Korean J Neurotrauma.  2019 Apr;15(1):11-18. 10.13004/kjnt.2019.15.e12.

Restoration of the Fronto-Orbital Buttress with Primary Bone Fragments

• Kim YH
• Kang DH

• KMID: 2444200
• DOI: http://doi.org/10.13004/kjnt.2019.15.e12

Abstract

OBJECTIVE
Forehead deformities are often caused by lack of treatment or incorrect restoration of the frontal buttress, so the underlying frontal buttress should be restored to its previous position to ensure that the previous forehead contour is restored in cases of complex depressed skull fractures. However, since brain injuries from skull fractures could have fatal consequences, the clinical concern in primary surgery has been to save the patient's life, and cosmetic concerns have always been secondary. We retrospectively reviewed fronto-orbital fracture patients who underwent primary restoration with primary bone fragments or an alloplastic implant and compared the surgical outcomes of autologous bone (group 1) and artificial materials (group 2).
METHODS
A retrospective review was conducted of 47 patients with fronto-orbital fractures between March 2012 and January 2018. The patients underwent primary reconstruction with primary bone fragments or an alloplastic implant. The surgical results were evaluated by the incidence of infection and cosmetic satisfaction of patients.
RESULTS
Infections occurred in one patient (5%) in group 1 and in two patients (15.3%) in group 2, which was not a statistically significant difference. In contrast, at 6 months after surgery, patient satisfaction showed a statistically significant between-group difference (group 1: 4.32 points, group 2: 3.54 points, p=0.001).
CONCLUSION
Primary reconstruction using fractured bone fragments is an effective and preferable method that could result in better surgical outcomes than restoration using an alloplastic implant.

Keyword

Frontal sinus; Skull fractures; Fracture treatment

MeSH Terms

Brain Injuries
Congenital Abnormalities
Forehead
Frontal Sinus
Humans
Incidence
Methods
Patient Satisfaction
Retrospective Studies
Skull Fracture, Depressed
Skull Fractures

Figure

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  FIGURE 1 (A) The transverse frontal buttress is a complex structure formed by the frontal bone, frontal sinus, and supraorbital rim that determines the upper facial width and projection of the forehead. (B) Forehead deformities are often caused by lack of treatment or incorrect restoration of the frontal buttress.

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  FIGURE 2 A 59-year-old woman with a compound comminuted depressed fronto-orbital fracture, underwent fronto-orbital reconstruction with primary bone fragments. Preoperative and postoperative three-dimensional computed tomography images.

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  FIGURE 3 A 19-year-old woman with a compound comminuted depressed fronto-orbital fracture, underwent fronto-orbital restoration with primary bone fragments. Preoperative and postoperative three-dimensional computed tomography images.

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