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Carraturo E, Germano C, Troise S, Spinelli R, Romano A, Giudice GL, Vaira LA, Piombino P. In house 3-D printed surgical Guide for frontal sinus osteotomy in traumatology: a technical note. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102023. [PMID: 39187038 DOI: 10.1016/j.jormas.2024.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/17/2024] [Accepted: 08/24/2024] [Indexed: 08/28/2024]
Abstract
Frontal sinus surgery and particularly frontal sinus osteotomy represent historically a procedure demanding precision and careful planning. Achieving optimal results while minimizing complications requires meticulous preoperative planning and execution. Cutting guides are crucial tools in surgical procedures, particularly in complex osteotomies like could be those involving the frontal sinus. The aim of the study is to show the worflow for the in-house custom made cutting guide for secure and accurated frontal sinus approach. Given the simplicity, efficacy, rapidity, and safety of the procedure, the workflow for programming the cutting guide can be considered valid for all surgical procedures that contemplate performing an osteotomy on the anterior wall of the frontal sinus, such as trauma pathology, inflammatory naso-sinus pathology, benign or malignant neoplastic pathology, and craniofacial malformation pathology.
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Affiliation(s)
- Emanuele Carraturo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy.
| | - Cristiana Germano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy
| | - Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy
| | - Raffaele Spinelli
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy
| | - Antonio Romano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy
| | - Giorgio Lo Giudice
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy; Maxillofacial Surgery Unit, Caserta Hospital "Sant'Anna e San Sebastiano", Via Palasciano, 81100 Caserta, Italy
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Vahidi N, Kwak P, Sismanis D, Schuman T, Hawkins D, Lee TS. Management of Complications and Secondary Deformity After Fractures of the Midface, Orbit, and Upper Third of the Maxillofacial Skeleton. Otolaryngol Clin North Am 2023; 56:1151-1167. [PMID: 37442663 DOI: 10.1016/j.otc.2023.05.011] [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] [Indexed: 07/15/2023]
Abstract
Craniomaxillofacial trauma is a challenging entity to manage effectively and often necessitates serial evaluation and treatment. A multidisciplinary team is best served to evaluate and treat these complex injury patterns with the use of necessary adjuncts, such as neuronavigation, intraoperative imaging, custom implant use, and virtual surgical planning. Complications of facial trauma can present at a spectrum of time points and manifest in a variety of manners and as such patients should be observed closely and longitudinally. Although not all complications and secondary deformities can be avoided, this article highlights some common pitfalls and our unique management strategies.
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Affiliation(s)
- Nima Vahidi
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Peter Kwak
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Dimitrios Sismanis
- Oculoplastic Surgery, Virginia Oculofacial Surgeons, 1630 WIlkes Ridges Parkway Suite 102, Richmond, VA 23233, USA
| | - Theodore Schuman
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Daniel Hawkins
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, School of Dentistry, Dental Building 1, 521 North 11th Street, Richmond, VA 23298-0566, USA
| | - Thomas S Lee
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA.
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Srinivasa R, Furtado SV, Sansgiri T, Vala K. Management of Frontal Bone Fracture in a Tertiary Neurosurgical Care Center—A Retrospective Study. J Neurosci Rural Pract 2022; 13:60-66. [PMID: 35110921 PMCID: PMC8803529 DOI: 10.1055/s-0041-1740615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Abstract
Aim We present our experience in the management of frontal bone fractures using the previously described radiologic classification of frontal bone fractures.
Methodology A retrospective study was conducted, which reviewed the medical records and computed tomographic (CT) scan images of patients with frontal bone fracture from January 2016 to February 2019. Patients with complete medical records and a follow-up of minimum 1 year were included in the study. Demographic details, mechanism of injury, associated intracranial injuries, maxillofacial fractures, management, and complications were analyzed. CT scan images were used to classify the frontal bone fractures using the novel classification given by Garg et al (2014). The indications for surgical treatment were inner table frontal sinus fracture with cerebrospinal fluid (CSF) leak, intracranial hematoma with significant mass effect requiring surgical evacuation, and outer table comminuted fracture that is either causing nasofrontal duct obstruction or for cosmetic purpose.
Results A total of 55 patients were included in the study. Road traffic accidents as the commonest cause of frontal bone fractures. The most common fracture pattern was type 1 followed by type 5 and depth B followed by depth A. Four patients presented with CSF rhinorrhea. CSF rhinorrhea was more frequent with fracture extension to the skull base (depth B, C, D), which was statistically significant (p < 0.001).
Conclusion Frontal bone fracture management has to be tailor-made for each patient based on the extent of the fracture, presence of CSF leak, and associated intracranial and maxillofacial injuries.
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Affiliation(s)
- Rakshith Srinivasa
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Sunil V. Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Tanvy Sansgiri
- Department of Oral and Maxillo-facial Surgery, MS Ramaiah Dental College and Hospital, Bangalore, Karnataka, India
| | - Kuldeep Vala
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
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Becelli R, Palmieri M, Facchini V, Armocida D, Pesce A, Kapitonov A, Zappalà M, Colangeli W, Bozza F, Salvati M, Santoro A, Frati A. Management of frontal sinus fractures: A comprehensive review and treatment algorithm from Sapienza university of Rome. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Podolsky DJ, Moe KS. Frontal Sinus Fractures. Semin Plast Surg 2021; 35:274-283. [PMID: 34819810 DOI: 10.1055/s-0041-1736325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Management of frontal sinus fractures is controversial with no universally accepted treatment protocol. Goals of management are to correct aesthetic deformity, preserve sinus function when it is deemed salvageable, prevent sequela related to the injury, and minimize complications associated with intervention. Studies suggest that frontal sinus injuries, including disruption of the nasofrontal outflow tract (NFOT), can be managed nonoperatively in many cases. Advances in the utilization of endoscopic techniques have led to an evolution in management that reduces the need for open procedures, which have increased morbidity compared with endoscopic approaches. We employ a minimally disruptive protocol that treats the majority of fractures nonoperatively with serial clinical and radiographic examinations to assess for sinus aeration. Surgical intervention is reserved for the most severely displaced and comminuted posterior table fractures and unsalvageable NFOTs utilizing endoscopic approaches whenever possible.
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Affiliation(s)
- Dale J Podolsky
- Department of Plastic Surgery, University of Washington, Seattle, Washington
| | - Kris S Moe
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, Washington
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Kim TG, Sin EG. A Case of Penetrating Brain Injury Followed by Delayed Cerebrospinal Fluid Leakage. Korean J Neurotrauma 2021; 17:168-173. [PMID: 34760829 PMCID: PMC8558028 DOI: 10.13004/kjnt.2021.17.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
Although penetrating brain injury is rare, it is associated with high morbidity and mortality. In several studies, even if very few patients arrive at the hospital alive, half of them eventually die, and the other half have significant neurological sequelae. Cerebrospinal fluid (CSF) leakage caused by traumatic brain injury is common. Therefore, we should be aware of the complications, prognosis, and follow-up strategies of penetrating brain injuries. A 55-year-old man was brought to our hospital with diffuse cerebral contusion and skull fracture. Three weeks after successful surgery, the patient returned with a large amount of pneumocephalus and pneumoventricle caused by delayed CSF leakage. Fortunately, the patient was discharged without neurological deficits after reoperation. In the urgent situation of penetrating brain injury, the treatment and prognosis vary depending on the initial actions and clinical factors. In addition, we should be aware that a variety of complications, as well as CSF leakage, can occur in patients with penetrating brain injuries.
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Affiliation(s)
- Tae Geon Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Eui Gyu Sin
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
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A Review of Frontal Orbital and Frontal Sinus Fractures and Associated Ocular Injuries - Level I Trauma Center - University Hospital Experience. J Craniofac Surg 2021; 32:1615-1618. [PMID: 33741886 DOI: 10.1097/scs.0000000000007422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Traumatic frontal fractures result from high force injuries and can result in significant morbidity and mortality. The purpose of the current study is to evaluate our Montreal General Hospital (MGH) experience with frontal bone fractures. METHODS A comprehensive review of our trauma database was performed. All adult patients (>18 years) presenting with a diagnosis of frontal sinus fracture were identified. A thorough retrospective electronic medical records search was performed and relevant data extracted. Specifically, all cases of ocular injury or sequelae were identified and an in-depth review was performed. RESULTS Between 2008 and 2014, 10,189 trauma patients presented to the MUHC Level 1 trauma center. A total of 1277 patients presented with a facial fracture and 140 had a frontal sinus fracture. The mean age was 43.5 years, 90% were male and the mean hospitalization time was 16.2 days. A significant proportion of patients suffered concomitant craniomaxillofacial fractures including orbital (79%), maxillary (66%), nasal (64%), zygomaticomaxillary complex (34%), nasoorbitoethmoid (31%), Lefort types I-III (18%), and mandibular (8%). Associated cervical spine injuries were documented in 16% of patients. Ocular injuries were present in 30% of subjects. 26% of patients had some form of permanent sequelae from their trauma, mainly neurological. CONCLUSIONS Due to the intimate association of the frontal bones with the brain and the orbits, frontal sinus fractures demand a sophisticated multidisciplinary craniofacial surgical approach. Given the high rate of ocular injury of 30% as well as severe systemic injuries, the authors propose a modified treatment algorithm for these complex cases.
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Frontal Sinus Fractures: A Review on Etiology and Management Emphasizing Minimally Invasive and Endoscopic Techniques. J Craniofac Surg 2021; 32:1246-1250. [PMID: 33770048 DOI: 10.1097/scs.0000000000007623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In spite of a long and tortuous history of the acute management of frontal sinus fractures, current optimal management remains steeped in controversy. These fractures are frequently produced by excessive forces and are often accompanied with other injuries. However, disruption of the nasofrontal duct persists as essential to maintain proper sinus function and should guide current management. Although there has never been any distinct procedure defining optimal outcomes, proper treatment is contingent on precise diagnosis culled from a complete history, physical examination, and imaging studies. This is further augmented by the surgeon's intraoperative findings. Reconstruction will ultimately rest on the degree of disruption of the anterior and posterior sinus walls, as well as the status and function of the nasofrontal ducts. For these reasons, current management continues to be challenging and evolving. Thus, this review will discuss the etiology and clinical presentation of frontal sinus fractures, the current complications arising in the subject, and the evolution of treatment options towards a more conservative and endoscopic approach to care.
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Repair of frontal sinus fractures: clinical and radiological long-term outcomes. The Journal of Laryngology & Otology 2021; 135:448-451. [PMID: 33879274 DOI: 10.1017/s0022215121001006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed. METHODS A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included. RESULTS Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6-132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration. CONCLUSION Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.
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Unilateral Cranialization as an Approach for Posterior Table Frontal Sinus Fractures. J Craniofac Surg 2020; 31:794-795. [PMID: 31934977 DOI: 10.1097/scs.0000000000006165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Management of posterior table fractures has seen a conservative shift in recent years. Patients who present with CSF leak may be safely monitored, while cranialization is reserved for patients with severe comminuted or displaced posterior table fractures. We report the case of a 20-year-old patient with a comminuted, displaced posterior table fracture that was missing a central segment and was associated with dural injury. The septum and contralateral sinus were unaffected, thus warranting unilateral cranialization. This is a reported case of hemicranialization, which falls on the spectrum of a conservative approach. At 12 months post-op, the patient has not experienced any complications historically associated with cranialization including persistent CSF leak, meningitis, wound infection, alopecia or facial nerve injury at the site of surgery.
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Bicsák Á, Abel D, Tack L, Smponias V, Hassfeld S, Bonitz L. Complications after osteosynthesis of craniofacial fractures-an analysis from the years 2015-2017. Oral Maxillofac Surg 2020; 25:199-206. [PMID: 32885304 DOI: 10.1007/s10006-020-00903-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Complications mean a recurring problem in everyday clinical practice. Complication rates between 6 and 13% are described for the treatment of bony injuries to the head and neck area. This paper aims to provide a detailed analysis of the complications after osteosynthesis in facial skull fractures. MATERIAL AND METHOD In this retrospective study, we reviewed all patient records of injured treated in the Department of Cranial and Maxillofacial Surgery at the Dortmund General Hospital between 2015 and 2017. RESULTS Of the 22,031 head and neck injuries, 685 were treated with osteosynthesis. A clinically significant complication was reported in 32 patients (4.76%). The number of total complications was 63. In total, 66.7% of all complications have been identified in the paramedian mandible (44%), median mandible, mandibular angle, and in the collar area (each 12.7%). Eleven implants (in 5 patients) showed a cancellous bone impaction. Broken implants have been recognized in two cases. In 8 cases, there was a pseudarthrosis in the fracture area; in one case, there was a broken implant and pseudarthrosis in combination. CONCLUSION Osteosynthesis is a safe method of treating facial skull fractures, which is why we consider it the gold standard of therapy. The complication rate is well below 5%. The 3-dimensional adaptation (bending) and shortening of the osteosynthesis implants do not lead to an increase in complications.
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Affiliation(s)
- Ákos Bicsák
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany.
| | - Dietmar Abel
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Laurence Tack
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Velissarios Smponias
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Stefan Hassfeld
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Lars Bonitz
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
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Abstract
Background: Timely, expeditious and appropriate management of Frontal bone fractures and associated Frontal Sinus (FS) injuries are both crucial as well as challenging. Treatment options vary considerably, depending upon the nature, extent and severity of these injuries as well as operator skill, expertise and experience. In cases of posterior table fractures of the Frontal Sinus, literature reports have in general, propounded direct visualization and exploration of the sinus via a bifrontal craniotomy, followed by sinus cranialization. Aims and Objectives: To review the standard protocols of management of Frontal bone fractures and Frontal Sinus injuries. To assess the efficacy of a more conservative approach in the management of outer and inner table fractures of the FS. Materials and Methods: Contemporary and evolving management protocols and changing treatment paradigms of different types and severities of frontal bone fractures and frontal sinus injuries, have been presented in this case series. A useful Treatment Algorithm has been proposed to efficiently and effectively manage these injuries. Results: In the present case series, effective and satisfactory results could be achieved in cases of significantly displaced inner and outer table fractures of the Frontal sinus by a more conservative protocol comprising of open reduction and internal fixation carried out via the existing scar of injury, without having to resort to the more radical intracranial approach and sinus cranialization. Nevertheless, presence of complicating factors such as cerebrospinal fluid rhinorrhea, evidence of meningitis or the development of encephalomeningocoeles necessitated the standard protocol of sinus exploration and its cranialization or obliteration. Conclusion: Management protocols of Frontal Sinus injuries vary, based on aspects such as the timing of presentation and intervention, degree of injury sustained, concomitant associated Craniomaxillofacial injuries present, presence of complicating factors or Secondary/Residual deformities & Functional debility, and need to be decided upon on a case to case basis.
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Affiliation(s)
- Priya Jeyaraj
- Commanding Officer Military Dental Centre (Gough Lines), Secunderabad, Telangana, India
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Kim IA, Boahene KD, Byrne PJ. Trauma in Facial Plastic Surgery: Frontal Sinus Fractures. Facial Plast Surg Clin North Am 2018; 25:503-511. [PMID: 28941504 DOI: 10.1016/j.fsc.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The optimal management of frontal sinus fractures remains controversial. Fortunately, the severity of these injuries has diminished with more stringent auto-safety regulations, changing the treatment paradigms used to repair these injuries. Appropriate patient selection and close follow-up may allow for conservative management strategies when dealing with frontal sinus fractures, largely replacing the more morbid and invasive techniques that have been the mainstay for years. Because acute and delayed sequelae can arise after the initial injury, patients should be thoroughly counseled about the importance of follow-up and the need to seek medical care if they develop any concerning signs or symptoms.
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Affiliation(s)
- Irene A Kim
- Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street 6th Floor, Baltimore, MD 21287-0910, USA.
| | - Kofi D Boahene
- Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street 6th Floor, Baltimore, MD 21287-0910, USA
| | - Patrick J Byrne
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Greater Baltimore Cleft Lip and Palate Team, Johns Hopkins University School of Medicine, 6701 N Charles Street, Baltimore, MD 21204, USA; Department of Dermatology, Johns Hopkins University School of Medicine, 601 North Caroline Street 6th Floor, Baltimore, MD 21287-0910, USA
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Contralateral Orbital Mucocele as a Complication of Unilateral Nasal Polyposis. SINUSITIS 2016. [DOI: 10.3390/sinusitis1010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kim YW, Lee DH, Cheon YW. Secondary Reconstruction of Frontal Sinus Fracture. Arch Craniofac Surg 2016; 17:103-110. [PMID: 28913266 PMCID: PMC5556797 DOI: 10.7181/acfs.2016.17.3.103] [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: 04/03/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/11/2022] Open
Abstract
Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.
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Affiliation(s)
- Yang Woo Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hun Lee
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Woo Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
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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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17
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Jafari A, Nuyen BA, Salinas CR, Smith AM, DeConde AS. Spontaneous ventilation of the frontal sinus after fractures involving the frontal recess. Am J Otolaryngol 2015; 36:837-42. [PMID: 26232884 DOI: 10.1016/j.amjoto.2015.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/28/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Frontal sinus fractures (FSF) have potentially catastrophic consequences due to frontal recess (FR) obstruction and proximity to the brain and orbit. Lack of follow-up and ability to predict which type of fractures predispose to complications has biased surgeons toward definitive interventions such as sinus obliteration and cranialization. These procedures carry inherent risk and may be unnecessary in a subset of patients. This study seeks to better characterize spontaneous ventilation in subjects with FSFs, including those involving the FR. MATERIALS AND METHODS Review of a prospectively maintained trauma database between 2009 and 2013 at a level 1 trauma center. Patients with frontal sinus fractures with follow-up imaging (>6 weeks) available were included. The medical records and imaging were reviewed for evidence of spontaneous ventilation of the frontal sinus. RESULTS Nineteen patients sustained frontal sinus fractures in the study period with mean imaging interval of 67.4 weeks (range, 6-188.4 weeks). Injury mechanisms included fall (32%), assault (31%), motor vehicle accident (17%), pedestrian-versus-automobile (12%), and gunshot wound (8%). 8/19 patients (42%) sustained FSFs involving the FR and 7/8 (87.5%) spontaneously ventilated by time of interval imaging. The one patient with persistent radiographic sinus opacification was associated with a naso orbital ethmoid and medial orbital blowout fracture. 6/19 patients (32%) sustained FSF sparing the FR, and all spontaneously ventilated by the time of interval imaging. 5/19 patients (26%) underwent surgical intervention. CONCLUSIONS An expectant, sinus-preserving approach to acute FSFs involving the FR is safe and effective. Etiology of re-ventilation failure may be due to tissue obstruction, rather than the frontal recess fracture itself.
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Affiliation(s)
- Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Brian A Nuyen
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Courtni R Salinas
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alan M Smith
- Department of Surgery, Division of Trauma, University of California San Diego, La Jolla, CA, USA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA.
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Preservation of frontal sinus anatomy and outflow tract following frontal trauma with dural defect. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e300. [PMID: 25750839 PMCID: PMC4350306 DOI: 10.1097/gox.0000000000000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/16/2014] [Indexed: 11/26/2022]
Abstract
Our case report describes a young male mechanic who was hit in his face by a spring while repairing a car, resulting in traumatic injury to the frontal sinus, with fractures of both the anterior and the posterior tables with dural defect and cerebrospinal fluid leak. Current guidelines recommend that comminuted and/or displaced fractures of the posterior table of the frontal sinus with dural defects should be either cranialized or obliterated. In this patient, instead of cranializing or obliterating the frontal sinus, we managed to preserve the frontal sinus anatomy and its outflow tract using a combined open bicoronal and nasoendoscopic approach. This avoids the long-term complications associated with cranialization or obliteration including mucocele formation and frontocutaneous fistula.
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Kellman R, Goyal P. Managing the frontal sinus in the endoscopic age: has the endoscope changed the algorithm? Craniomaxillofac Trauma Reconstr 2014; 7:203-12. [PMID: 25136409 DOI: 10.1055/s-0034-1371773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 05/27/2013] [Indexed: 10/25/2022] Open
Abstract
Management of fractures involving the frontal sinus seems to be more complex than merely obtaining an ideal reduction of the bony injuries. Multiple articles on the management of these fractures suggest that a great deal of controversy persists despite many years of surgical experience. The question posed in this article is whether or not the advent of endoscopic approaches has changed or should change the approaches/algorithms used in the management of these challenging fractures. It is the conclusion of these authors that endoscopic techniques can indeed allow us to change the algorithm for management of frontal sinus trauma. New algorithms are proposed that should provide guidance to craniomaxillofacial surgeons treating these injuries in the endoscopic age.
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Affiliation(s)
- Robert Kellman
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York
| | - Parul Goyal
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York
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Agrawal A, Singh SP. Use of autologous comminuted calvarial fragments and pedicled pericranial graft for single stage repair of frontal and cranial base injury. INDIAN JOURNAL OF NEUROTRAUMA 2013. [DOI: 10.1016/j.ijnt.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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