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Elimination of Frontal Sinus Because of Fronto-Oronasal Communication after Trauma

Flores-Lima, Gerardo, M.D.; Lovo Iglesias, Eduardo E., M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 2189-2190
doi: 10.1097/PRS.0b013e3181bcf628
LETTERS
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Military Hospital of El Salvador, El Salvador

Correspondence to Dr. Flores-Lima, Military Hospital of El Salvador, floresguandique@hotmail.com

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Sir:

Having read the article by Cole et al. in the Journal,1 we would like to present an interesting case of one patient operated on by a plastic surgery and neurosurgical team, in whom we used a similar approach to cover a wide defect at the frontal sinus area.

The patient was a 34-year-old man with severe craniofacial trauma (Fig. 1). He also had a cleft lip and palate that had been operated on 30 years previously that had a secondary palatal and dentoalveolar fistula. The patient had a wide loss of bone tissue over the frontal area and orbital rims. He also had a Le Fort II fracture in which one of the fracture lines crossed the dentoalveolar fistula, and a fracture of the cribriform plate that produced a dural tear and pneumocephalus. The first approach was performed by the neurosurgery team; they evacuated the epidural and frontal hematomas, closed the dural tears, and extracted all the frontal sinus and the residual bone at the nasal cavity. Then, an anterior base pedicle pericranium flap was raised by the plastic surgery team to reconstruct the anterior cranial fossa. Afterward, the plastic surgery team performed the frontal bone and orbital rim reconstruction with titanium mesh (Fig. 2). The titanium mesh was bent backward at the level of the orbital rim to reproduce the orbital concavity.

Fig. 1.

Fig. 1.

Fig. 2.

Fig. 2.

The second operation was performed 7 days after the first one. The dentoalveolar fistula was closed with palatal and gingival local flaps. Then, a vestibular approach was used, and a titanium mesh was placed over the area of the closed fistula (Fig. 3). The titanium mesh crossed from the right maxilla to the left, avoiding the nasal cavity. Then, the mesh was secured with self-tapping 5-mm screws. The titanium mesh produced adequate stability of the Le Fort II fracture. The patient did not present any signs of exposure of the titanium mesh or signs of dural fistula. Olfactory nerves were irreversibly damaged, producing permanent anosmia.

Fig. 3.

Fig. 3.

Gerardo Flores-Lima, M.D.

Eduardo E. Lovo Iglesias, M.D.

Military Hospital of El Salvador

El Salvador

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REFERENCE

1. Cole P, Kaufman Y, Momoh A, et al. Techniques in frontal sinus fracture repair. Plast Reconstr Surg. 2009;123:1578–1579.

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