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Titanium Mesh Repair of the Severely Comminuted Frontal Sinus Fracture
Raam S. Lakhani, MD;
Terry Y. Shibuya, MD;
Robert H. Mathog, MD;
Steven C. Marks, MD;
Don L. Burgio, MD;
George H. Yoo, MD
Arch Otolaryngol Head Neck Surg. 2001;127:665-669.
Background Severely comminuted frontal sinus fractures are difficult to contour
and immobilize. Frequently, plates or wires are inadequate in fixating all
fragments together, resulting in less than optimal outcomes. Advancements
in the development of biomaterials have now made titanium mesh a new option
for the repair of severely comminuted fractures.
Methods Fourteen patients with severely comminuted frontal sinus fractures were
treated with titanium mesh from 1994 to 1999. The fractures were reduced and
immobilized using a simple algorithm: (1) Isolated anterior table fractures
were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior
table fractures with nasofrontal duct involvement were repaired by sinus obliteration
and anterior wall reconstruction with reduced bony fragments attached to titanium
mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid
leak or displacement were treated with the cranialization of the sinus and
anterior wall reconstruction with reduced bony fragments attached to titanium
mesh.
Results Of the 14 patients treated, 12 were available for postoperative evaluation.
Parameters such as nasal function, cranial nerve V and VII function, cosmesis,
and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis,
mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak)
were evaluated. All patients had good function of the superior division of
cranial nerves V and VII. Two patients (16%) had minor wound infections, which
resolved under treatment with antibiotics. All had excellent cosmetic results
as measured by postreduction radiographs and personal and family perceptions
of forehead contour.
Conclusion Titanium mesh reconstruction of severely comminuted frontal sinus fractures
has few complications while providing excellent forehead contour and cosmesis.
From the Departments of Otolaryngology–Head & Neck Surgery,
Wayne State University School of Medicine, Detroit, Mich (Drs Lakhani, Mathog,
Marks, Burgio, and Yoo) and the University of California Irvine College of
Medicine, Orange, Calif (Dr Shibuya).
Corresponding author: Terry Y. Shibuya, MD, Department of Otolaryngology–Head
& Neck Surgery, University of California Irvine College of Medicine, 101
The City Drive South, Bldg 25, Orange, CA 92868, (e-mail: tshibuya{at}uci.edu).
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Archives of Otolaryngology–Head & Neck Surgery Reader's Choice: Continuing Medical Education
Arch Otolaryngol Head Neck Surg. 2001;127(6):725-726.
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