Frontal Sinus Obliteration Utilizing Autogenous Abdominal Fat Graft

Abstract

BACKGROUND:Frontal sinus fractures have always been unique because of the controversy surrounding their ideal treatment protocol and the fatal complications that could follow if the wrong treatment opts.AIM:The purpose of this study was to assess clinically and radiographically frontal sinus obliteration technique utilising autogenous abdominal fat graft.PATIENTS AND METHODS:This study was carried out on 20 patients having anterior table fracture of their frontal sinuses indicated for sinus obliteration. All sinuses were obliterated using autogenous abdominal fat graft. Post-operatively, patients were clinically evaluated for any signs or symptoms of intracranial infections, wound dehiscence, sinus affections, or aesthetic deformity. Computerized tomography (CT) radiographic evaluations were carried out immediately and 12 months postoperatively to evaluate any uneventful healing of the graft.RESULTS:Clinical follow-up showed no cerebrospinal fluid leak, no postoperative infection or wound dehiscence in 18 cases. There were two cases however that showed infection. Radiographic follow-up revealed uneventful healing of the abdominal fat grafts with no abnormality detected in the sinus cavity throughout the whole postoperative period.CONCLUSION:Autogenous abdominal fat graft appears to be a successful obliteration material in the frontal sinus cavity and is beneficial in fractures of the anterior table.

Multi-layer approach to complex traumatic anterior skull base fracture repair: A case report

“…Grafted abdominal fat is easily available and has been shown to encourage healing and prevent regrowth of mucoperiosteum. [ 3 , 4 ] While the use of abdominal fat grafts is a standard practice for sinus obliteration when the posterior wall of the frontal sinus remains intact,[ 3 ] fewer reports have investigated its use in the context of frontal sinus cranialization as demonstrated here. Risks associated with grafting abdominal fat to the frontal sinuses include infection as well as mucocele formation in the setting of graft resorption,[ 2 , 3 ] though the incidence of these complications is reportedly low, even in long-term follow-up.…”

“…Risks associated with grafting abdominal fat to the frontal sinuses include infection as well as mucocele formation in the setting of graft resorption,[ 2 , 3 ] though the incidence of these complications is reportedly low, even in long-term follow-up. [ 3 , 4 ]…”

A practical and economical method for frontal sinus reconstruction after frontal craniotomy: A single-center experience with 140 patients

“…Fat has a wide range of sources and strong plastic characteristics, which makes it widely used in the frontal sinus obliteration. However, the use of fat could cause additional damage to the donor sites and prolonge the operative time ( 11 , 17 , 18 , 23 ). The pericranial flap is commonly used for anterior skull base reconstruction ( 24 – 26 ).…”

Choice of Material for Nasofrontal Duct Obliteration in Frontal Sinus Fracture

“…Prior studies have raised the possibility that avascular bone grafts may be associated with greater risk of postoperative infection given that they have demonstrated higher rates of bony resorption, posing a risk of nonpermanent NFD obliteration and resulting ascending infection of the frontal sinus. 29 The present systematic review corroborated these limitations of avascular bone grafts by demonstrating 34 Case report 1 Tibial epiphyseal bone graft and fibrin sealant Rodríguez et al 36 Prospective 18 Cranial bone and DBX de Melo et al 21 Case report 1 Galeal frontalis flap Kim et al 26 Case report 1 Autologous bone graft and hydroxyapatite Kalavrezos et al 10 Retrospective 51 Pericranial flap Singh et al 11 Case report 1 Bone graft from iliac crest Polo et al 12 Case report 1 Pericranium and fascia and temporal muscle flap Faverani et al 22 Case report 1 Pedicled pericranium flap Baccarani et al 28 Case report 1 Combined pericranial flap and free radial fasciosubcutaneous extension forearm flap Eledeissi et al 17 Retrospective 20 Pericranial flap and bone chips Sailer et al 13 Retrospective 66 Pedicled pericranial flap Bluebond-Langner et al 25 Case report 2 Free fibula flap Kim et al 23 Case report 5 Reverse pedicled temporalis muscle flap Jaźwiec et al 24 Case report 1 Pericranial flap Kang et al 31 Retrospective 17 Autogenous calvarial bone de Melo et al 21 Case 27 Case report 7 Fibula free flap Kamoshima et al 19 Case report 1 Pericranial flap Disa et al 20 Case report 6 Pedicled transverse glabellar muscle flap Griner and Sargent 8 Case report 1 Bone graft and pericranial flap Pollock et al 32 Retrospective 34 Bone graft Kim et al 33 Retrospective 14 Bone and fat statistically significant increases in various postoperative morbidities. Bone grafts, when used without any other materials such as an accompanying flap, were associated with an increased occurrence of reoperation, frontal sinus infection, mucocele formation, and total overall number of postoperative complications.…”

“…7,[9][10][11][12][13][14][15][16] Surgical mismanagement of FSF can lead to serious morbidities such as FACE 2 (4) infection, intracranial abscess, mucocele formation, chronic pain, and reoperation. [6][7][8]17 As a result, an analysis of treatment algorithm optimization for FSF is warranted. While numerous studies have examined various aspects of the management ladder for FSF, high-level evidence for specific choice of NFD obliteration material has not yet been established.…”