Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures

Justine C. Lee, Brian T. Andrews, Hamid Abdollahi, Alex G. Lambi, Clifford Pereira, James P. Bradley

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging. Methods: Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded. Results: Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%). Conclusions: A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.

Original languageEnglish (US)
Pages (from-to)e64-e67
JournalJournal of Craniofacial Surgery
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Frontal Sinus
Osteotomy
Tomography
Operative Time
Intraoperative Complications
Length of Stay
Wounds and Injuries
Demography
Mucocele
Cerebrum
Operating Rooms
Meningitis
Hematoma
Tissue Donors
Transplants
Bone and Bones

Keywords

  • anterior table frontal sinus
  • CT-guided navigation
  • Frontal sinus fracture

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures. / Lee, Justine C.; Andrews, Brian T.; Abdollahi, Hamid; Lambi, Alex G.; Pereira, Clifford; Bradley, James P.

In: Journal of Craniofacial Surgery, Vol. 26, No. 1, 01.01.2015, p. e64-e67.

Research output: Contribution to journalArticle

Lee, Justine C. ; Andrews, Brian T. ; Abdollahi, Hamid ; Lambi, Alex G. ; Pereira, Clifford ; Bradley, James P. / Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures. In: Journal of Craniofacial Surgery. 2015 ; Vol. 26, No. 1. pp. e64-e67.
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abstract = "Background: Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a {"}cut-as-you-go{"} technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging. Methods: Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded. Results: Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25{\%} of patients had inadvertent dural exposure, and 12.5{\%} required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11{\%} required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95{\%}) compared with plain radiograph template (85{\%}) and the cut-as-you-go group (72.5{\%}). Conclusions: A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.",
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AB - Background: Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging. Methods: Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded. Results: Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%). Conclusions: A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.

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