Dear Friends! It’s a relatively straight forward case but I am posting it as a Badge of honor and an instance of personal pride. This is because he was brought to me by Neuro-Surgery HOD himself, who incidentally happens to be a Retired Professor from my ‘alma mater’.
Dileep(Patient) had suffered multiple injuries while riding his bike in his hometown in Bihar, about 4 months back. He was even admitted in a local hospital for 9 days but the attending Surgeon convinced him that this injury is too risky to correct. So Dileep came to Delhi especially for getting this treated as he was supposed to get married next year.
On examination and history taking, it seemed like an isolated Frontal bone Fracture. I got his CT scan done to check the extent of frontal sinus involvement. It was only the Anterior Wall fracture of Frontal Sinus which was displaced backwards. There was no involvement of posterior wall of Frontal Sinus and the inner table of skull seemed intact.
Refracture & Reduction of Frontal bone was planned via Bicoronal approach to the skull. The procedure was carried out via oral intubation and Incision was given from one preauricular crease to another. Coronal flap was raised via conventional technique and the Frontal fracture site was exposed. Depressed fragments were teased out and reduced like a jigsaw puzzle.Frontal sinus mucosa was curretted out to prevent any mucocele formation and Fronto-nasal recess was inspected to ensure patency. Micro plates (1 mm profile Synthes) were use to fix the fragments in place to the surrounding stable frontal bone.
The coronal flap was draped back to check the improvement in profile and make any further adjustments in position of fragments. Once satisfied with reduction and fixation, the flap was closed in layers to prevent any dead space formation. Postoperatively, the wounds healed very well and there were no signs of any CSF leak.
Frontal Fracture management is relatively easy if the treating surgeon knows the relevant anatomy and is otherwise adept in techniques of facial fracture management.
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