Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Reduction of comminuted fractures of the anterior wall of the frontal sinus using threaded Kirschner wires and a small eyebrow incision

  • Lee, Da Woon (Department of Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Kwak, Si Hyun (Department of Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Choi, Hwan Jun (Department of Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Jun Hyuk (Department of Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine)
  • Received : 2022.09.29
  • Accepted : 2022.10.19
  • Published : 2022.10.20
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Abstract

Background: Frontal sinus fractures are relatively rare. Their surgical management significantly differs depending on whether the posterior wall is invaded and the clinical features vary. A bicoronal incision or endoscopic approach can be used. However, the minimally invasive approach has been attracting attention, leading us to introduce a simple and effective surgical method using multiple-threaded Kirschner wires. Methods: All patients had isolated anterior wall fractures without nasofrontal duct impairment. The depth from the skin to the posterior wall was measured using computed tomography to prevent injury. The edge of the bone segment on the skin was marked, a threaded Kirschner wire was inserted into the center of the bone segment, and multiple Kirschner wires were gently reduced simultaneously. Results: Surgery was performed on 11 patients. Among them, seven patients required additional support for appropriate fracture reduction. Therefore, a periosteal elevator was used as an adjunct through a small sub-brow incision because the reduction was incomplete with the Kirschner wire alone. The reduction results were confirmed using facial bone computed tomography 1 to 3 days postoperatively. The follow-up period was 3 to 12 months. Conclusion: The patients had no complications and were satisfied with the surgical results. Here we demonstrated an easy and successful procedure to reduce a pure anterior wall frontal sinus fracture via non-invasive threaded Kirschner wire reduction.

Keywords

Acknowledgement

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (2021R1G1A1008337) and was supported by the Soonchunhyang University Research Fund.

References

  1. Sakat MS, Kilic K, Altas E, Gozeler MS, Ucuncu H. Comminuted frontal sinus fracture reconstructed with titanium mesh. J Craniofac Surg 2016;27:e207-8. https://doi.org/10.1097/SCS.0000000000002466
  2. Kim J, Choi H. A review of subbrow approach in the management of non-complicated anterior table frontal sinus fracture. Arch Craniofac Surg 2016;17:186-9. https://doi.org/10.7181/acfs.2016.17.4.186
  3. Gerbino G, Roccia F, Benech A, Caldarelli C. Analysis of 158 frontal sinus fractures: current surgical management and complications. J Craniomaxillofac Surg 2000;28:133-9. https://doi.org/10.1054/jcms.2000.0134
  4. Nahum AM. The biomechanics of facial bone fracture. Laryngoscope 1975;85:140-56. https://doi.org/10.1288/00005537-197501000-00011
  5. Bellamy JL, Molendijk J, Reddy SK, Flores JM, Mundinger GS, Manson PN, et al. Severe infectious complications following frontal sinus fracture: the impact of operative delay and perioperative antibiotic use. Plast Reconstr Surg 2013;132:154-62.
  6. McGrath MH, Smith CJ. A simple method to maintain reduction of unstable fractures of the frontal sinus. Plast Reconstr Surg 1981;68:948-9. https://doi.org/10.1097/00006534-198112000-00020
  7. Strong EB. Frontal sinus fractures: current concepts. Craniomaxillofac Trauma Reconstr 2009;2:161-75. https://doi.org/10.1055/s-0029-1234020
  8. Manolidis S, Hollier LH Jr. Management of frontal sinus fractures. Plast Reconstr Surg 2007;120(7 Suppl 2):32S-48S. https://doi.org/10.1097/01.prs.0000260732.58496.1b
  9. Jin HR, Shim WS, Jung HJ. Minimally invasive technique to reduce the isolated anterior wall fracture of the frontal sinus. J Craniofac Surg 2019;30:2375-7. https://doi.org/10.1097/SCS.0000000000005931
  10. Hewitt DK, Scheidt TD, Calhoun KH. Depressed anterior table fracture: a minimally invasive method of reduction. Ear Nose Throat J 2009;88:734-5. https://doi.org/10.1177/014556130908800110
  11. Hwang K, Song YB. Closed reduction of fractured anterior wall of the frontal bone. J Craniofac Surg 2005;16:120-2. https://doi.org/10.1097/00001665-200501000-00023
  12. Meiklejohn BD, Lynham A, Borgna SC. A simplified approach for the reduction of specific closed anterior table frontal sinus fractures. Br J Oral Maxillofac Surg 2014;52:81-4. https://doi.org/10.1016/j.bjoms.2013.09.012
  13. Kim KS, Kim ES, Hwang JH, Lee SY. Transcutaneous transfrontal approach through a small peri-eyebrow incision for the reduction of closed anterior table frontal sinus fractures. J Plast Reconstr Aesthet Surg 2010;63:763-8. https://doi.org/10.1016/j.bjps.2009.01.085
  14. Graham HD 3rd, Spring P. Endoscopic repair of frontal sinus fracture: case report. J Craniomaxillofac Trauma 1996;2:52-5.
  15. Shumrick KA. Endoscopic management of frontal sinus fractures. Facial Plast Surg Clin North Am 2006;14:31-5. https://doi.org/10.1016/j.fsc.2005.11.004
  16. Yoo MH, Kim JS, Song HM, Lee BJ, Jang YJ. Endoscopic transnasal reduction of an anterior table frontal sinus fracture: technical note. Int J Oral Maxillofac Surg 2008;37:573-5. https://doi.org/10.1016/j.ijom.2008.03.010
  17. Shin SJ, Lim H, Park DH, Park MC. Closed reduction of fractured anterior wall of the frontal sinus using threaded K-wires. J Craniofac Surg 2012;23:e251-3. https://doi.org/10.1097/SCS.0b013e3182518695
  18. Kim NH, Kang SJ. A simple aesthetic approach for correction of frontal sinus fracture. J Craniofac Surg 2014;25:544-6. https://doi.org/10.1097/SCS.0000000000000469
  19. Bourry M, Oliver C, Maalouf J, Corre P, Bertin H. Surgical approach of isolated fracture of the anterior wall of the frontal sinus: the upper eyelid incision. J Stomatol Oral Maxillofac Surg 2019;120:240-3. https://doi.org/10.1016/j.jormas.2018.11.010
  20. Hahn HM, Lee YJ, Park MC, Lee IJ, Kim SM, Park DH. Reduction of closed frontal sinus fractures through suprabrow approach. Arch Craniofac Surg 2017;18:230-7. https://doi.org/10.7181/acfs.2017.18.4.230
  21. Shin HS, Kim SY, Cha HG, Han BL, Nam SM. Real time navigation- assisted orbital wall reconstruction in blowout fractures. J Craniofac Surg 2016;27:370-3. https://doi.org/10.1097/SCS.0000000000002410
  22. Franz L, Isola M, Bagatto D, Tuniz F, Robiony M. A novel approach to skull-base and orbital osteotomies through virtual planning and navigation. Laryngoscope 2019;129:823-31. https://doi.org/10.1002/lary.27479