Definitive treatment of persistent frontal sinus infections: elimination of dead space and sinonasal communication
| Autor: | Matthew G. Stanwix, Arthur J. Nam, Paul N. Manson, Hugo St. Hilaire, Eduardo D. Rodriguez, Oliver P. Simmons |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Dead space medicine.medical_treatment Surgical Flaps medicine Paranasal Sinus Diseases Humans In patient Nose Sinus (anatomy) Aged Frontal sinus Debridement Skull Fractures business.industry Trauma center Bacterial Infections Middle Aged Surgery medicine.anatomical_structure Fibula Frontal Sinus Female business Motor vehicle crash |
| Zdroj: | Plastic and reconstructive surgery. 123(3) |
| ISSN: | 1529-4242 |
| Popis: | Background: Frontal sinus injury involving nasofrontal outflow tract obstruction is routinely managed by obliteration or cranialization; however, a small percentage of patients develop persistent indolent infections despite routine measures. The authors discuss the course of persistent infection following frontal sinus fractures and propose a novel treatment that definitively obliterates and separates the nasofrontal outflow tract from the cranium in these patients. Methods: Seven consecutive patients with persistent indolent infections associated with frontal sinus fractures were identified and treated at the R Adams Cowley Shock Trauma Center and The Johns Hopkins Hospital from 2005 to 2008. Results: There were three women and four men, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 4), motorcycle crash (n = 1), fall (n = 1), and other accident (n = 1). All patients were previously treated with conventional techniques (average, 3.6 procedures and 11 years from initial injury) and prolonged antibiotic therapy without resolution of symptoms. Definitive treatment included radical debridement and obliteration with a free fibula flap in a single stage. All flaps survived and resulted in complete sinonasal separation and eradication of infection. There were no donor-site or frontal sinus complications. Conclusions: Radical debridement, meticulous removal of the tenacious sinus mucosa, and reconstruction with a free fibular flap in a single stage is a superb choice for eliminating persistent infectious complications associated with frontal sinus fractures in patients who have failed conventional management. The fibular flap provides a secure horizontal buttress, seals the nasofrontal outflow tract with vascularized muscle, and obliterates dead space. |
| Databáze: | OpenAIRE |
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