Table Fractures Research Articles

Frontal Sinus Obliteration Utilizing Autogenous Abdominal Fat Graft.

BACKGROUND:Frontal sinus fractures have always been unique because of the controversy surrounding their ideal treatment protocol and the fatal complications that could follow if the wrong treatment opts.AIM:The purpose of this study was to assess clinically and radiographically frontal sinus obliteration technique utilising autogenous abdominal fat graft.PATIENTS AND METHODS:This study was carried out on 20 patients having anterior table fracture of their frontal sinuses indicated for sinus obliteration. All sinuses were obliterated using autogenous abdominal fat graft. Post-operatively, patients were clinically evaluated for any signs or symptoms of intracranial infections, wound dehiscence, sinus affections, or aesthetic deformity. Computerized tomography (CT) radiographic evaluations were carried out immediately and 12 months postoperatively to evaluate any uneventful healing of the graft.RESULTS:Clinical follow-up showed no cerebrospinal fluid leak, no postoperative infection or wound dehiscence in 18 cases. There were two cases however that showed infection. Radiographic follow-up revealed uneventful healing of the abdominal fat grafts with no abnormality detected in the sinus cavity throughout the whole postoperative period.CONCLUSION:Autogenous abdominal fat graft appears to be a successful obliteration material in the frontal sinus cavity and is beneficial in fractures of the anterior table.

Frontal Sinus Morphology: A Reliable Factor for Classification of Frontal Bone Fractures?

The frontal sinus shows a wide range of morphologic variations. The aim of this study was to evaluate the influence of frontal sinus size on fracture characteristics in frontal bone trauma. In this cross-sectional study, data from patients with traumatic fractures of the frontal bone were retrospectively collected from the institution's database.Radiometric analysis of computed tomography and cone-beam computed tomography datasets was performed. Frontal sinus size was measured as variables of height, width, and depth. The secondary predictor was morphologic sinus type according to Guerram's classification: hyperplasia, medium size, hypoplasia, or aplasia of the frontal sinus. To determine outcomes, we classified fractures into the following categories: fracture isolated to the anterior table, combined fractures of the anterior and posterior tables, fracture isolated to the posterior table, and frontal bone fracture without sinus involvement. Further study variables were patients' demographic characteristics, combined midfacial fractures, orbital rim involvement, fracture displacement, and surgical approach. For statistical analysis, fracture types were assessed for frontal sinus metric size and morphologic type using bivariate tests with P<.05 defined as significant. We enrolled 53 consecutive patients with a mean age of 35years; male patients comprised 91%.Fracture types differed significantly in sinus width and height (both P<.001), as well as depth (P=.002). Frontal sinus morphology was hyperplastic in 66%, medium in 30.2%, and hypoplastic in 3.8%. Patients with a hyperplastic frontal sinus had an increased likelihood of isolated anterior table fractures (odds ratio, 6.0; P=.007) compared with medium-sized types.Fractures without sinus involvement were more likely in hypoplastic and medium types (P<.001). The morphology of the frontal sinus determines the probability of fracture types from craniofacial trauma. Thus the frontal sinus size appears to be a major factor for frontal bone resistance to traumatic force impingement.

Outer Table Frontal Bone Fracture: When Need Surgical Intervention?

Frontal bone fracture is a common facial bone fracture which commonly involved the outer table part. Most of the time outer table fracture is treated conservatively. However, when there is involvement of orbital wall fracture, as well as entrapment of extraocular muscle, surgical intervention via open reduction and internal fixation is needed. We described a case of outer table frontal bone fracture with left orbital roof fracture complicated with superior rectus muscle entrapment which was successfully treated via open reduction and internal fixation.International Journal of Human and Health Sciences Vol. 02 No. 03 July’18. Page : 167-169

Fronto-nasal cranioplasty using polymethylmethracylate - case report

Patients who present a background of bone defects seek for harmonic facial contours through surgical rehabilitation. To facilitate the maxillofacial reconstruction, there are two groups of grafts that can be used: the bone and alloplastic materials, such as the polymethyl methacrylate (PMMA), which is one of the alloplastic materials usually used by surgeons in facial rehabilitation. The aim of this study is to present a clinical report about a frontal cranioplasty using PMMA and compare its use with other materials in the literature. A male patient, 35 years old, ASA I, had a motorcycle accident, and a physical examination showed a sinking in the frontal region, deviation of right nasal dorsum and restriction of air passage through the left nostril. At the imaging examination, it was found suggestive signs of naso-orbit-ethmoid fracture and external table fracture in the middle region of the frontal bone. The patient was submitted to a surgical procedure for reconstruction of bone defect and a PMMA graft was used in the frontal bone region. PMMA is usually used because of its ease of adaptation to the bone, reduction of time of the surgery and decrease of blood loss and possibility of infection. PMMA is an attractive alternative for maxillofacial reconstructions.

Management of Frontal Sinus Injuries.

Purpose:The purpose of the present study is to report an overview of fracture patterns and surgical approaches for 15 patients who were treated in our Indhira Gandhi Institute of Dental Sciences, Pondicherry, India from 2010 to 2015.Method and Material:Fifteen people were included in the study, which were diagnosed with anterior table fracture of the frontal sinus and were randomly admitted in our institution. All patients were evaluated preoperatively with axial and coronal computed tomography scans before operating. The parameters used to classify the patients were age, mode of injury, associated injury, and details of fracture, surgical approaches, fixation, and conservative management.Results:Analysis of 15 patients based on parameters showed that the ages of patients varied between 22 and 36 years due to road traffic accident as the common etiology. There were associated fractures in the maxillofacial region seen in 11 patients and the rest were isolated frontal sinus fractures. Conservative management was opted in six patients and for others, surgical approach to the fracture site was done through existing laceration and by bicoronal approach. Three of the cases showed comminuted fracture of anterior and posterior table. The overall contour of the frontal bone was good in all the patients. None of the patients required any immediate reoperation or developed any delayed abscess or mucocele formation.Conclusion:Decision-making regarding the best time to treat, the surgical approach and the technique depends on the severity and the extent of the fracture and associated complications. Our protocol was to follow up and observe the undisplaced fractures and operate anterior wall defects. If there was a fracture involvement of posterior frontal wall, treatment can be planned along with neurosurgical consultation and then operate depending on the associated complications.

Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures.

The purpose of this manuscript is to review the current literature regarding the management of frontal sinus fractures and offer the authors opinion on the current management of these traumatic injuries. We evaluate recently proposed management algorithms as well as novel surgical approaches reported within the last few years. Patient selection for sinus sparing treatment modalities is balanced between fracture severity, involved structures, and reliable patient surveillance. Minimally invasive, aesthetically favorable approaches grow in diversity for anterior table fractures. For fractures of the posterior sinus wall and nasofrontal outflow tract, the literature focuses on sinus sparing surgery, as well as better defining the patients in which obliteration and/or cranialization is appropriate. Lack of large patient cohorts and follow-up limits generalizability of frontal sinus fracture research, and the ability to develop national guidelines of management. Evidence-based literature shows growing support for conservative management and sinus preservation. Improvements in frontal sinus fracture classification schemes, surgical technique, and patient selection direct this treatment paradigm shift.

An alternative to the orthopaedic traction table (fracture table): A prototype of low cost, easy reproduction and good applicability

Abstract&#x0D; Background: Orthopaedic traction tables are used as an aid in numerous surgical procedures. The present paper aims to present a prototype of an external device of lower limb traction, which is portable, of simple construction, and can be installed on any operating table, with possible application in surgical and teaching practices. We will compare the quality of radiographic images obtained with the help of this prototype (PT) to those images obtained with the aid of the conventional traction table (CT).&#x0D; Materials and methods: Cross-sectional, observational, and double blind study, approved by the Research Ethics Committee. On two occasions 36 randomly selected radiographs of the lower limbs, 18 of which obtained on the CT and the remaining on the PT, were evaluated by nine physicians. These radiographs were obtained from three volunteer and none of them presented musculoskeletal system disorders previously diagnosed in the study. Examiners rated each picture from 1 to 5, according to the quality of the image obtained. The responses were submitted to statistical analysis by SPSS ®, v23. Comparisons were considered significant when p &lt;0.05, with a 95% confidence interval.&#x0D; Results: The average ratings were similar and all significance tests between the averages were higher than 0.9. The intra-observer agreement was 76.13% for the PT and 82.69% for the CT. The inter-observer agreement was low for both models. Due to its lower weight and smaller size compared to the CT and the material used for prototyping, the production cost of the PT is quite affordable.&#x0D; Conclusions: The PT presented in this paper is a good alternative to CT.&#x0D; &#x0D; Keywords: Traction table, Fracture table, Orthopaedic surgery, Orthopaedic prototype, Lower limbs.

FRONTAL SINUS OBLITERATION UTILIZING AUTOGENOUS ABDOMINAL FAT GRAFT

Introduction & Purpose: Frontal sinus fractures pose an interesting and challenging problem, as optimal treatment strategies for their management remain controversial. These fractures are peculiar in that a wrong treatment encompasses not only functional or aesthetical problems but also more dangerous complications. Various techniques have been advocated to repair or remove the frontal sinus that depend on the mechanism and extent of the injury and the status of the nasofrontal duct (NFD). Management options include: observation, open reduction and fixation of anterior table, sinus obliteration (with a wide range of materials); and, in more complex situations, sinus cranialization, and endoscopy (not in complex cases but in simple minimally displaced fractures). The purpose of this study was to assess clinically and radiographically frontal sinus obliteration technique utilizing autogenous abdominal fat graft.Patients & Methods: This study was carried out on 10 patients suffering unilateral and/or bilateral anterior table fracture of their frontal sinuses approximating the nasofrontal duct and having intact posterior tables indicated for sinus obliteration, selected from Cranio-Maxillofacial Surgeryl Department, Nasser Institute Hospital. All Patients were treated under general anesthesia and the sinus was approached either through a bicoronal approach or the existing lacerations. All sinuses were obliterated using autogenous abdominal fat graft and the anterior table was reduced and fixed with rigid internal fixation and the associated fractures were managed as required. All patients were clinically evaluated for any signs or symptoms of intracranial infections (brain abscess or meningitis), wound dehiscence, Sinus affections (sinusitis-mucocele- pyomucocele) or aesthetic deformity. Computerized tomography (CT) radiographic evaluations were carried out at immediate and 12 months post operatively to evaluate any uneventful healing of the graft detected by the amount of sinus expansion, thinning or bone erosion and bone occupying lesions or infection.Results: In the current study, motor vehicle accidents were the most common cause and 90% of the included subjects were males with a mean age of 35 years (21-53). In 80% of the studied sample, the frontal sinus fracture was associated with other maxillofacial fractures, other 20% was isolated sinus Fracture. Clinical follow-up showed no neurologic impairment, no cerebrospinal fluid leak, no postoperative infection or wound dehiscence except only one case (10%). Radiographic follow-up revealed that the abdominal fat grafts underwent uneventful healing and no abnormality was detected in the sinus cavity throughout the whole postoperative period. Conclusion: Frontal sinus obliteration using autogenous abdominal fat appears to be successful and useful for patients with anterior table fractures.

Frontal Sinusitis and Nasocutaneous Fistula as Complication of Frontal Sinus Posterior Table Fracture

Frontal Sinusitis and Nasocutaneous Fistula as Complication of Frontal Sinus Posterior Table Fracture

Preservation of Functioning Sinus in Frontal Sinus Posterior Table Fractures

Objective: Sinus preservation after posterior table frontal fractures (PTFF) may be preferable to obliteration/cranialization for minimizing risk of mucocele. This study assessed functional outcomes and complications after open reduction and internal fixation (ORIF) with sinus preservation for PTFF. Study Design: Consecutive case series. Patients and Methods: Patients with PTFF undergoing ORIF with sinus preservation from July 2012 to December 2013 were assessed. Fracture type/extent, presence/extent of dural injury, and cerebrospinal fluid (CSF) leak were recorded. Type of frontal sinusotomy, use of frontal stents, and lumbar drain were recorded. Outcomes evaluated were CSF leak closure, incidence of perioperative meningitis and frontal patency. Results: For two patients with intact dura and no CSF leak, displaced fragments were removed without dural repair. For one patient with CSF leak, a 1 cm dural defect was associated with comminuted PTFF; two-layered closure with underlay Duragen sheet and pericranial flap (PF) was performed. Lumbar drainage was not used. In two patients, Draf 2a frontal sinusotomy was performed with silastic stenting for 3 weeks. Frontal sinuses were aerated with widely patent frontal recess in all cases with no postoperative CSF leak, meningitis or cranial prolapse at mean 14.0 ± 5.0 months. Conclusion: Preservation of frontal sinus is an option for selected PTFF cases. Dural graft plus vascularized PF without a rigid layer may be used for frontal sinus CSF leak repair.

Recurrent Meningitis and Frontal Encephalocele as Delayed Complications of Craniofacial Trauma

Frontal sinus back table fractures are seen rarely; also, typical presentation of frontal sinus encephalocele as a delayed complication of frontal sinus fracture is seen more rarely. We present a case of frontal encephalocele and recurrent meningitis as delayed complications of craniofacial trauma. Diagnosis, management, and treatment approaches of these complications are discussed.

A simplified approach for the reduction of specific closed anterior table frontal sinus fractures

We describe a simplified approach to the management of closed anterior table fractures of the frontal sinus. Forty-seven patients were diagnosed with this type of fracture during a 3-year period. Of these, 6 had minimally-invasive periosteal raising of the anterior table through a small perieyebrow skin incision, and access to the fracture was through a small trephine or the edge of the fracture itself. We compared this with the more traditional approach of a coronal flap, which was associated with an increased duration of stay in hospital and the potential for neurological complications. Surgical intervention with a minimally-invasive trephine approach provides good cosmesis, minimal blood loss, intact neurological function, and rapid recovery. This makes it an important technique to consider in carefully selected patients.

Endoscopic Repair of Isolated Anterior Table Frontal Sinus Fractures Without Fixation

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

A Novel Approach to Frontal Sinus Surgery

Access to the frontal sinus remains a challenging problem for the craniofacial surgeon. A wide array of techniques including minimally invasive endoscopic approaches have been described. Here we present our technique using medical modeling to gain fast and safe access for multiple indications. Computer-aided surgery involves several distinct phases: planning, modeling, surgery, and evaluation. Computer-aided, precise cutting guides are designed preoperatively and allowed to perfectly outline and then cut the anterior table of the frontal sinus at its junction to the surrounding frontal bone. The outcomes are evaluated by postoperative three-dimensional computed tomography scan. Eight patients sustaining frontal sinus fractures were treated with the aid of medical modeling. Three patients (37.5%) had isolated anterior table fractures, and 4 (50%) had combined anterior and posterior table fractures, whereas 1 patient (12.5%) sustained isolated posterior table fractures. Operative times were significantly shorter using the cutting guides, and fracture reduction was more precise. There was no statistically significant difference in complication rates or overall patient satisfaction. The surgical approach to the frontal sinus can be made more efficient, safe, and precise when using computer-aided medical modeling to create customized cutting guides.

Management of Frontal Sinus Fracture

One-third of frontal sinus fractures are isolated to the anterior table. Accurate reduction and stable fixation are important in the treatment of frontal sinus fracture. Traditional approaches to the reduction of an isolated anterior table fracture include the coronal incision, the bilateral brow incision, an endoscopic brow lift with an incision either directly over the fracture or in the brow, and delayed repair with a camouflaging implant. In our experience, autogenous bone graft is considered to be the best grafting material. It has the less short-term or long-term complications, and the donor site morbidity is insignificant. We describe a case involving a 45-year-old man with a depressed anterior table fracture that we successfully treated using an iliac bone graft.

Transnasal Endoscopic Repair of Posterior Table Fractures

Conventional treatment of frontal sinus posterior table fractures has included osteoplastic flap or cranialization procedures despite considerable advances in endoscopic technique and experience. The objective of the current study was to evaluate outcomes of frontal sinus fractures involving the posterior table managed using endoscopic approaches. Prospective cohort. Tertiary care, academic university hospital. Prospective evaluation of patients with posterior table fractures was performed. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of the skull base defect, complications, and clinical follow-up. Thirteen patients (average age 37 years) with posterior table fractures were treated using endoscopic techniques from 2008 to 2012. Mean follow-up time was 68 weeks (range, 2-206 weeks). Patients were primarily managed using Draf IIb frontal sinusotomies with 1 individual requiring a concomitant trephine. A Draf III procedure was performed in 1 patient. Average fracture defect (length vs width) was 13 × 4.5 mm, and average length involving the posterior table was 9.7 mm (1-30 mm). Skull base defects were covered with a septal flap and/or free tissue grafts. Although 1 individual required a revision frontal sinusotomy and follow-up was short in several patients, all sinuses remained patent on last clinical examination. Management of frontal sinus posterior table fractures using minimally invasive endoscopic techniques provides excellent outcomes in selected cases. Fractures of up to 30 mm in length were adequately managed in this series and indicate this approach can be a viable alternative in the treatment of these fractures.

A 10-Year Review of Frontal Sinus Fractures

Frontal sinus cranialization is commonly indicated for posterior table fractures with significant comminution, displacement, or cerebrospinal fluid leaks. This study assessed the clinical outcomes of conservative management. A 10-year retrospective review of all frontal sinus fractures treated at a level 1 trauma center was performed using medical records and radiographic images. A total of 875 patients with frontal sinus fractures were identified, and 68 had posterior table involvement. Nine died within the first 48 hours from other injuries. The remaining 59 patients constituted the study population. Average follow-up approached 1 year (342 days). The more common mechanisms of injury were blunt interpersonal violence (29 percent) and motor vehicle accidents (27 percent). Concurrent central nervous system injury was common (73 percent), and the average Glasgow Coma Scale score was 12.7. Posterior wall fracture pattern was nondisplaced and noncomminuted in 33 patients (54 percent) and comminuted and/or displaced in 27 (46 percent). Cerebrospinal fluid leak was recorded in 11 patients (19 percent). Conservative management was the more common strategy (78 percent), followed by open reduction and internal fixation with sinus preservation (12 percent), obliteration (8 percent), and cranialization (2 percent). Of the 27 patients with comminuted and/or displaced fractures, 16 (59 percent) underwent conservative management, and 11 (41 percent) underwent surgical management, but only one patient (2 percent) underwent cranialization. There was no incidence of intracranial infection, except for one patient who died from encephalitis secondary to a gunshot wound to the head. The vast majority of frontal sinus fractures involving the posterior table, including those with comminution, displacement, or cerebrospinal fluid leaks, can be safely managed without cranialization. Therapeutic, IV.

Endoscopic Management of Frontal Sinus Fractures

Objective: Conventional treatment of frontal sinus posterior table fractures has included osteoplastic flap or cranialization procedures despite considerable advances in endoscopic technique and experience. The objective of the current study was to evaluate outcomes of frontal sinus fractures involving the posterior table managed using endoscopic approaches. Method: Retrospective evaluation of patients with posterior table fractures was performed at the University of Alabama at Birmingham from January 2008 through December 2011. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of the skull base defect, complications, and clinical follow up Results: Eleven patients (age 39 ± 5 years) with posterior table fractures were treated using endoscopic techniques from 2008-2011. Mean follow-up time was 44 ± 15 weeks (range 2-164). Patients were primarily managed using Draf IIb frontal sinusotomies with 1 individual requiring a concomitant trephine. A Draf III procedure was performed in 1 patient. Average fracture defect (length vs width) was 13.5 3.6 mm and the average length involving the posterior table was 9.6 mm (1-30 mm). Skull base defects were covered with a septal flap and/or Surgisus tissue grafts. One patient referred after failed cranialization was endoscopically obliterated. Although 1 individual required a revision frontal sinusotomy, all sinuses remain patent on last follow-up. Conclusion: Management of frontal sinus posterior table fractures using minimally invasive endoscopic techniques provides excellent outcomes in selected cases. Posterior table fractures of up to 30 mm in length were adequately managed in this series and indicate this approach should become an active part of the treatment algorithm.

Postoperative Complications of Frontal Sinus Fractures: A Retrospective Review of 47 Cases

Postoperative Complications of Frontal Sinus Fractures: A Retrospective Review of 47 Cases

Role of the Sagittal View of Computed Tomography in Evaluation of the Nasofrontal Ducts in Frontal Sinus Fractures

Frontal sinus fractures are relatively uncommon due to the high-impact force required to produce these. However, their management is quite complex, with the treatment algorithm incorporating many factors in which the status of the nasofrontal ducts is critically important. Traditionally, this has been evaluated by both axial and coronal computed tomographic (CT) scan views. Anatomically, we propose that this is better evaluated by coronal and sagittal CT views. We evaluated the role of sagittal CT scan views in determining the status of the nasofrontal ducts in patients with frontal sinus fractures. A retrospective analysis examining 8 patients with frontal sinus fractures, from August 2004 to January 2008, was performed. Axial, coronal, and sagittal CT scan views were obtained routinely as part of the facial trauma workup. These views were assessed to determine the status of the nasofrontal ducts. The operative findings were also reviewed. Five of the 8 patients had displaced anterior and posterior table frontal sinus fractures. Of these, 4 required surgical intervention that included addressing the nasofrontal ducts. Two of the 8 patients had displaced anterior table fractures that required no intervention of the nasofrontal ducts. One patient had nondisplaced anterior and posterior table fractures and did not require surgery. The sagittal CT view clearly demonstrated the anatomy of the nasofrontal ducts in all 8 patients, including patients in whom the axial and/or coronal views were questionable. Intraoperatively, where the patency of the nasofrontal ducts was directly evaluated, there was a direct correlation with the sagittal image findings. The sagittal CT view provides invaluable information for evaluating the patency of the nasofrontal ducts in frontal sinus fractures. The ability to evaluate the frontal sinus in an anteroposterior dimension (the usual vector of the injury) and in a superoinferior dimension (the anatomic pathway of the ducts) is the reason for this imaging advantage.