Reconstruction of the Forehead and FrontalCavity

Overview

Reconstruction of the forehead and frontal cavity is necessary in case of injury, tumourand chronic inflammation in this region. From 1996 to 2001 19 patients were operated on for frontalfracture (12) tumour (6) and frontal sinusitis (1). The postoperative bone defect was reconstructedin all cases. Several approaches were used. In the case of injury with torn skin the operative fieldwas reached through the wound. Eyebrow incision was used in 7 cases, eyebrow incision with skinincision in nasal root in 5 cases, and coronal incision with scalp stripping was used in 5 cases wherewide frontal exposure was desired. Impression fracture of the frontal bone was managed either byelevation and fixation of bony fragments using permanent suture material or metal splints. Initiallya bony graft from the iliac crest, or rib cartilage was used for reconstruction of a large bony defect,now metal titanium minisplints and mesh are used instead. In three cases the anterior frontal wallwas destroyed by big osteoma and there was no healthy bone suitable for reconstruction. On patientsuffered from hyperostosis, which had to be removed. Aesthetic results were very good in all butone patient and a second operation because of sinusitis was required in two patients. In patientswith frontobasal fractures with liquorrhea and a damaged posterior wall cooperation with a neurosurgeon is neccessary. Peroperative revision of the frontonasal duct is recommended.

Key words:
forehead reconstruction, frontobasal injury, titanic minisplints, hyperostosis.