Minimizing complications associated with coronal approach by application of various modifications in surgical technique for treating facial trauma: A prospective study

Abstract

Background:Coronal incision is a popular and versatile surgical approach to the anterior cranial vault and upper and middle third facial skeleton. The flap itself permits widespread exposure of the fractures in this region. The bicoronal flap was first described by Hartley and Kenyon (neurosurgeons) to gain access to the anterior cranium in 1907. It extension as an access flap to the upper and lateral aspect of the face was pioneered by Tessier (1971). Esthetically, it is pleasing as the surgical scar is hidden within the hair.Aims:To evaluate the versatility of coronal incision using various modifications advocated in incision, exposure to fractured site, and closure of flap in treating the upper and middle third facial fractures.Materials and Methods:A total of ten patients diagnosed with upper and middle third facial fractures requiring open reduction and internal fixation/correction of contour defect were selected after preoperative clinical and radiographic (computed tomography scan) evaluation. All the cases were operated by coronal approach to gain the access to the fracture/defect site for reduction/correction of the defect. Advantages and complication are evaluated.Results:Excellent access and anatomical reduction by this approach with least number of complications; if it is performed with healthy knowledge of anatomy of the scalp and temporal region. Certain minimal complications have also been noted using various modifications used in the procedure.Conclusion:Despite of prolonged surgical time for the exposure, it is very advantages in treating upper and middle third facial fractures due to wide access and discreet scar (minimal).

Transpalpebral Frontal Sinus Septectomy: Feasibility and Results

“…2,[22][23][24] The coronal approach does not induce facial scarring but may be associated with permanent hypoesthesia or alopecia. 25 The transfacial approach is less exposed to these complications but can lead to a visible facial scar. With this approach, the lateral extent can be visualized using angled optics (30 or 70 ), although surgical access remains difficult.…”

Tissue engineering strategies combining molecular targets against inflammation and fibrosis, and umbilical cord blood stem cells to improve hampered muscle and skin regeneration following cleft repair

“…Tissue engineering/regenerative medicine scaffolds require the appropriate physical and cellular signals to promote tissue regeneration . The sum of the biochemical signals and biophysical cues from the microenvironment dictate the fate of stem cells . The sum of pro‐ and anti‐inflammatory and fibrotic factors, the shape of scaffolds, stiffness of the matrix, nanotopography and the presence of biofunctional groups as RGD‐sequences discriminates between scarring and regeration of tissue .…”

“…181 The sum of the biochemical signals and biophysical cues from the microenvironment dictate the fate of stem cells. 182 The sum of pro-and anti-inflammatory and fibrotic factors, the shape of scaffolds, stiffness of the matrix, nanotopography and the presence of biofunctional groups as RGD-sequences discriminates between scarring and regeration of tissue. 183 Mechanical cues may be applied in tissue engineering by adjusting the type, stiffness and architecture of the scaffolds facilitating the differentiation of cord blood stem cells into either skin or muscle tissue.…”

Transpalpebral approach for frontal sinus diseases: A camouflaged technique

“…The advantage of the coronal approach is the avoidance of visible facial scars. However, this technique can be associated with residual hypoesthesia and alopecia . Albathi et al and Knipe et al described combined endonasal and eyelid approaches for limited surgical indications …”