FRONTAL SINUS OBLITERATION UTILIZING AUTOGENOUS ABDOMINAL FAT GRAFT

Introduction & Purpose: Frontal sinus fractures pose an interesting and challenging problem, as optimal treatment strategies for their management remain controversial. These fractures are peculiar in that a wrong treatment encompasses not only functional or aesthetical problems but also more dangerous complications. Various techniques have been advocated to repair or remove the frontal sinus that depend on the mechanism and extent of the injury and the status of the nasofrontal duct (NFD). Management options include: observation, open reduction and fixation of anterior table, sinus obliteration (with a wide range of materials); and, in more complex situations, sinus cranialization, and endoscopy (not in complex cases but in simple minimally displaced fractures). The purpose of this study was to assess clinically and radiographically frontal sinus obliteration technique utilizing autogenous abdominal fat graft.
Patients & Methods: This study was carried out on 10 patients suffering unilateral and/or bilateral anterior table fracture of their frontal sinuses approximating the nasofrontal duct and having intact posterior tables indicated for sinus obliteration, selected from Cranio-Maxillofacial Surgeryl Department, Nasser Institute Hospital. All Patients were treated under general anesthesia and the sinus was approached either through a bicoronal approach or the existing lacerations. All sinuses were obliterated using autogenous abdominal fat graft and the anterior table was reduced and fixed with rigid internal fixation and the associated fractures were managed as required. All patients were clinically evaluated for any signs or symptoms of intracranial infections (brain abscess or meningitis), wound dehiscence, Sinus affections (sinusitis-mucocele- pyomucocele) or aesthetic deformity. Computerized tomography (CT) radiographic evaluations were carried out at immediate and 12 months post operatively to evaluate any uneventful healing of the graft detected by the amount of sinus expansion, thinning or bone erosion and bone occupying lesions or infection.
Results: In the current study, motor vehicle accidents were the most common cause and 90% of the included subjects were males with a mean age of 35 years (21-53). In 80% of the studied sample, the frontal sinus fracture was associated with other maxillofacial fractures, other 20% was isolated sinus Fracture. Clinical follow-up showed no neurologic impairment, no cerebrospinal fluid leak, no postoperative infection or wound dehiscence except only one case (10%). Radiographic follow-up revealed that the abdominal fat grafts underwent uneventful healing and no abnormality was detected in the sinus cavity throughout the whole postoperative period.
Conclusion: Frontal sinus obliteration using autogenous abdominal fat appears to be successful and useful for patients with anterior table fractures.