Fractures of the posterior wall of the frontal sinus: non-surgical management and complications

BACKGROUND

treatment of frontal sinus fractures remains controversial. If the posterior wall is fractured and there is cerebrospinal fluid leak, treatment seeks to restore the integrity of the dura and isolate the intracranial contents through the obliteration of the nasofrontal duct and cranialization. Another group supports nonoperative management CSF leakage is produced. The purpose is to avoid complications of meningitis, fistula and late sequelae. The difficulty lies in predicting which patients will develop complications. The aim of this study is to identify complications in patients with posterior wall fracture of the frontal sinus treated nonsurgically.

METHODS

an observational, cross-sectional, retrospective study was conducted with 20 patients with posterior wall fractures of the frontal sinus treated nonsurgically at the Hospital de Traumatología y Ortopedia Lomas Verdes, Service of Maxillofacial Surgery from January 2007 to October 2009.

RESULTS

twenty patients with posterior wall fractures of the frontal sinus were included. There were 17 males and 3 females. Fractures were divided into groups according to their degree of movement and presence of cerebrospinal fluid fistula. Postoperative complications were cerebrospinal fluid fistula and frontal abscess.

CONCLUSIONS

nonsurgical treatment has proven to be an option, although not free from complications, the most common being CSF fistula and abscess. Future comparative studies should be carried out to define therapeutic strategies usibg clinical monitoring and long-term imaging.

[OsiriX, a useful tool for processing tomographic images in patients with facial fracture]

BACKGROUND

OsiriX, a Mac OS X-based open source program, is presented as a useful tool to process tomographic images for diagnosis and preoperative planning in patients with facial fractures.

METHODS

CT scans were performed on 124 patients with facial fractures treated at the Department of Maxillofacial and Reconstructive Surgery of the Hospital de Traumatología y Ortopedia "Lomas Verdes" in Mexico City. Information obtained was recorded in DICOM format in CDs and processed in a Macintosh laptop with OsiriX software, doing multiplanar and 3D reconstructions. Surgical findings were compared to the images obtained by the software.

RESULTS

Of the surgical findings, 96.5% matched with the OsiriX images. Only 3.5% of the OsiriX images were not consistent because of distortion or artifacts in the CT due to firearm projectiles and Erich arch bars near the involved area.

CONCLUSIONS

Based on the results obtained, the authors consider that the OsiriX software is a useful tool for diagnosis and preoperative planning in patients with facial fractures. Furthermore, it prevents the loss of information due to the process of image selection by the radiology staff.

Frozen human epidermal allogeneic cultures promote rapid healing of facial dermabrasion wounds

BACKGROUND

Clinical studies have shown that cultured human epidermal allogenic sheets promote faster reepithelization of skin donor sites and deep partial-thickness wounds.

OBJECTIVE

We describe the results of a controlled, clinical study of facial dermabrasion sites treated with a single application of frozen cultured human allogenic epidermal sheets that were thawed for 5-10 minutes at room temperature before application.

METHODS

Ten patients with scars from acne or of other etiology underwent facial dermabrasion. One side of the face was treated with the frozen and thawed cultures, the other side was treated with standard dry dressing.

RESULTS

The epidermal cultures promoted faster reepithelization of the wounds, with complete reepithelization in an average time of 4.6 days, whereas controls healed in an average of 7. 9 days. The reduction in healing time was 42% (P = 4.82 x 10(-7)). Pain was reduced in sites treated with the thawed cultures.

CONCLUSION

Epidermal allogenic cultures, preserved by freezing, promoted significantly faster reepithelization and reduced pain intensity of dermabraded facial wounds, suggesting that they could be used routinely to improve the recovery from dermabrasion.