Cirurgia das fraturas do seio frontal: estudo epidemiológico e análise de técnicas

Abstract

The frontal sinus trauma is not rare and it is 8% of the facial fractures. It can affect the anterior and/or posterior plates, with or without hitting the nasofrontal duct. It has a large potential of complications and its management still being a controversy. Objective: To present the casuistic of fractures frontal sinus, the epidemiology and clinical and surgical management of frontal sinus fractures. Materials and Methods: Not randomized retrospective study of 24 patients with frontal sinus fractures Hospital of Clinics, School of Medicine Botucatu, São Paulo, Brazil. Results: From the 24 patients, we had 16 (66,6%) fractures of the extern plate and 8 (33,4%) of both. In 2 patients the nasofrontal duct was involved. Others facial fractures were associated in 20 (83,4%) cases and major lesions of the cerebral segment were found in 13 (54,2%). Subpalpebral incision was performed in the majority with satisfactory aesthetic results. The basis of the surgical treatment was reduction and fixation with different materials (steel wire, mononylon, titanium miniplates) and if necessary we used alogen implants or parietal bone to reconstruct the anterior plate. Conclusion: The principal cause of frontal sinus fractures is crashed car. The management depends of the complexity, because commonly there are cranioencephalic lesions associated. The surgical thecniques used are the incisions, bicoronal flap or browglabella, infra-orbital rim ("butterfly"), associated a endoscopy sinus surgery in cases of infection, cerobrospinal fluid leak and orbital complications.

Tratamento cirúrgico de fratura em parede anterior do seio frontal

“…Sendo necessário em alguns casos, quando verificado por meio do uso de azul de metileno ou substancias fluorescentes, inseridas pelo ducto nasofrontal, observa-se a perda de continuidade desse ducto, realiza-se a obliteração do seio frontal e do ducto nasofrontal além Research, Society and Development, v. 9, n. 9, e850998118, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i9.8118 da reparação da parede anterior do seio frontal ( Montovani, Nogueira, Ferreira, Lima Neto, & Nakajima, 2006) (Manolidis & Hollier, 2007). Sendo sequelas cosméticas importantes quando a parede anterior é envolvida e sofre deslocamento de seus fragmentos, mucoceles quando há encarceramento de epitélio respiratório em meio aos fragmentos ósseos, mucopielocele quando o quadro de mucocele torna-se infectado, sinusites devido a interrupção da correta drenagem do seio frontal em casos de obliteração do ducto nasofrontal, além de casos mais graves devido a infecção do local do trauma podendo ocorrer abscesso cerebral e meningite , além de sequelas tardias como osteomielites (Sprott, Aceh, & Sprott, 2020); (Stephen Metzinger, Aldo Guerra, 2005); ( Studies et al, 2015).…”

Treatment of frontal bone fracture sequelae through inversion of the bone fragment

“…When there is a dislocated and fragmented fracture of the posterior wall, the treatment of choice is cranialization, always associated with the obliteration of the nasofrontal duct, so that there is no communication of intracranial structures with the external environment 9,11 . Several techniques with different materials are described in the literature for this obliteration, such as abdominal fat, temporal fascia, pericranium, calcium phosphate, and hydroxyapatite 1 .…”

“…Anterior wall displaced fractures are usually treated with open reduction and fixation with miniplates, but other methods of treatment, such as the endoscopicallyassisted and the "camouflage" of the aesthetic defect, can also be used 2,3 . The main advantage of using the endoscope is the lower invasiveness, with conservative surgical access, resulting in better postoperative recovery, but with limited resolution of complex cases or sequelae [9][10][11] . In sequelae case, the technique of camouflage with biomaterials and titanium meshes is the most used, since it allows the correction of the esthetic defect without the need of an osteotomy, with overlaying of only one material.…”

“…The treatment of frontal sinus fractures may range from a simple fixation of the anterior wall to a cranialization and obliteration of the nasofrontal duct, depending on anatomical location, bone comminution, degree of displacement, and presence of brain injury 3,5,9,10 . In cases where only the anterior wall is affected, the treatment varies from reduction and bone fixation, and correction with titanium meshes or with the use of biomaterials 2,3,7,8,11 . In cases of sequelae of the anterior wall fractures, the inversion of the fractured segment becomes an interesting option to correct the local depression.…”

Alterações craniométricas em indivíduos acromegálicos

“…Estas medidas revelam o fenômeno do "bossing frontal", característica importante dentro dos estigmas da acromegalia 1 . Além disso, em associação com a maior espessura da tábua óssea frontal, representar um entrave neurcirúrgico às técnicas transcranianas, pois aumenta a chance de violação do seio frontal durante a craniotomia, elevando o risco de fístula liquórica pós-operatória e infecção no sítio cirúrgico 10,11 .…”