Forehead crease-An approach to frontal-naso-orbito-ethmoid fractures

Abstract

Introduction: Fractures of frontal bone and naso-orbito -ethmoid region are usually associated with facial trauma. These usually present a frontal depression, csfrhinorrhoea, nasal deformity, diplopia, nasal bleeding with physical signs of midrace injury. In our study we had used this transverse forehead crease as an approach. This has provided good surgical exposure for managing these traumatic injuries. By careful dissection and preserving sensory nerves supplying the forehead and scalp, a cosmetically well accepted scar within the crease and normal forehead sensation could be achieve. Material and Methods: The study was conducted from Aug 2007 to august 2011. During this period patients who presented with isolated faciomaxillary injury involving fronto-naso-orbito-ethmoidwere part of the study. A total of 13 patients with these isolated injuries presented. The age of patients ranged from 23 years to 65 yrs. All patients were male. Surgical procedure: All the patients were explained the details of operative procedure pre operatively and informed consent was taken. Skin incision was given along the transverse crease. Subcutaneous dissection was done, followed by dissection of frontal is muscle along verticalplane splitting the fibres in order to avoid trauma to supratrochlear and supraorbital nerves branches. Dissection was then preceded to periosteum. Subperiosteal dissection was carried to expose Fracture segments. The fracture segments were elevated when depressed and reduced. Fracture segments were fixed with mini plates. Results: The age of patient ranged from 23yrs to 65yrs. All patients were male. Depressed isolated frontal bone fracture were present in two casesand in remaining 11 patients this was associated with nasoethmoid fractures. CSF rhinorhea was present in two of these patients. There was no wound over forehead in 10 of our patient. The follow up ranged from 1 month to 48 months. The was nopermanent loss of sensation or motor anesthesia over forehead. All patients were satisfied with surgical procedure. Keywords: Forehead crease, Frontal, Orbital, Ethmoid, Nasal fractures.