screw reduction. The median operative time, length of hospital stays, and treatment cost of the OR-IF group were 100 min (range 60-130), 4 days (range 3-9), and $727 (range $642-$1291), respectively. The same variables for the closed reduction group were 30 min (range 20-40), 2 days (range 1-2), and $303 (range $252-$349), respectively. The closed reduction group exhibited a shorter operative time (p< 0.001), reduced length of hospital stays (p< 0.001), lower treatment cost (p< 0.001), and a lower complication rate (p = 0.025) compared to the OR-IF group. Late-term outcomes in both groups showed no visible contour changes or step deformities. In conclusion, the percutaneous screw reduction technique is a safe and effective option with minimal morbidity in the treatment of frontal sinus anterior table fractures. Therefore, traditional OR-IF should be reserved for fractures that are not suitable for reduction using minimally invasive techniques.
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Affiliation(s)
- Güven Ozan Kaplan
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Kutluhan Yusuf Küçük
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Murat Kara
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Mert Calis
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey.
| | - Gökhan Tunçbilek
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
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Kim DW, Lee SH, Choi JH, Hwang JH, Kim KS, Lee SY. Relationship between midfacial fractures and maxillary sinus pathology. Arch Craniofac Surg 2023; 24:117-123. [PMID: 37415469 PMCID: PMC10365897 DOI: 10.7181/acfs.2023.00283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures. METHODS A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined. RESULTS The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology. CONCLUSION The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.
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Affiliation(s)
- Dong Wan Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Hyuk Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
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Lee DW, Kwak SH, Choi HJ, Kim JH. Reduction of comminuted fractures of the anterior wall of the frontal sinus using threaded Kirschner wires and a small eyebrow incision. Arch Craniofac Surg 2022; 23:220-227. [DOI: 10.7181/acfs.2022.00934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Frontal sinus fractures are relatively rare. Their surgical management significantly differs depending on whether the posterior wall is invaded and the clinical features vary. A bicoronal incision or endoscopic approach can be used. However, the minimally invasive approach has been attracting attention, leading us to introduce a simple and effective surgical method using multiple-threaded Kirschner wires.Methods: All patients had isolated anterior wall fractures without nasofrontal duct impairment. The depth from the skin to the posterior wall was measured using computed tomography to prevent injury. The edge of the bone segment on the skin was marked, a threaded Kirschner wire was inserted into the center of the bone segment, and multiple Kirschner wires were gently reduced simultaneously.Results: Surgery was performed on 11 patients. Among them, seven patients required additional support for appropriate fracture reduction. Therefore, a periosteal elevator was used as an adjunct through a small sub-brow incision because the reduction was incomplete with the Kirschner wire alone. The reduction results were confirmed using facial bone computed tomography 1 to 3 days postoperatively. The follow-up period was 3 to 12 months.Conclusion: The patients had no complications and were satisfied with the surgical results. Here we demonstrated an easy and successful procedure to reduce a pure anterior wall frontal sinus fracture via non-invasive threaded Kirschner wire reduction.
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Sert G, Canter HI, Mavili E. Re: Reverse umbrella technique - percutaneous reduction of frontal bone fracture using an intermaxillary fixation screw device. Br J Oral Maxillofac Surg 2021; 59:1324-1325. [PMID: 34275676 DOI: 10.1016/j.bjoms.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- G Sert
- Operating Doctor at Ankara Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 06230, Ankara, Turkey.
| | - H I Canter
- Anadolu Medical Center, Department of Plastic Reconstructive and Aesthetic Surgery, 41400, Gebze, Kocaeli, Turkey.
| | - E Mavili
- Hacettepe University Faculty of Medicine Department of Plastic, Reconstructive and Aesthetic Surgery, 06230, Ankara, Turkey.
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Bande CR, Goel M, Dombre SS, Kurawar K, Maheshkar A. Utility of esthetic eyebrow incision in the management of anterior table fracture of frontal bone: our experience. Oral Maxillofac Surg 2021; 25:257-262. [PMID: 33025268 DOI: 10.1007/s10006-020-00910-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The purpose of this study was to provide detailed information about the eyebrow approach for the reduction of the frontal bone and its esthetic results with the help of clinical data available. Thus, suggesting this technique is minimally invasive and highly esthetic for frontal bone management. METHOD In this series, 96 cases were studied, and results were based on variable clinical criteria and satisfaction of patients. All the surgeries were performed through eyebrow incision for the management of fractures. Intraoperatively, minimal tissue dissection, less invasion with reduced operating time was observed. RESULTS Postoperatively, the eyebrow approach leads to its normal contour and esthetics. No complications related to the procedure were seen with partially recoverable neuropraxia and speedy recovery. This makes it an important technique to consider in carefully selected patients. CONCLUSION In craniofacial trauma, frequently involved site is the frontal bone, and its treatment should be completed more esthetically. Eyebrow approach is a good alternative to other surgical approaches, and it is a minimally invasive technique and thus should be practiced for esthetic management of frontal bone fractures.
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Affiliation(s)
- Chandrashekhar R Bande
- Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri, Nagpur, India.
| | - Manu Goel
- Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri, Nagpur, India
| | - Supriya S Dombre
- Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri, Nagpur, India
| | - Krishna Kurawar
- Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri, Nagpur, India
| | - Ashish Maheshkar
- Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri, Nagpur, India
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Buller J, Kreppel M, Maus V, Zirk M, Zöller JE. Risk of frontal sinus anterior table fractures after craniofacial trauma and the role of anatomic variations in frontal sinus size: A retrospective case-control study. J Craniomaxillofac Surg 2019; 47:611-615. [PMID: 30718214 DOI: 10.1016/j.jcms.2019.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/09/2018] [Accepted: 01/11/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Purpose of this study was to evaluate a probable risk of frontal sinus size for traumatic depressed anterior table fractures in patients with similar forehead trauma. METHODS We conducted a retrospective case-control study with a case group of consecutive treated patients with displaced frontal sinus anterior table fractures. The control group was randomly sampled from patients who presented with a blunt forehead trauma in our institution's emergency unit. In computed tomography data sets, all patients' frontal sinus size was categorized by Guerram's classification that is defined as aplasia, hypoplasia, medium-size and hyperplasia. Odds for prevalence of the sinus types as well as sinus total width and height were compared between both groups. RESULTS In total, 47 cases and 93 controls were identified. Hyperplasia in the case group had an odds ratio of 46:1 (p < 0.001) compared to the controls. Mean sinus width (73 mm vs. 46 mm; p < 0.001) and sinus height (30 mm vs. 15 mm; p < 0.001) were larger in the case group. CONCLUSION Depressed traumatic fractures of the anterior table are an injury with a high risk specific for enlarged frontal sinus sizes. Anatomy is the predictive factor for this mode of craniofacial trauma.
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Affiliation(s)
- Johannes Buller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Volker Maus
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
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Nguyen D, Hakimi M, Sinha SR, Martin M. Upper Eyelid Approach for the Reconstruction of Isolated Fractures of the Anterior Wall of the Frontal Sinus. J Craniofac Surg 2018; 29:1903-1905. [PMID: 30234709 DOI: 10.1097/scs.0000000000005004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The management of frontal sinus fractures can vary widely depending on involvement of the anterior wall, the posterior wall, and the frontonasal duct. The main morbidity associated with isolated anterior wall fractures is an aesthetic deformity. Treatment includes coronal, endoscopic, and transcutaneous approaches. However, each has reported limitations and associated risks of iatrogenic injuries. In this paper, the authors discuss a novel approach through the upper eyelid crease and examine 4 cases where it is utilized for anterior frontal sinus wall, superior orbital rim, and orbital roof fracture repair.
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Affiliation(s)
- David Nguyen
- Loma Linda University, Loma Linda.,Riverside University Health System, Moreno Valley
| | - Michael Hakimi
- Loma Linda University, Loma Linda.,Riverside University Health System, Moreno Valley
| | | | - Mark Martin
- Loma Linda University, Loma Linda.,Riverside University Health System, Moreno Valley
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The Supratarsal Approach for Correction of Anterior Frontal Bone Fractures. J Craniofac Surg 2018; 29:1906-1909. [DOI: 10.1097/scs.0000000000004984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kim KS, Hwang JH. Aesthetic treatment of frontal sinus fractures and their complications. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.12.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
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Hahn HM, Lee YJ, Park MC, Lee IJ, Kim SM, Park DH. Reduction of Closed Frontal Sinus Fractures through Suprabrow Approach. Arch Craniofac Surg 2017; 18:230-237. [PMID: 29349046 PMCID: PMC5759657 DOI: 10.7181/acfs.2017.18.4.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022] Open
Abstract
Background The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. Methods From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. Results Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. Conclusion The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.
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Affiliation(s)
- Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Jung Lee
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Myong Chul Park
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Il Jae Lee
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sue Min Kim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Dong Ha Park
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
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Kim J, Choi H. A Review of Subbrow Approach in the Management of Non-Complicated Anterior Table Frontal Sinus Fracture. Arch Craniofac Surg 2016; 17:186-189. [PMID: 28913281 PMCID: PMC5556834 DOI: 10.7181/acfs.2016.17.4.186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/11/2022] Open
Abstract
Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are controversial. The subbrow approach enables accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by allowing direct visualization of the fracture. Given the surgical success in reduction and rigid fixation, patient satisfaction, and aesthetic benefits, the transcutaneous approach through a subbrow incision is superior to other reduction techniques used in the management of an anterior table frontal sinus fracture.
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Affiliation(s)
- Jeenam Kim
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Hyungon Choi
- Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea
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Delaney SW. Treatment strategies for frontal sinus anterior table fractures and contour deformities. J Plast Reconstr Aesthet Surg 2016; 69:1037-45. [PMID: 27345471 DOI: 10.1016/j.bjps.2016.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 11/17/2022]
Abstract
Anterior table frontal sinus fractures can result in aesthetically displeasing contour deformities. Acute anterior table frontal sinus fractures that are depressed may be reduced with an open, closed, or endoscope-assisted approach. Delayed contour deformity camouflage can be achieved using bone grafts, titanium meshes, methyl methacrylate, hydroxyapatite cement, and polyether ether ketone implants. The selection of surgical approach to repair a frontal sinus contour deformity depends on the fracture severity, chronicity, complexity, patient comorbidities, and surgeon preference and experience. Advancement in endoscopic technology and expertise has created a paradigm shift toward a less invasive approach to the frontal region, with considerably less morbidity than conventional open techniques.
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Affiliation(s)
- Sean W Delaney
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Suite 204Q, Los Angeles, CA 90033, USA.
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Rai A, Shrivastava A, Khan MM. "Bone Mapping/Sketching" in Management of Anterior Table Frontal Sinus Fracture. J Maxillofac Oral Surg 2016; 16:127-130. [PMID: 28286398 DOI: 10.1007/s12663-016-0917-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this present article was to know the efficacy of bone mapping/sketching in management of anterior table frontal sinus fracture. MATERIAL AND METHODS This prospective clinical study includes 10 patients who reported to department of dentistry, AIIMS Bhopal with anterior table frontal sinus fracture. Sterile plain white paper or a glove cover was used for mapping/sketching. The patients were evaluated for post-operative contour of the fractured frontal sinus defect and any mucocele formation. RESULTS All the 10 patients had no infection or post-operative mucocele formation and all have excellent aesthetic of the anterior table of the frontal sinus. CONCLUSION Bone mapping/sketching should be done in all comminuted fractures of cranio-maxillofacial region.
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Affiliation(s)
- Anshul Rai
- Department of Trauma and Emergency Medicine, AIIMS, Bhopal, MP India
| | | | - Manal M Khan
- Department of Plastic Surgery, AIIMS, Bhopal, MP India
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Subbrow approach as a minimally invasive reduction technique in the management of frontal sinus fractures. Arch Plast Surg 2014; 41:679-85. [PMID: 25396180 PMCID: PMC4228210 DOI: 10.5999/aps.2014.41.6.679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/08/2022] Open
Abstract
Background Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures. Methods Between March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws. Results Contour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed. Conclusions The subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.
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Spinelli G, Lazzeri D, Arcuri F, Agostini T. Closed reduction of the isolated anterior frontal sinus fracture via percutaneous screw placement. Int J Oral Maxillofac Surg 2014; 44:79-82. [PMID: 25448407 DOI: 10.1016/j.ijom.2014.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/16/2014] [Accepted: 09/25/2014] [Indexed: 11/24/2022]
Abstract
Fractures of the frontal sinus are a common maxillofacial trauma and constitute 5-15% of all maxillofacial fractures. Conventional surgical approaches include the coronal flap, direct cutaneous incision, and endoscopic techniques. Minimally invasive techniques have recently been described for the reduction of the isolated anterior frontal sinus fracture via a closed approach. The medical records and radiological findings of all patients who underwent surgical treatment for anterior frontal sinus fractures from January 2009 to December 2013 at the study hospital in Florence, Italy, were reviewed. The final study sample consisted of 15 patients (13 males and two females) with isolated anterior frontal sinus fractures who were treated with closed reduction using percutaneous screws. The mean age was 32.1 years. The skin incisions healed without any visible scarring, and no depressions of the frontal sinuses were evident in the postoperative period. Computed tomography scans performed at 6 months postoperatively showed adequate reduction of the displaced fragments. This closed technique is a good option for displaced isolated fractures of the anterior frontal sinus. However, the technique is not adequate for complex fractures of the frontal sinus.
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Affiliation(s)
- G Spinelli
- CTO-AOUC, "Careggi Hospital", Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital", Florence, Italy
| | - D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
| | - F Arcuri
- CTO-AOUC, "Careggi Hospital", Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital", Florence, Italy.
| | - T Agostini
- CTO-AOUC, "Careggi Hospital", Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital", Florence, Italy
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Guy WM, Brissett AE. Contemporary management of traumatic fractures of the frontal sinus. Otolaryngol Clin North Am 2014; 46:733-48. [PMID: 24138734 DOI: 10.1016/j.otc.2013.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article discusses the classic and contemporary management strategies for treating frontal sinus fractures. The goals of management of frontal sinus fractures are to create a safe sinus by minimizing the likelihood of early and late complications while preserving the function of the sinus and maintaining the cosmetic appearance of the upper face. The assessment and classification of patients with frontal sinus injuries, their management, and the treatment of complications are reviewed.
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Affiliation(s)
- W Marshall Guy
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 6501 Fannin Suite NA 102, Houston, Texas 77030, USA
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20
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Robiony M, Pietra LD, Bertossi D, Albanese M, Fresku A. A simple method for the repair of frontal sinus fracture: the bone mesh pull-up technique. Craniomaxillofac Trauma Reconstr 2014; 7:79-84. [PMID: 24624261 PMCID: PMC3931769 DOI: 10.1055/s-0033-1364201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/22/2013] [Indexed: 10/25/2022] Open
Abstract
Accurate reduction and stable fixation are important in the treatment of frontal sinus fracture. In this article, we introduce a rapid and simple method for the treatment of frontal fractures and restoration of normal forehead contour, named the "bone mesh pull-up technique" (BMPUT). We describe our experience with this technique in frontal trauma cases, with emphasis on the technical aspects and clinical results of this simple method. Postoperative computed tomography scans showed adequate reduction of displaced bone fragments in all cases. Esthetic results were satisfactory and no complications related to this procedure, such as uncontrollable sinus bleeding, infection, and posterior table and brain injuries, were observed. Follow-ups ranged from 1 to 24 months, with an average of 12 months. Contour deformities were effectively restored and cosmetic results were very good. The BMPUT is a safe procedure that can be performed with minimal morbidity and offers, good access, and excellent esthetic results.
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Affiliation(s)
- Massimo Robiony
- Department of Medical and Biological Science, University of Udine, Udine, Italy
| | | | - Dario Bertossi
- Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Massimo Albanese
- Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Arsa Fresku
- Department of Maxillofacial Surgery, University of Udine, Udine, Italy
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21
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Meiklejohn BD, Lynham A, Borgna SC. A simplified approach for the reduction of specific closed anterior table frontal sinus fractures. Br J Oral Maxillofac Surg 2013; 52:81-4. [PMID: 24238874 DOI: 10.1016/j.bjoms.2013.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/19/2013] [Indexed: 11/27/2022]
Abstract
We describe a simplified approach to the management of closed anterior table fractures of the frontal sinus. Forty-seven patients were diagnosed with this type of fracture during a 3-year period. Of these, 6 had minimally-invasive periosteal raising of the anterior table through a small perieyebrow skin incision, and access to the fracture was through a small trephine or the edge of the fracture itself. We compared this with the more traditional approach of a coronal flap, which was associated with an increased duration of stay in hospital and the potential for neurological complications. Surgical intervention with a minimally-invasive trephine approach provides good cosmesis, minimal blood loss, intact neurological function, and rapid recovery. This makes it an important technique to consider in carefully selected patients.
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Affiliation(s)
- Braden D Meiklejohn
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia.
| | - Anthony Lynham
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia
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Yakirevitch A, Bedrin L, Alon EE, Yoffe T, Wolf M, Yahalom R. Relation between preoperative computed tomographic criteria of injury to the nasofrontal outflow tract and operative findings in fractures of the frontal sinus. Br J Oral Maxillofac Surg 2013; 51:799-802. [PMID: 23810457 DOI: 10.1016/j.bjoms.2013.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 06/01/2013] [Indexed: 11/17/2022]
Abstract
Injury to the nasofrontal outflow tract is important in the treatment of fractures of the frontal sinus. In 2008 preoperative computed tomographic (CT) criteria or signs of such injuries were proposed and stated to be reliable. The aim of this study was to evaluate the validity of these criteria by comparing the radiological evidence with the operative findings. Thirty-nine patients for whom the data from preoperative CT could be compared with operative findings were eligible for the study, all but 4 of whom had at least one indicator of injury to the outflow tract. Patients whose tracts were found to be obstructed at operation had at least 2 preoperative CT signs of obstruction of the tract. If the outflow tract was obstructed all 3 criteria were significantly more likely to be present than if it was intact (p=0.02). Two criteria or fewer did not correlate significantly with obstruction. Fractures were managed by reconstruction (n=18), obliteration (n=11), or cranialisation (n=10). This study is the first to our knowledge to examine the correlation between preoperative CT criteria and operative findings, and there was a significant difference in the number of criteria present depending on whether the outflow tract was intact or injured. Our findings allow for more accurate planning of management of fractures of the frontal sinus.
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Affiliation(s)
- Arkadi Yakirevitch
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
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Abstract
The management of frontal sinus fractures has changed over the past 20 years. Whereas the indications for an invasive procedure had been much broader in the past, it has become more common to treat these fractures conservatively, due to improved imaging modalities, the advent of endoscopic surgical treatment of the nasofrontal outflow tracts, and the improved understanding of frontal sinus physiology. A variety of algorithms have been proposed for the management of frontal sinus fractures; however, we present a simplified treatment algorithm, which uses cranialization, obliteration, reconstruction, observation, and endoscopic sinus surgery.
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Affiliation(s)
- Anthony Echo
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Molendijk J, van der Wal KGH, Koudstaal MJ. Surgical treatment of frontal sinus fractures: the simple percutaneous reduction revised. Int J Oral Maxillofac Surg 2012; 41:1192-4. [PMID: 22832664 DOI: 10.1016/j.ijom.2012.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/14/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
Frontal sinus fractures are common fractures in high-energetic trauma. Different treatments options are available for different types of frontal sinus fractures. A fracture that consists only of the anterior wall is most commonly reduced with the coronal approach. This approach is invasive and produces a large scar on the scalp, which can result in an unfavourable situation in patients with alopecia and in balding men. To avoid this, a percutaneous reduction method can be used to treat patients with simple anterior wall fractures. This approach is less invasive and does not result in a conspicuous scar. The disadvantages of this procedure are the absence of direct vision and less control of the fracture, which can reduce the chances of complete reduction. This paper provides an overview of anterior wall fractures of the frontal sinus and elaborates on the simple percutaneous reduction technique.
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Affiliation(s)
- J Molendijk
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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25
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Doonquah L, Brown P, Mullings W. Management of frontal sinus fractures. Oral Maxillofac Surg Clin North Am 2012; 24:265-74, ix. [PMID: 22386855 DOI: 10.1016/j.coms.2012.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The traditional treatment of frontal sinus fractures is undergoing a review by many clinicians. This review will undoubtedly contribute to the existing controversy surrounding the management of patients with this condition. This article seeks to further the review and suggest the authors' perspective on a more appropriate approach to the care of patients with frontal sinus injuries.
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Affiliation(s)
- Ladi Doonquah
- Department of Surgery, University Hospital of the West Indies, Mona, Jamaica.
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