Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures.

Abstract

BACKGROUND:

Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging.

METHODS:

Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded.

RESULTS:

Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%).

CONCLUSIONS:

A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.

• Authors: Justine C Lee, Brian T Andrews, Hamid Abdollahi, Alex G Lambi, Clifford T Pereira, James P Bradley
• Journal: The Journal of craniofacial surgery (J Craniofac Surg) Vol. 26 Issue 1 Pg. e64-7 (Jan 2015) ISSN: 1536-3732 [Electronic] United States
• PMID: 25569422 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Bone Transplantation (adverse effects)
• Cohort Studies
• Dura Mater (injuries)
• Ethmoid Bone (injuries)
• Female
• Follow-Up Studies
• Frontal Sinus (injuries, surgery)
• Hematoma (etiology)
• Humans
• Intraoperative Complications
• Length of Stay
• Male
• Nasal Cavity (injuries)
• Operative Time
• Osteotomy (methods)
• Postoperative Complications
• Skull Fractures (surgery)
• Surgery, Computer-Assisted (methods)
• Tomography, X-Ray Computed (methods)
• Transplant Donor Site (surgery)
• Young Adult