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8/9/2019 Frontal Sinus Fx Slides 070117
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Frontal Sinus FracturesFrontal Sinus Fractures
Jeffrey Buyten, MDJeffrey Buyten, MD
Matthew Ryan, MDMatthew Ryan, MD
University of Texas Medical Branch
Department of OtolaryngologyJanuary 17, 2006
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OutlineOutline
EtiologyEtiology
Associated injuriesAssociated injuries
ManagementManagement Fixation methodsFixation methods
Sinus obliterationSinus obliteration
CranializationCranialization
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Frontal Sinus Anatomy FactsFrontal Sinus Anatomy Facts
Absent @ birthAbsent @ birth
Radiographically evident @ 8 yearsRadiographically evident @ 8 years
Adult size by 15 yrsAdult size by 15 yrs 15% with unilateral sinus15% with unilateral sinus
4% with no sinus4% with no sinus
Anterior table 2Anterior table 2--12 mm thick12 mm thick Posterior table 0.1 to 4.8 mm thickPosterior table 0.1 to 4.8 mm thick
Strong,EB et al. Frontal sinus fractures: A 28Strong,EB et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and Neck Surgery (2006) 135, 774Head and Neck Surgery (2006) 135, 774--779779
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Demographics/EtiologyDemographics/Etiology
55 -- 12% of facial fractures12% of facial fractures
30 year old males30 year old males
800800 1600 ft lb to fracture1600 ft lb to fracture
Strong,EB et al. Frontal sinus fractures: A 28Strong,EB et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and Neck Surgery (2006) 135, 774Head and Neck Surgery (2006) 135, 774--779779
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Demographics/EtiologyDemographics/Etiology
High velocity impactsHigh velocity impacts MVA 71% to 52%MVA 71% to 52%
19741974--86 to 198786 to 1987--0202
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Demographics/EtiologyDemographics/Etiology
MVA
Assault
Recreational
Accidents
Industrial
Accidents
52%52%
26%26%
9%9%5%5%
Strong,EB et al. Frontal sinus fractures: A 28Strong,EB et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and Neck Surgery (2006) 135, 774Head and Neck Surgery (2006) 135, 774--779779
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Soccer
Rugby
Extreme sports
Martial Arts
Other
Sports InjuriesSports Injuries
Maladiere et al. Aetiology and Incidence of Facial Fractures Sustained During Sports: A Prospective Study of 140 Patients. InMaladiere et al. Aetiology and Incidence of Facial Fractures Sustained During Sports: A Prospective Study of 140 Patients. Int Jt J OralOralMaxillofac Surg, 2001: 30; 291Maxillofac Surg, 2001: 30; 291--295.295.
34%34%
25 %
15%
6%
20%
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FractureDistributionFractureDistribution
AnteriorAnterior PosteriorPosterior Ant/PostAnt/Post Frontal recessFrontal recess TotalTotal
Wallis et alWallis et al19741974--19861986 13 (18%)13 (18%) 2 (3%)2 (3%) 55 (79%)55 (79%) 22 7070
Strong et alStrong et al19871987--20022002 35 (28%)35 (28%) 4 (3%)4 (3%) 88 (69%)88 (69%) 33 127127
Gossman et alGossman et al 19901990--20032003 48 (50%)48 (50%) 00 48 (50%)48 (50%) n/an/a 9696
Chen et alChen et al 19941994--20022002 22 (28%)22 (28%) 00 56 (72%)56 (72%) n/an/a 7878
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Associated injuriesAssociated injuries
Loss of consciousnessLoss of consciousness 72%72%
Obtunded/intubatedObtunded/intubated 21%21%
Intracranial injuriesIntracranial injuries
Pneumocephalus 26%Pneumocephalus 26%
Cerebral contusion 18%Cerebral contusion 18%
Dural tear 14%Dural tear 14%
CSF leak 11%CSF leak 11%
5% with persistent CSF leaks5% with persistent CSF leaks
Epidural hematoma 8%Epidural hematoma 8%
Strong,EB et al. Frontal sinus fractures: A 28Strong,EB et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and Neck Surgery (2006) 135, 774Head and Neck Surgery (2006) 135, 774--779779
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Taiwan dataTaiwan data
Other Facial FracturesOther Facial Fractures Multiple facial fractures in 75% of pts.Multiple facial fractures in 75% of pts.
Pediatric frontal sinus fracturesPediatric frontal sinus fractures
100% with concomitant orbital fractures100% with concomitant orbital fractures
California dataCalifornia data
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ComplicationsComplications
Major complications 5%Major complications 5%
MeningitisMeningitis
MucoceleMucocele Minor complications 8%Minor complications 8%
Wound infections, frontal paresthesias, temporalWound infections, frontal paresthesias, temporalnerve paresis, frontal bone irregularities, diplopia onnerve paresis, frontal bone irregularities, diplopia on
upward gazeupward gaze
Strong,E
B et al. Frontal sinus fractures: A 28Strong,E
B et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and Neck Surgery (2006) 135, 774Head and Neck Surgery (2006) 135, 774--779779
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CSF leakCSF leak
1212--30% basilar skull fx30% basilar skull fx
Spontaneous resolution 24Spontaneous resolution 24--48 hrs48 hrs
Temporal bone > Ant cranial fossaTemporal bone > Ant cranial fossa SxsSxs
Postural headachePostural headache
Bacterial meningitisBacterial meningitis 77--30%30%
Friedman, JA et al. Persistent Posttraumatic Cerebrospinal Fluid Leakage. Neurosurg Focus. 2000 (9), 1Friedman, JA et al. Persistent Posttraumatic Cerebrospinal Fluid Leakage. Neurosurg Focus. 2000 (9), 1--5.5.
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ManagementManagement
Weigh intervention risks in critical patientsWeigh intervention risks in critical patients
PE, CT scanPE, CT scan
Primary goalPrimary goal Protect brain from further injuryProtect brain from further injury
Secondary goalsSecondary goals
+/+/-- Sinus functionSinus function CosmeticCosmetic
Anterior, Posterior, Nasofrontal duct, CSF leakAnterior, Posterior, Nasofrontal duct, CSF leak
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Anterior TableManagementAnterior TableManagement
NonNon--displaceddisplaced
ObservationObservation
DisplacedDisplaced ORIF (coronal, midORIF (coronal, mid--brow approach)brow approach)
Endoscopic vs openEndoscopic vs open
Comminuted fracturesComminuted fractures ORIF (mesh vs miniplates)ORIF (mesh vs miniplates)
Ensure no mucosa trapped between fragmentsEnsure no mucosa trapped between fragments
Rice, DH. Management of Frontal Sinus Fractures. Curr Opin Otolaryngol Head Neck Surg. Curr Opin Otolaryngol Head Neck SurgRice, DH. Management of Frontal Sinus Fractures. Curr Opin Otolaryngol Head Neck Surg. Curr Opin Otolaryngol Head Neck Surg12:4612:4648. 2004 Lippincott Williams & Wilkins.48. 2004 Lippincott Williams & Wilkins.
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Posterior TableManagementManagement
Separate nasal cavity/sinus from intracranialSeparate nasal cavity/sinus from intracranial
cavitycavity
CSF leakCSF leak No spontaneous resolutionNo spontaneous resolution exploreexplore
Repair dural tearsRepair dural tears
Sinus obliterationSinus obliteration Severely comminutedSeverely comminuted
CranializationCranialization
Rice, DH. Management of Frontal Sinus Fractures. Curr Opin Otolaryngol Head Neck Surg. Curr Opin Otolaryngol Head Neck SurgRice, DH. Management of Frontal Sinus Fractures. Curr Opin Otolaryngol Head Neck Surg. Curr Opin Otolaryngol Head Neck Surg12:4612:4648. 2004 Lippincott Williams & Wilkins.48. 2004 Lippincott Williams & Wilkins.
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Nasofrontal DuctManagementDuctManagement
ObliterationObliteration
Endoscopic Lothrup procedureEndoscopic Lothrup procedure
ObservationObservation Minor injury in a reliable patientMinor injury in a reliable patient
Reimage the patient in 1 to 3 monthsReimage the patient in 1 to 3 months
Rice, DH. Management of Frontal Sinus Fractures. Curr Opin Otolaryngol Head Neck Surg. Curr Opin Otolaryngol Head Neck SurgRice, DH. Management of Frontal Sinus Fractures. Curr Opin Otolaryngol Head Neck Surg. Curr Opin Otolaryngol Head Neck Surg12:4612:4648. 2004 Lippincott Williams & Wilkins.48. 2004 Lippincott Williams & Wilkins.
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Chen et al. Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases. Plast.Chen et al. Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases. Plast.Reconstr. Surg. 118: 457, 2006.Reconstr. Surg. 118: 457, 2006.
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AnteriorAnterior PosteriorPosterior Ant/PostAnt/Post Frontal recessFrontal recess TotalTotal
Gossman et alGossman et al 19901990--20032003 48 (50%)48 (50%) 00 48 (50%)48 (50%) ???? 9696
Observation
ORIF
tent
ranialization
Obliteration
47%
30%
11%
8%
3%
Gossman et Laryngoscope al. Management of Frontal Sinus Fractures: A Review of 96 Cases., 116: 1357Gossman et Laryngoscope al. Management of Frontal Sinus Fractures: A Review of 96 Cases., 116: 1357--136, 2006.136, 2006.
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Anterior Posterior Ant/Post
Chen et al 94-2002 22 00 56
Chen et al. Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases. Plast.Chen et al. Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases. Plast.Reconstr. Surg. 118: 457, 2006.Reconstr. Surg. 118: 457, 2006.
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Strong,E
B et al. Frontal sinus fractures: A 28Strong,E
B et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and Neck Surgery (2006) 135, 774Head and Neck Surgery (2006) 135, 774--779779
AnteriorAnterior PosteriorPosterior Ant/PostAnt/Post Frontal recessFrontal recess TotalTotal
Wallis et alWallis et al19741974--19861986 13 (18%)13 (18%) 2 (3%)2 (3%) 55 (79%)55 (79%) 22 7070
Strong et alStrong et al19871987--20022002 35 (28%)35 (28%) 4 (3%)4 (3%) 88 (69%)88 (69%) 33 127127
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Endoscopic RepairEndoscopic Repair
Allows fixation of favorable ant table fxsAllows fixation of favorable ant table fxs
Opportunity for nasofrontal aperture proceduresOpportunity for nasofrontal aperture procedures
at same setting.at same setting.
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Endoscopic RepairEndoscopic Repair
Fracture reductionFracture reduction
Endoscopic browlift (subperiosteal)Endoscopic browlift (subperiosteal)
30 degree scope w/endosheath30 degree scope w/endosheath Central stab incisionCentral stab incision
Lateral incision to assist with the reductionLateral incision to assist with the reduction
Fracture camouflageFracture camouflage
Old fracturesOld fractures
Alloplastic implant hides defectAlloplastic implant hides defect
Pham, A and Strong, EB. Endoscopic management of facial fractures. Curr Opin Otolaryngol Head Neck Surg 14:234Pham, A and Strong, EB. Endoscopic management of facial fractures. Curr Opin Otolaryngol Head Neck Surg 14:234241. 2006241. 2006
Lippincott Williams & Wilkins.Lippincott Williams & Wilkins.
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FrontalDepressionsFrontalDepressions
Alloplastic fillersAlloplastic fillers
Acrylic implantsAcrylic implants
Commonly usedCommonly used Hydroxyapatite cementHydroxyapatite cement
OsseointegrationOsseointegration
Good biocompatibilityGood biocompatibility
Friedman, C et al. Reconstruction of the Frontal Sinus and Frontofacial Skeleton With Hydroxyapatite Cement. Arch Facial PlasFriedman, C et al. Reconstruction of the Frontal Sinus and Frontofacial Skeleton With Hydroxyapatite Cement. Arch Facial Plastt
Surg.2000;2:124Surg.2000;2:124--129129
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Friedman, C et al. Reconstruction of the Frontal Sinus and Frontofacial Skeleton With Hydroxyapatite Cement. Arch Facial PlasFriedman, C et al. Reconstruction of the Frontal Sinus and Frontofacial Skeleton With Hydroxyapatite Cement. Arch Facial Plastt
Surg.2000;2:124Surg.2000;2:124--129129
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TitaniumMeshTitaniumMesh
Severely Comminuted fxsSeverely Comminuted fxs
Lakhani, Raam S. MD et al. Titanium Mesh Repair of the Severely Comminuted Frontal Sinus Fracture. Arch Otolaryngol Head NecLakhani, Raam S. MD et al. Titanium Mesh Repair of the Severely Comminuted Frontal Sinus Fracture. Arch Otolaryngol Head Neckk
Surg.2001;127:665Surg.2001;127:665--669669
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Closed ReductionClosed Reduction
Case reportCase report
Lost tip of probe in sinusLost tip of probe in sinus
Hwang et al. Closed Reduction of Fractured Anterior Wall of the Frontal bone. Journal of Craniofacial Surgery. 2005 (16); 120Hwang et al. Closed Reduction of Fractured Anterior Wall of the Frontal bone. Journal of Craniofacial Surgery. 2005 (16); 120--12122.2.
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Obliteration HistoryObliteration History
Dates back to 1950s (Bergara)Dates back to 1950s (Bergara)
HypothesisHypothesis
Transplanted fat would remain vascularizedTransplanted fat would remain vascularized NonNon--viable fat would fibroseviable fat would fibrose
Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique andLongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using MagneticicResonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487--91, 2005.91, 2005.
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Obliteration HistoryObliteration History
Goodale and MontgomeryGoodale and Montgomery (late 50s and 60s)(late 50s and 60s) Fat obliterationFat obliteration standard of care for difficult frontal sinusstandard of care for difficult frontal sinus
diseasedisease
No sx recurrence or radiographic recurrence after 5 yearsNo sx recurrence or radiographic recurrence after 5 years
Hardy and Montgomery (1976)Hardy and Montgomery (1976) 250 patients; median follow250 patients; median follow--up 8 yearsup 8 years
Complication rate 18%Complication rate 18% Abdominal woundAbdominal wound -- 5.2%5.2% Acute postoperative infections (necrosis of implanted fat)Acute postoperative infections (necrosis of implanted fat) -- 3%3% Recurrent chronic sinusitisRecurrent chronic sinusitis -- 3%3% 4% of cases had to be revised4% of cases had to be revised No report on the occurrence of mucocelesNo report on the occurrence of mucoceles
Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique andLongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using MagneticicResonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487--91, 2005.91, 2005.
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Obliteration IndicationsObliteration Indications
Mucopyocele, orMucopyocele, or
recurrent acuterecurrent acutesinusitissinusitis
Severe fracturesSevere fractures
Chronic sinusitisChronic sinusitis
TumorTumor
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Obliteration PrinciplesObliteration Principles
Meticulous removal of all visible mucosaMeticulous removal of all visible mucosa Removal of the inner cortexRemoval of the inner cortex Cutting burr for thick bone and a diamond burr for theCutting burr for thick bone and a diamond burr for the
dura and orbital roofdura and orbital roofperiorbitaperiorbita Results do not depend on the choice of microscope orResults do not depend on the choice of microscope orLoupe magnificationLoupe magnification
Permanent occlusion of the nasofrontal ductPermanent occlusion of the nasofrontal duct Material that forms a fibrous barrier between theMaterial that forms a fibrous barrier between the
obliterated sinus and the nasal cavity.obliterated sinus and the nasal cavity. Prevents the implanted material from sliding downward andPrevents the implanted material from sliding downward and
impairs the ingrowth of nasal mucosa.impairs the ingrowth of nasal mucosa.
Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and LongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using Magneticic
Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
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ObliterationMaterialsObliterationMaterials
Adipose tissueAdipose tissue
PericraniumPericranium
HydroxyapatiteHydroxyapatite
Temporalis fasciaTemporalis fascia Bone chipsBone chips
Bio glassBio glass
Polytetrafluoroethylene carbon fiberPolytetrafluoroethylene carbon fiber
Calcium sulfate methylmethacrylateCalcium sulfate methylmethacrylate
Oxidized celluloseOxidized cellulose
GelfoamGelfoam
Lyophilized cartilageLyophilized cartilage
Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487--91, 2005.91, 2005.
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HydroxyapatiteObliterationHydroxyapatiteObliteration
Friedman and Costantino (1991)Friedman and Costantino (1991)
HAC obliteration feline frontal sinuses.HAC obliteration feline frontal sinuses.
30% replacement of the HAC with bone at 1230% replacement of the HAC with bone at 12monthsmonths
63% at 18 months.63% at 18 months.
There was no evidence of mucosal membraneThere was no evidence of mucosal membrane
ingrowth or mucocele formationingrowth or mucocele formation No complications in recent report in humansNo complications in recent report in humans
Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487Fattahi et al. Comparison of 2 Preferred Methods Used for Frontal Sinus Obliteration. J Oral Maxillofac Surg 63; 487--91, 2005.91, 2005.
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Pericranial Flap ObliterationPericranial Flap Obliteration
Vascularized flapVascularized flap
Does not rely on sinus walls for blood supplyDoes not rely on sinus walls for blood supply
Low post op infection rateLow post op infection rate Bulky enough to obliterate frontal sinusBulky enough to obliterate frontal sinus
Axial or random flapAxial or random flap
Axial flapsAxial flapsAnteriorAnterior supraorbital / supratrochlear arteriessupraorbital / supratrochlear arteries
LateralLateral -- anterior division of superficial temporal arteryanterior division of superficial temporal artery
Parhiscar et al. Frontal Sinus Obliteration with the Pericranial Flap. Otolaryngol Head Neck Surg 2001; 124: 304Parhiscar et al. Frontal Sinus Obliteration with the Pericranial Flap. Otolaryngol Head Neck Surg 2001; 124: 304--7.7.
Ducic, Y et al. Frontal Sinus Obliteration Using a Laterally Based Pedicled Pericranial Flap.Laryngoscope 1999; 109 (4), p 5Ducic, Y et al. Frontal Sinus Obliteration Using a Laterally Based Pedicled Pericranial Flap.Laryngoscope 1999; 109 (4), p 54141--55.55.
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Ducic, Y et al. Frontal Sinus Obliteration Using a Laterally Based Pedicled Pericranial Flap. Laryngoscope 1999; 109 (4), p 5Ducic, Y et al. Frontal Sinus Obliteration Using a Laterally Based Pedicled Pericranial Flap. Laryngoscope 1999; 109 (4), p 54141--55.55.
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Fat ObliterationFat Obliteration
Outcome not influenced by degree of survivingOutcome not influenced by degree of surviving
fat.fat.
Post op fat distributionPost op fat distribution < 20%< 20% 53% of cases53% of cases
> 60%> 60% 18% of cases18% of cases
Statistical tests and modelingStatistical tests and modeling
Significant decrease of adipose tissue with timeSignificant decrease of adipose tissue with time
Median halfMedian half--life 15.4 molife 15.4 mo
Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and LongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using Magneticic
Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
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Post op scansPost op scans
CTCT
Soft tissue windowsSoft tissue windows
Low attenuation of fat may be confused with airLow attenuation of fat may be confused with air
Range of normal appearancesRange of normal appearances stages of partialstages of partialfibrosis of the obliterating fat.fibrosis of the obliterating fat.
Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and LongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using Magneticic
Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
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Post op scansPost op scans
MRIMRI FatFat
High signal intensity (T1)High signal intensity (T1)
Intermediate signal (T2)Intermediate signal (T2)
Fibrotic areasFibrotic areas Low to intermediate signal (T1 and T2)Low to intermediate signal (T1 and T2)
Patients with persistent symptoms had no distinguishing MRI featuresPatients with persistent symptoms had no distinguishing MRI featureswhen compared with asymptomatic patients.when compared with asymptomatic patients.
Appearance of mucoceles.Appearance of mucoceles.
Varies according to the protein concentration of the secretionsVaries according to the protein concentration of the secretions T1T1 -- low, intermediate, or high signallow, intermediate, or high signal
T2T2 -- high signal intensityhigh signal intensity
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Fat ObliterationFat Obliteration
CatalanoCatalano 59 patients (1 to 9 years post op)59 patients (1 to 9 years post op) 8.5% needed revision of osteoplastic flap8.5% needed revision of osteoplastic flap
6.7% required correction of frontal bossing6.7% required correction of frontal bossing
LoevnerLoevner 13 patients (1 to 12 years post op)13 patients (1 to 12 years post op) 3 mucoceles3 mucoceles
Weber, DrafWeber, Draf 59 patients (1 to 12 post op)59 patients (1 to 12 post op)
MucocelesMucoceles 5 of 51 cases5 of 51 cases
1, 3, 4, 8 and 10 years1, 3, 4, 8 and 10 years
Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and LongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using Magneticic
Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
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Weber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and LongWeber, R, Draf, W et al. Osteoplastic Frontal Sinus Surgery With Fat Obliteration: Technique and Long--Term Results Using MagnetTerm Results Using Magneticic
Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037Resonance Imaging in 82 Operations. Laryngoscope. 2000. 1037--44.44.
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Pericranial Flap Craniali ationPericranial Flap Craniali ation
Donald and Bernstein (1978)Donald and Bernstein (1978)
First report of cranializationFirst report of cranialization
By convention; frontal sinus left as dead space or filled withBy convention; frontal sinus left as dead space or filled with
free adipose tissue.free adipose tissue. Consider with displacement > one table widthConsider with displacement > one table width
Severely comminuted fxSeverely comminuted fx
Donath et al (2006)Donath et al (2006)
19 patients, no reported complications19 patients, no reported complications
One sphenoid CSF leak post opOne sphenoid CSF leak post op
No post op infectionsNo post op infections
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Donath, A. Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection.Laryngoscope, 116:15851588, 2006
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Donath, A. Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection.Laryngoscope, 116:15851588, 2006
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Donath, A. Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection.Laryngoscope, 116:15851588, 2006
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Donath, A. Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection.Laryngoscope, 116:15851588, 2006
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What would you do?What would you do?
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ReferencesReferences
1.1. Strong, EB et al. Frontal sinus fractures: A 28Strong, EB et al. Frontal sinus fractures: A 28--year retrospective review. Otolaryngologyyear retrospective review. OtolaryngologyHead and NeckHead and NeckSurgery (2006) 135, 774Surgery (2006) 135, 774--779.779.
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