The perimeter marking technique for rigid fixation of frontal sinus fractures: Procedure and report of cases

Abstract

Purpose : Fractures of the frontal sinus region frequently need operative intervention in the form of reconstruction and obliteration. This requires removing the anterior table of the frontal sinus to gain access to the floor as well as the entire lateral extent of the sinus. Prior techniques to obtain this access have involved fabrication of preoperative radiographic templates. This article describes a technique of perimeter marking for delineating the precise location of the frontal sinus perimeter without the use of a radiographic template. Methods: A 7-cm bayonet forceps is used for the perimeter marking. One prong is placed inside the sinus to the maximum peripheral extent and the corresponding prong then reflects its position on the external surface of the outer table. A no. 701 bur in a high-speed drill marks the perimeter adjacent to the bayonet forceps. After sinus marking is complete, the osteotomy is accomplished using either a drill or oscillating saw. Results: Because the exact perimeter of the proposed osteoplastic flap is known prior to the osteotomy, bone plates can be preinserted, removed, and then replaced at the end of the procedure to anatomically reconstruct the frontal contour. Additionally, it is possible to remove a large region of the anterior table during the osteoplasty in one segment. Conclusion: This technique creates an unobstructed view of the lateral recesses of the frontal sinus and makes esthetic reconstruction of the frontal bar region possible.