April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Facial plastic surgery

FIGURE 4. Algorithm for management of posterior table frontal sinus fractures.

not without morbidity. Complication rates after cranialization or obliteration range from 10–17% and include headaches, wound infections, persis- tent CSF leaks, mucocele, intracranial infection, and esthetic abnormalities [18]. Therefore, there has been a trend toward observation of injuries deemed low risk for mucocele formation and acute management of persistent CSF leaks via a Draf III approach. These endoscopic techniques are new and have not completely replaced more traditional approaches. However, successful clinical experience and publications continue to validate this approach. Woodworth and colleagues demonstrate the long- term safety of transnasal endoscopic repair of

posterior table frontal sinus fractures [16 && ]. In their prospective series of 46 patients, 87% ( n ¼ 40) had isolated posterior table fractures with associated CSF leaks. Access was obtained via a Draf IIa, IIb, or III frontal sinusotomy (Table 1), and posterior table fractures were treated with removal of mucosa at the fracture site for simple fractures and, additionally, removal of comminuted bone segments for complex fractures (Fig. 3). CSF leak and skull base defects (measuring 17.1 11.4mm 9.1 11.3mm) were performed with porcine small intestine submucosal grafts, nasoseptal flaps, cadaveric perichondrium grafts or fat. During their average follow-up period of 26months (range, 2weeks to 79months), they had no CSF leaks and a 4% ( n ¼ 2) complication rate. One

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Volume 27 Number 4 August 2019

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