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Kim I, Kim JM, Kim J, Lee SJ, Nam EC. Management of frontal sinus trauma: a retrospective study of surgical interventions and complications. Maxillofac Plast Reconstr Surg 2024; 46:4. [PMID: 38233722 PMCID: PMC10794673 DOI: 10.1186/s40902-024-00414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Frontal sinus injuries are relatively rare among facial bone traumas. Without proper treatment, they can lead to fatal intracranial complications, including meningitis or brain abscesses, as well as aesthetic and functional sequelae. The management of frontal sinus injuries remains controversial, with various treatment methods and outcomes being reported. This article describes the clinical characteristics, surgical methods, and outcomes among 17 patients who underwent surgery for frontal sinus injury and related complications. CASE PRESENTATION We retrospectively included 17 patients who underwent surgery for frontal sinus injury and its related complications at the Kangwon National University Hospital between July 2010 and September 2021. Among them, six underwent simple open reduction and fixation of the anterior wall, eight underwent sinus obliteration, and three underwent cranialization. Two patients who underwent sinus obliteration died due to infection-related complications. The patient who underwent cranialization reported experiencing chronic headache and expressed dissatisfaction regarding the esthetic outcomes of the forehead. Except for these three patients, the other patients achieved satisfactory esthetic and functional recovery. CONCLUSION Active surgical management of frontal sinus injuries is often required owing to the various complications caused by these injuries; however, several factors, including the fracture type, clinical presentation, related craniomaxillofacial injury, and medical history, should be considered while formulating the treatment plan. Surgical treatment through the opening of the frontal sinus should be actively considered in patients with severely damaged posterior wall fractures and those at risk of developing infection.
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Affiliation(s)
- InKyeong Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeong-Mo Kim
- Department of Oral & Maxillofacial Surgery, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Gangwon-do, 24289, Korea.
| | - Jiha Kim
- Department of Neurosurgery, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Eui-Cheol Nam
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Korea
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2
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Dennis SK, Steele TO, Gill AS, Hwang JC, Sarhadi KS, Cheema KS, Aulakh SS, Wilson MD, Strong EB. Treatment Outcomes With Conservative Management of Frontal Sinus Outflow Tract Fractures. Otolaryngol Head Neck Surg 2023; 169:1455-1461. [PMID: 37573490 PMCID: PMC10840897 DOI: 10.1002/ohn.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Historically, early surgical management of frontal sinus outflow tract (FSOT) fractures has been standard practice. There has been a paradigm shift toward nonsurgical or delayed management. Unfortunately, clinical indications and treatment outcomes for this approach are poorly understood. This study evaluates radiologic indicators, as well as sinus reaeration and complication rates for FSOT injuries treated nonsurgically. STUDY DESIGN A retrospective cohort study of FSOT injuries between 2005 and 2019. SETTING Academic, tertiary care medical center. METHODS Radiographic fracture patterns of the frontal ostia (FO) and frontal recess (FR) were recorded as either patent, disrupted, or obstructed. Sinus reaeration, surgical rescue, and complication rates were documented. Patients with follow-up imaging >42 days were included. Patients undergoing immediate surgical intervention were excluded. RESULTS One hundred patients were identified and 44 met the criteria (88 sinuses). Among nonobstructed FSOT injuries (ie, patent or disrupted), reaeration occurred in 91% of the FO and 98% of FR injuries. Two sinuses required surgical rescue including 1 Draf IIB (1%), and 1 obliteration (1%). Two sinuses had complications including 1 mucocele (1%) and 1 cerebrospinal fluid leak (1%). FO and FR fracture patterns had no identifiable correlation with long-term reaeration rates or the need for surgical intervention. CONCLUSION Among nonobstructive injuries to the FSOT, average reaeration rates in observed patients were high (91%-98%). Rescue surgery (2%) and complication rates (2%) were low, suggesting that nonsurgical management of nonobstructed FSOT is a viable strategy. No radiographic features were clearly identified to be predictive of sinus reaeration.
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Affiliation(s)
- Steven Kennedy Dennis
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Joshua C Hwang
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Kamron S Sarhadi
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Karmtej S Cheema
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Sukhkaran S Aulakh
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Machelle D Wilson
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
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Shadamarshan Rengasayee A, Sharma R, Agrawal N. Frontal Sinocutaneous Fistula with Frontal Osteomyelitis as a Delayed Complication of Bone Wax Obliteration of Frontal Sinus Fracture. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Panfacial trauma refers to high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, Advanced Trauma Life Support (ATLS) protocols should be followed. The airway should be secured, bleeding controlled, and sequential examinations should take place to avoid overlooking injuries. When indicated, neurosurgery and ophthalmology should be consulted as preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging. Lost or comminuted bone can be replaced with bone grafts, although adequate reduction should be ensured prior to any grafting. Operative sequencing can be performed from top-down and outside-in or from bottom-up and inside-out depending on patient presentation. All protocols can successfully manage panfacial injuries, and the emphasis should be placed on a systematic approach that works from known areas to unknown areas.
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Affiliation(s)
- Benjamin B Massenburg
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Melanie S Lang
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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5
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Basa K, Lee A, Shehan JN, Mahoney TF, LeClair J, Kuperstock JE, Jabbour N, Spiegel JH. Frontal Bone Cranioplasty for Facial Feminization: Long-Term Follow-Up of Postoperative Sinonasal Symptoms. Facial Plast Surg Aesthet Med 2021. [PMID: 34558989 DOI: 10.1089/fpsam.2021.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Forehead feminization cranioplasty (FFC) risks entering the frontal sinus to achieve the desired contour. To date, no study has investigated long-term FFC complications. Objective: Determine if long-term sinus and headache symptoms worsen secondary to frontal sinus mucosal violation, measured by patient-reported outcomes. Methods: Single database retrospective chart review of patients who underwent forehead contouring between August 2012 and August 2019 was conducted. Two cohorts-frontal sinus mucosal violation versus mucosal preservation-were surveyed postprocedurely for postprocedure SNOT (Sinonasal Outcome Test)-22 scores and pre- and postprocedure sinus and headache symptoms. Results: Frontal sinus violation, mean time between surgery and response was 4.16 ± 1.88 years (range: 1-8). Without violation, mean time between surgery and response was 2.5 ± 1.10 years (range: 1-5). Postoperative SNOT-22 severity scores were not different (12.55 vs. 8.6, p = 0.20). Postoperative SNOT-22 scores were equivalent to a control nonrhinosinusitis population. No difference was found between violation of the frontal sinus with worse postoperative sinus (22 vs. 5, p = 0.60) or headache symptoms. Conclusion: Our data did not detect a difference in sinus or headache outcomes in patients who experienced violation of the anterior frontal table compared with a similar population with preservation of the frontal sinus, over an 8-year follow-up.
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Affiliation(s)
- Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrew Lee
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jennifer N Shehan
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Jeffrey H Spiegel
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
- The Spiegel Center, Newton, Massachusetts, USA
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Repair of frontal sinus fractures: clinical and radiological long-term outcomes. The Journal of Laryngology & Otology 2021; 135:448-451. [PMID: 33879274 DOI: 10.1017/s0022215121001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed. METHODS A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included. RESULTS Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6-132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration. CONCLUSION Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.
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Is there still a role for cranialization in modern sinus surgery? Curr Opin Otolaryngol Head Neck Surg 2020; 29:53-58. [PMID: 33278134 DOI: 10.1097/moo.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses. RECENT FINDINGS Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options. SUMMARY Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus.
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8
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Frontal sinus fractures and cerebrospinal fluid leaks: a change in surgical paradigm. Curr Opin Otolaryngol Head Neck Surg 2020; 28:52-60. [PMID: 31834027 DOI: 10.1097/moo.0000000000000602] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Traditionally, frontal sinus trauma has been treated using open incisions to access the anterior and/or posterior table. Mounting evidence indicates frontal sinus trauma can be managed using an endoscopic endonasal approach (EEA) with less morbidity. Such an approach permits preservation of a functional sinus and less reliance on computed tomography for postoperative follow up. The goal of this article is to highlight a shift in paradigm away from open approaches using external incisions towards an EEA to repair cerebrospinal fluid (CSF) leaks and fractures of the frontal sinus. RECENT FINDINGS In a prospective case series of 46 patients undergoing EEA to frontal sinus fractures, 41 patients had active CSF leaks arising from the posterior table of the frontal sinus. A successful endoscopic repair was achieved in 97.6% with only one patient requiring revision Draf IIB surgery. Anterior table fractures were also successfully reduced with excellent cosmesis. SUMMARY Endoscopic repair of frontal sinus fractures and CSF leaks is effective and well tolerated. In select patients, it is the preferred treatment as it maintains normal sinus structure and function, minimizing both early and late complications.
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Oh SY, Choi JS, Lim JS, Kim MC. Eyeball deviation by orbital mucocele after midface sinus injury. Arch Craniofac Surg 2020; 21:53-57. [PMID: 32126622 PMCID: PMC7054188 DOI: 10.7181/acfs.2019.00605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/06/2019] [Indexed: 11/30/2022] Open
Abstract
A mucocele is an epithelium-lined, mucus-filled cavity in the paranasal sinuses. Mucocele may develop due to scarring and obstruction of the sinus ostium caused by midface sinus trauma, such as orbital bone fracture or endoscopic sinus surgery. The authors report two cases of orbital mucocele as complications following midface sinus injury (endoscopic sinus surgery in one case, and orbital fracture repair in the other). In both cases, imaging studies showed a large orbital mucocele accompanied by bony erosion and orbital wall remodeling, compressing the ocular muscle. Using an open approach, the lesion was excised and marsupialized. The symptoms resolved, and the postoperative eyeball position was normal. Orbital mucocele may cause serious complications such as ocular symptoms, orbital cellulitis, osteomyelitis, and the formation of an abscess with the potential to invade the brain. Therefore, surgeons should consider the possibility of mucocele as a late complication of surgery and initiate an immediate work-up and surgical treatment if needed.
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Affiliation(s)
- Se Young Oh
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Seon Choi
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin Soo Lim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Min Cheol Kim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Pisano J, Tiwana PS. Management of Panfacial, Naso-Orbital-Ethmoid and Frontal Sinus Fractures. Atlas Oral Maxillofac Surg Clin North Am 2019; 27:83-92. [PMID: 31345494 DOI: 10.1016/j.cxom.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Justin Pisano
- Department of Oral & Maxillofacial Surgery, University of Oklahoma Health Sciences Center, 1201 North Stonewall Avenue, Suite 206, Oklahoma City, OK 73117, USA
| | - Paul S Tiwana
- Department of Oral & Maxillofacial Surgery, University of Oklahoma Health Sciences Center, 1201 North Stonewall Avenue, Suite 206, Oklahoma City, OK 73117, USA.
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Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures. Curr Opin Otolaryngol Head Neck Surg 2018; 25:326-331. [PMID: 28504985 DOI: 10.1097/moo.0000000000000369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.
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12
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Mandrioli S, Valente L, Galiè M. Posttraumatic Glabellar Mucocele: Case Report. Craniomaxillofac Trauma Reconstr 2017; 11:320-323. [PMID: 30574277 DOI: 10.1055/s-0037-1608698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/15/2017] [Indexed: 10/18/2022] Open
Abstract
Mucoceles are benign, expansile cystic masses covered by respiratory epithelium filled with mucus secreted by goblet cells interspersed in the ciliated mucosa. Mucoceles result from the accumulation and retention of the products of secretion, desquamation, and inflammation in cases where the drainage is obstructed. We present a case of a nasal mucocele that developed in a 50-year-old man, possibly related to a craniofacial trauma that had occurred 24 years earlier. This is an unusual case of posttraumatic glabellar mucocele with subcutaneous extension and nasal bone erosion without any neurologic or ophthalmologic involvement.
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Affiliation(s)
- Stefano Mandrioli
- Unit of Craniomaxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Luisa Valente
- Unit of Craniomaxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Manlio Galiè
- Unit of Craniomaxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
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13
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Grayson JW, Jeyarajan H, Illing EA, Cho DY, Riley KO, Woodworth BA. Response to: Letter to the Editor regarding "Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair". Int Forum Allergy Rhinol 2017; 7:1109-1110. [PMID: 28853224 DOI: 10.1002/alr.22003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL
| | - Hari Jeyarajan
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL
| | - Kristen O Riley
- Department of Neurosurgical Sciences, University of Alabama Birmingham, Birmingham, AL
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL
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Grayson JW, Jeyarajan H, Illing EA, Cho DY, Riley KO, Woodworth BA. Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair. Int Forum Allergy Rhinol 2017; 7:441-449. [PMID: 28207197 DOI: 10.1002/alr.21897] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/20/2016] [Accepted: 11/15/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Management of frontal sinus trauma includes coronal or direct open approaches through skin incisions to either ablate or obliterate the frontal sinus for posterior table fractures and openly reduce/internally fixate fractured anterior tables. The objective of this prospective case-series study was to evaluate outcomes of frontal sinus anterior and posterior table trauma using endoscopic techniques. METHODS Prospective evaluation of patients undergoing surgery for frontal sinus fractures was performed. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of skull base defects, complications, and clinical follow-up. RESULTS Forty-six patients (average age, 42 years) with frontal sinus fractures were treated using endoscopic techniques from 2008 to 2016. Mean follow-up was 26 (range, 0.5 to 79) months. Patients were treated primarily with a Draf IIb frontal sinusotomies. Draf III was used in 8 patients. Average fracture defect (length vs width) was 17.1 × 9.1 mm, and the average length involving the posterior table was 13.1 mm. Skull base defects were covered with either nasoseptal flaps or free tissue grafts. One individual required Draf IIb revision, but all sinuses were patent on final examination and all closed reductions of anterior table defects resulted in cosmetically acceptable outcomes. CONCLUSION Frontal sinus trauma has traditionally been treated using open approaches. Our findings show that endoscopic management should become part of the management algorithm for frontal sinus trauma, which challenges current surgical dogma regarding mandatory open approaches.
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Affiliation(s)
- Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hari Jeyarajan
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristen O Riley
- Department of Neurosurgical Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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15
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Endoscopic-Assisted Removal of a Rare Mucocele Complicating From Alloplastic Medial Orbital Fracture Reconstruction. J Craniofac Surg 2017; 28:967-969. [PMID: 28118188 DOI: 10.1097/scs.0000000000003454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Orbital wall fracture reconstruction is usually recommended to prevent subsequent functional and esthetic complications. Mucocele development following such injuries or its management is recognized but rare sequelae. When they occur, they represent a diagnostic and management dilemma. The authors described a patient with orbital and ethmoidal mucocele. A 62-year-old female patient presented with progressive left exophthalmos 1 year following titanium mesh reconstruction of a medial orbital wall fracture. Computed tomography and magnetic resonance imaging demonstrated an encysted lesion encasing the mesh plate in the left orbit and extending into the ethmoidal sinus. The patient is treated surgically through endoscopic-assisted approach with complete removal of the lesion and lacrimal duct stenting. The patient improved immediately after surgery.
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Menezes JDDSD, Moura LB, Pereira-Filho VA, Hochuli-Vieira E. Maxillary Sinus Mucocele as a Late Complication in Zygomatic-Orbital Complex Fracture. Craniomaxillofac Trauma Reconstr 2016; 9:342-344. [PMID: 27833714 DOI: 10.1055/s-0036-1582453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/22/2015] [Indexed: 10/21/2022] Open
Abstract
This article presents an unusual case of maxillary sinus mucocele as a late complication of zygomatic-orbital complex fracture, 23 years after the initial treatment. The patient was referring diplopia and decreased visual acuity with signs of dystopia, proptosis, and epiphora. Computed tomographic scan revealed an expansive lesion in the maxillary sinus with surrounding bone erosion and displacement of the eyeball. Treatment option was excisional biopsy and orbital floor reconstruction with titanium mesh restoring the appropriate orbital position. We propose that in the case of postoperative ophthalmological sequelae of facial fractures involving paranasal sinuses, mucocele should be considered in the differential diagnosis.
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Affiliation(s)
- Juliana Dreyer da Silva de Menezes
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dentistry School at Araraquara - Unesp, Araraquara-SP, Brazil
| | - Lucas Borin Moura
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dentistry School at Araraquara - Unesp, Araraquara-SP, Brazil
| | - Valfrido Antonio Pereira-Filho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dentistry School at Araraquara - Unesp, Araraquara-SP, Brazil
| | - Eduardo Hochuli-Vieira
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dentistry School at Araraquara - Unesp, Araraquara-SP, Brazil
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Kim YW, Lee DH, Cheon YW. Secondary Reconstruction of Frontal Sinus Fracture. Arch Craniofac Surg 2016; 17:103-110. [PMID: 28913266 PMCID: PMC5556797 DOI: 10.7181/acfs.2016.17.3.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/11/2022] Open
Abstract
Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.
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Affiliation(s)
- Yang Woo Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hun Lee
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Woo Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Demonstrate an understanding of some of the changes in aspects of facial fracture management. 2. Assess a patient presenting with facial fractures. 3. Understand indications and timing of surgery. 4. Recognize exposures of the craniomaxillofacial skeleton. 5. Identify methods for repair of typical facial fracture patterns. 6. Discuss the common complications seen with facial fractures. SUMMARY Restoration of the facial skeleton and associated soft tissues after trauma involves accurate clinical and radiologic assessment to effectively plan a management approach for these injuries. When surgical intervention is necessary, timing, exposure, sequencing, and execution of repair are all integral to achieving the best long-term outcomes for these patients.
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Foy JP, Khonsari RH, Bertolus C, Espitalier F, Ferron C, Corre P, Faure A. 'Canalization' of the frontal sinus: a functional approach for the management of post-traumatic sinusitis with lateral bony septa. Report of two cases and long-term follow-up. Int J Oral Maxillofac Surg 2016; 45:884-6. [PMID: 26922495 DOI: 10.1016/j.ijom.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 12/11/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
The patency of the naso-frontal duct is a key issue in the surgical management of chronic frontal sinusitis. Most of the current operative techniques only provide access to the paramedian portions of the frontal sinus. A canalization approach that allows a functional frontal sinus to be maintained while providing good access to the most lateral areas of the sinus is described herein. Two cases of severe post-traumatic frontal sinusitis, operated on successfully by canalization method based on the conservation of the frontal sinus and the maintenance of the patency of the naso-frontal duct, using both open and endonasal approaches, are reported. One patient was followed-up for 8 years and the other for 7 months. Canalization requires validation in a larger series. This approach provides an alternative to both cranialization and strictly endoscopic methods in lateralized frontal sinus retentions and allows mucocele to be avoided.
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Affiliation(s)
- J-P Foy
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France
| | - R H Khonsari
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France.
| | - C Bertolus
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France
| | - F Espitalier
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, CHU Nantes, Nantes, France
| | - C Ferron
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, CHU Nantes, Nantes, France
| | - P Corre
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes, France
| | - A Faure
- Service de Neurotraumatologie, CHU Nantes, Nantes, France
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Frontal Mucocele following Previous Facial Trauma with Hardware Reconstruction. Case Rep Emerg Med 2016; 2016:4236421. [PMID: 28003917 PMCID: PMC5149613 DOI: 10.1155/2016/4236421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/12/2016] [Indexed: 11/23/2022] Open
Abstract
Mucoceles are cysts that can develop after facial bone fractures, especially those involving the frontal sinuses. Despite being rare, mucoceles can result in serious delayed sequelae. We present a case of a frontal mucocele that developed two years after extensive facial trauma following a motor vehicle crash (MVC) and review the emergency department (ED) evaluation and treatment of mucocele. Early recognition, appropriate imaging, and an interdisciplinary approach are essential for managing these rare sequelae of facial trauma.
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Carmichael RA, Kang DR. Frontal Sinus Mucopyocele Presenting as a Subcutaneous Forehead Mass. J Oral Maxillofac Surg 2015; 73:2155-61. [DOI: 10.1016/j.joms.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
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Jafari A, Nuyen BA, Salinas CR, Smith AM, DeConde AS. Spontaneous ventilation of the frontal sinus after fractures involving the frontal recess. Am J Otolaryngol 2015; 36:837-42. [PMID: 26232884 DOI: 10.1016/j.amjoto.2015.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/28/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Frontal sinus fractures (FSF) have potentially catastrophic consequences due to frontal recess (FR) obstruction and proximity to the brain and orbit. Lack of follow-up and ability to predict which type of fractures predispose to complications has biased surgeons toward definitive interventions such as sinus obliteration and cranialization. These procedures carry inherent risk and may be unnecessary in a subset of patients. This study seeks to better characterize spontaneous ventilation in subjects with FSFs, including those involving the FR. MATERIALS AND METHODS Review of a prospectively maintained trauma database between 2009 and 2013 at a level 1 trauma center. Patients with frontal sinus fractures with follow-up imaging (>6 weeks) available were included. The medical records and imaging were reviewed for evidence of spontaneous ventilation of the frontal sinus. RESULTS Nineteen patients sustained frontal sinus fractures in the study period with mean imaging interval of 67.4 weeks (range, 6-188.4 weeks). Injury mechanisms included fall (32%), assault (31%), motor vehicle accident (17%), pedestrian-versus-automobile (12%), and gunshot wound (8%). 8/19 patients (42%) sustained FSFs involving the FR and 7/8 (87.5%) spontaneously ventilated by time of interval imaging. The one patient with persistent radiographic sinus opacification was associated with a naso orbital ethmoid and medial orbital blowout fracture. 6/19 patients (32%) sustained FSF sparing the FR, and all spontaneously ventilated by the time of interval imaging. 5/19 patients (26%) underwent surgical intervention. CONCLUSIONS An expectant, sinus-preserving approach to acute FSFs involving the FR is safe and effective. Etiology of re-ventilation failure may be due to tissue obstruction, rather than the frontal recess fracture itself.
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Affiliation(s)
- Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Brian A Nuyen
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Courtni R Salinas
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alan M Smith
- Department of Surgery, Division of Trauma, University of California San Diego, La Jolla, CA, USA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA.
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Ravindra VM, Neil JA, Shah LM, Schmidt RH, Bisson EF. Surgical management of traumatic frontal sinus fractures: Case series from a single institution and literature review. Surg Neurol Int 2015; 6:141. [PMID: 26392917 PMCID: PMC4553660 DOI: 10.4103/2152-7806.163449] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/07/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neurosurgeons are frequently involved in the management of patients with traumatic frontal sinus injury; however, management options and operative techniques can vary significantly. In this study, the authors review the current literature and retrospectively review the clinical series at a single tertiary referral center. METHODS After Institutional Review Board approval, the medical records and computed tomographic (CT) imaging of patients whose traumatic frontal sinus fractures were treated surgically at the University of Utah were retrospectively reviewed. Demographic information, mechanism of injury, associated injuries, operative technique, and pattern of injury on CT were analyzed. RESULTS Between 2000 and 2012, 33 patients underwent successful cranialization of the frontal sinus following traumatic injury. The material used to obliterate the sinus varied. No patients required immediate or delayed reoperation. Nasofrontal outflow tract obstruction, the importance of which has been emphasized in the plastic surgery literature, was apparent on either initial or retrospective review of the available CT imaging in 96%. CONCLUSIONS In this series, we successfully surgically treated 33 patients with frontal sinus fractures. The presence of cerebrospinal fluid leak, nasofrontal outflow tract injury, associated depressed skull fractures, and subsequent formation of communicating pathways and infection must be considered when constructing a treatment plan. The goals of treatment should be: (i) surgical repair of the defect and elimination of the conduit from the intracranial space to the outside and (ii) elimination of any cerebrospinal fluid pressure gradient that may develop across the surgical repair. We present a treatment algorithm focusing on the presence of nasofrontal outflow tract injury/obstruction, cosmetic deformity, and cerebrospinal fluid leak.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
| | - Jayson A Neil
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
| | - Lubdha M Shah
- Department of Radiology, University of Utah, 30 North 1900 East, Salt Lake City, Utah, 84132, USA
| | - Richard H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, Utah, 84132, USA
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Kojima Y, Tsuzuki K, Yukitatsu Y, Oka H, Takebayashi H, Sakagami M. Clinical Features of Patients Treated with Endoscopic Sinus Surgery for Posttraumatic Paranasal Sinus Mucocele. ORL J Otorhinolaryngol Relat Spec 2015; 77:162-70. [DOI: 10.1159/000381918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 03/24/2015] [Indexed: 11/19/2022]
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Husain Q, Sanghvi S, Kovalerchik O, Shukla PA, Choudhry OJ, Liu JK, Eloy JA. Assessment of mucocele formation after endoscopic nasoseptal flap reconstruction of skull base defects. ALLERGY & RHINOLOGY 2013; 4:e27-31. [PMID: 23772323 PMCID: PMC3679564 DOI: 10.2500/ar.2013.4.0050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Advances in endoscopic skull base (SB) surgery have led to the resection of increasingly larger cranial base lesions, resulting in large SB defects. These defects have initially led to increased postoperative cerebrospinal fluid (CSF) leaks. The development of the vascularized pedicled nasoseptal flap (PNSF) has successfully reduced postoperative CSF leaks. Mucocele formation, however, has been reported as a complication of this technique. In this study, we analyze the incidence of mucocele formation after repair of SB defects using a PNSF. A retrospective review was performed from December 2008 to December 2011 to identify patients who underwent PNSF reconstruction for large ventral SB defects. Demographic data, defect site, incidence of postoperative CSF leaks, and rate of mucocele formation were collected. Seventy patients undergoing PNSF repair of SB defects were identified. No postoperative mucocele formation was noted at an average radiological follow-up of 11.7 months (range, 3–36.9 months) and clinical follow-up of 13.8 months (range, 3–38.9 months), making the overall mucocele rate 0%. The postoperative CSF leak rate was 2.9%. Proper closure of SB defects is crucial to prevent CSF leaks. The PNSF is an efficient technique for these repairs. Although this flap may carry an inherent risk of mucocele formation when placed over mucosalized bone during repair, we found that meticulous and strategic removal of mucosa from the site of flap placement resulted in a 0% incidence of postoperative mucocele formation in our cohort.
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Affiliation(s)
- Qasim Husain
- Departments of Otolaryngology- Head and Neck Surgery and
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Two late complications of craniofacial trauma: case report and review of the literature. Am J Otolaryngol 2012; 33:615-8. [PMID: 22306787 DOI: 10.1016/j.amjoto.2011.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/05/2011] [Indexed: 11/21/2022]
Abstract
Injuries after blunt and penetrating trauma to the face are a common occurrence and are managed by specialists from several disciplines. After short-term care and immediate recovery, long-term complications can develop including cosmetic deformity, unsightly scarring, problems with soft tissue healing, malunion or nonunion of bony segments, diplopia or other visual complaints, malocclusion, hardware failure, and mucocele formation. Here, we present a report of 2 late complications recognized and treated in a patient 40 years after an episode of craniofacial trauma: epistaxis with symptomatic nasal congestion from fixation wires and mucocele formation. Management of this patient accompanied by endoscopic photographs and computed tomographic images is presented, and discussion of these complications along with review of the literature is provided.
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Molendijk J, van der Wal KGH, Koudstaal MJ. Surgical treatment of frontal sinus fractures: the simple percutaneous reduction revised. Int J Oral Maxillofac Surg 2012; 41:1192-4. [PMID: 22832664 DOI: 10.1016/j.ijom.2012.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/14/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
Frontal sinus fractures are common fractures in high-energetic trauma. Different treatments options are available for different types of frontal sinus fractures. A fracture that consists only of the anterior wall is most commonly reduced with the coronal approach. This approach is invasive and produces a large scar on the scalp, which can result in an unfavourable situation in patients with alopecia and in balding men. To avoid this, a percutaneous reduction method can be used to treat patients with simple anterior wall fractures. This approach is less invasive and does not result in a conspicuous scar. The disadvantages of this procedure are the absence of direct vision and less control of the fracture, which can reduce the chances of complete reduction. This paper provides an overview of anterior wall fractures of the frontal sinus and elaborates on the simple percutaneous reduction technique.
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Affiliation(s)
- J Molendijk
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Kamoshima Y, Terasaka S, Nakamaru Y, Takagi D, Fukuda S, Houkin K. Giant frontal mucocele occurring 32 years after frontal bone fracture: a case report. Case Rep Neurol 2012; 4:34-7. [PMID: 22393324 PMCID: PMC3291888 DOI: 10.1159/000336326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Giant mucoceles of the frontal sinus are rare but their recognition is important in the differential diagnosis of proptosis and fronto-orbital lesions. The authors describe a patient with frontal giant mucocele with intracranial as well as orbit and ethmoid sinus involvement. Thirty-two years after a frontal sinus fracture, a 51-year-old female presented with headache, and left exophthalmos and ophthalmoplegia. Computed tomography and magnetic resonance imaging demonstrated a giant frontal sinus mucocele with extension into the left anterior cranial fossa. The mucocele was treated with a transcranial and endoscopic transnasal approach. The frontal sinus was then cranialized with reconstruction of the posterior wall, and finally a wide nasal drainage was performed. The clinical symptoms disappeared immediately after surgery.
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Affiliation(s)
- Yuuta Kamoshima
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Abstract
Mucoceles of the frontal sinus are expansive cysts filled of the mucus secreted by goblet cells interspersed in the ciliated mucosa. The aim of this article was to present a case of a frontal mucocele that was developed in a 31-year-old man 19 years after having had a frontal sinus fracture. This is a rare entity. Frontal sinus fractures must be treated by a multidisciplinary team to avoid all possible sequelae. An adequate primary management of frontal sinus fractures is essential to prevent complications. This may include conservative attitude, reduction and fixation with miniplates, obliteration, cranialization, or grafting. Removal of any rest of epithelium is mandatory in this sense.
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Abstract
The authors report the case of a 75-year-old man presenting with an exceptionally large giant posttraumatic mucocele of the frontal sinus years after a gunshot blast to the head. The lesion had grown so extensively that the right eye had shrunk and calcified, resulting in total monocular blindness, a complication that has been reported only once. To the best of our knowledge, it is the first time that a giant mucocele of such a large size is reported. We describe how the patient underwent surgical removal of this massive lesion, cranial base reconstruction, and a cosmetic oculoplastic procedure. The etiology, clinical presentation, and possible complications are reviewed, as well as the importance of a regular clinical follow-up and early surgical cure. Although the diagnosis and management of mucoceles are nowadays considered quite standard, the exceptional size of the lesion illustrated here emphasizes the destructive potential of such seemingly indolent lesions. Despite the benign histology of mucoceles, one should never underestimate their morbid potential or be lulled in delaying surgical cure. Large mucoceles should be removed as quickly as possible to prevent such unacceptable complications as permanent visual loss.
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Mucocele after transnasal endoscopic repair of traumatic anterior skull base fistula in children. Int J Pediatr Otorhinolaryngol 2011; 75:1137-42. [PMID: 21820187 DOI: 10.1016/j.ijporl.2011.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/09/2011] [Accepted: 06/11/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To report the long-term sinonasal complications after endoscopic repair of anterior skull base fractures in children. This study describes mucocele formation in 6 patients treated endoscopically for posttraumatic CSF fistulae. We aim to address possible etiologic factors, specific treatments and follow-up modalities. PATIENTS AND METHODS 12 children, mean age 5.8 years (3-10), treated endoscopically at our institution between 2004 and 2010 for an anterior cranial base fracture complicated by a CSF fistula. An iatrogenic mucocele was observed in 6 cases. A retrospective review of the files of these 6 patients was carried out demonstrating demographic characteristics, presenting signs/symptoms, site of skull base defect, repair technique, timing and onset of the mucoceles, their presentation and management. A systematic CT-scan and/or MRI was carried out at 3 months, 1 year and then annually. RESULTS 3 patients presented after cranial trauma with persistent CSF nasal leak, and 4 with meningitis. Posttraumatic defects reached the posterior wall of the frontal sinus and the junction of ethmoid and frontal bone in 3 cases, and the cribriform plate in 3 cases. Endoscopic closure was performed in all cases, with the middle turbinate as an overlay patch. No recurrence of a CSF leak was observed. After a mean period of 16 months, a single iatrogenic mucocele was observed in 4 patients (radiological detection only), and multiple mucoceles in 2 patients. Surgical treatment was advocated in cases of proptosis, quick expansion of the mucocele leading to sinus bony wall remodelling or erosion (2 cases), and meningitis related to an erosion of the cribriform plate by the mucocele. Three mucoceles were successfully treated endoscopically, and 1 required an external approach. CONCLUSION Mucocele incidence after endoscopic repair of skull base fractures in children is not insignificant (50% in our 12 patients series). Paediatric anatomical features, cranial trauma, and the transethmoidal approach may play a role in mucocele pathogenesis. Long-term clinical and radiological follow-up is therefore recommended. These mucoceles may be managed endoscopically with good outcomes.
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Definitive treatment of persistent frontal sinus infections: elimination of dead space and sinonasal communication. Plast Reconstr Surg 2009; 123:957-967. [PMID: 19319061 DOI: 10.1097/prs.0b013e318199f4cd] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frontal sinus injury involving nasofrontal outflow tract obstruction is routinely managed by obliteration or cranialization; however, a small percentage of patients develop persistent indolent infections despite routine measures. The authors discuss the course of persistent infection following frontal sinus fractures and propose a novel treatment that definitively obliterates and separates the nasofrontal outflow tract from the cranium in these patients. METHODS Seven consecutive patients with persistent indolent infections associated with frontal sinus fractures were identified and treated at the R Adams Cowley Shock Trauma Center and The Johns Hopkins Hospital from 2005 to 2008. RESULTS There were three women and four men, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 4), motorcycle crash (n = 1), fall (n = 1), and other accident (n = 1). All patients were previously treated with conventional techniques (average, 3.6 procedures and 11 years from initial injury) and prolonged antibiotic therapy without resolution of symptoms. Definitive treatment included radical débridement and obliteration with a free fibula flap in a single stage. All flaps survived and resulted in complete sinonasal separation and eradication of infection. There were no donor-site or frontal sinus complications. CONCLUSIONS Radical débridement, meticulous removal of the tenacious sinus mucosa, and reconstruction with a free fibular flap in a single stage is a superb choice for eliminating persistent infectious complications associated with frontal sinus fractures in patients who have failed conventional management. The fibular flap provides a secure horizontal buttress, seals the nasofrontal outflow tract with vascularized muscle, and obliterates dead space.
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Mourouzis C, Evans BT, Shenouda E. Late presentation of a mucocele of the frontal sinus: 50 years postinjury. J Oral Maxillofac Surg 2008; 66:1510-3. [PMID: 18571041 DOI: 10.1016/j.joms.2007.12.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 12/12/2007] [Indexed: 10/21/2022]
Affiliation(s)
- Constantinos Mourouzis
- Department of Oral and Maxillofacial Surgery, Southampton University Hospitals NHS Trust, Southampton, UK.
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Yoon SH, Park SH. Delayed development of frontal mucocele after fronto-orbital advancement in a child with craniosynostosis. ACTA ACUST UNITED AC 2007; 67:517-21. [PMID: 17445623 DOI: 10.1016/j.surneu.2006.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 07/03/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sinus mucoceles rarely develop as a consequence of inadequate sinus ventilation that arises due to inflammation, allergy, polyps, tumors, surgery, and trauma. The development of frontal sinus is delayed until older than 6 years. Therefore, the development of the mucocele in the frontal sinus after fronto-orbital advancement surgery in young children with craniosynostosis may provide essential information for the development of the frontal sinus. CASE DESCRIPTION We report a rare case of a 22-year-old man presenting with a frontal mucocele manifested by dull headache, proptosis, and diplopia, and which developed 16 years after fronto-orbital advancement surgery for craniosynostosis. Magnetic resonance imaging demonstrated that a multiple cystic mass extended from the frontal sinus to the retro-orbital space along the optic nerve. During surgery, we found that the cyst consisted of mostly thin, yellow mucosa, which developed from an anomalously overdeveloped frontal sinus containing yellow pus-like intracystic fluid. There was no gross local invasion by the cyst. We easily dissected and removed the mucosal cyst from the large frontal sinus completely with frontal sinus obliteration. We cranialized the anomalously large frontal sinus by removal of the posterior wall of the frontal sinus and then widening the ethmoidal drainage with endoscopic ethmoidectomy. CONCLUSION We report the first case of a frontal sinus mucocele that developed after fronto-orbital advancement surgery in the literature and suggest that the mucocele development after fronto-orbital advancement supports the hypothesis of frontal bone-inducing role in frontal sinus development.
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Affiliation(s)
- Soo Han Yoon
- Department of Neurosurgery, Ajou University School of Medicine, Suwon 443-721, South Korea
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Cultrera F, Giuffrida M, Mancuso P. Delayed post-traumatic frontal sinus mucopyocoele presenting with meningitis. J Craniomaxillofac Surg 2006; 34:502-4. [PMID: 17157027 DOI: 10.1016/j.jcms.2006.07.863] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Accepted: 07/24/2006] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To highlight a rare but potentially serious complication of frontal sinus injuries. PATIENT A case of delayed post-traumatic frontal sinus mucopyocoele presenting with meningitis in a 23-year-old male patient is reported. DISCUSSION The anatomy of the frontal sinus is described in relation to the pathogenesis of muco(pyo)coele formation and the relevant literature is reviewed. CONCLUSION This case, in our opinion, emphasizes the importance of thorough evaluation and adequate management of craniofacial trauma involving the paranasal sinuses, with special regard to paediatric patients. Mucocoeles and mucopyocoeles are rare complications that can develop many years after trauma, thus necessitating a virtually life-long follow-up.
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Affiliation(s)
- Francesco Cultrera
- Neurosurgery Unit (Head: Dr. Pietro Mancuso), Clinica Villa Azzurra, Siracusa, Italy.
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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37
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Poetker DM, Smith TL. Endoscopic treatment of the frontal sinus outflow tract in frontal sinus trauma. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.otot.2005.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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