**Author details**

**12.4. Surgical procedures**

noticed preoperatively.

**Type No.**

**12.5. Discussion**

cases are given in the following table.

**CNS injury** **Other**

**CSF leak**

obliteration and 23 anterior wall reconstructions.

464 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

From patients with **Type 1** injuries 4 patients died due to concomitant CNS trauma. Two patients were operated: both of them were children with severe disruption of FB and the purpose of surgeries was to repair calvarial defects. Only one patient from **Type 2** group was operated to remove a foreign body from the FS. In patients with **Type 3** fractures, there was the highest relative incidence of operative treatment: 24 patients were operated with 1 sinus

**Type 4** group had 33 operated patients, 31 of them received cranialization and 2 obliteration of FS. Dural tears were found in 21 patients in this group despite only 5 cases of CSF leak

**Type 5** group had the lowest relative incidence of operated cases and only 4 patients were operated. In five cases we were not able to reach an agreement with neurosurgery service about the indication to operate. The overview of operative treatment and reasons for not operating

 51 2 18 20 2 4 - - - - 60 0 18 23 1 0 - - - - 35 0 6 6 24 0 7 4 - - 53 5 33 19 33 7 6 3 3 1 11 1 5 0 4 0 1 1 - 5 **∑ 210 8 80 68 64 11 14 8 3 6**

Surprisingly, only one of our operated patients developed an early infectious complicationsoft tissue abscess in the vicinity of the orbital rim, which responded to local incision and antibiotic treatment. The other 2 patients had persistent postoperative CSF leakage and were successfully treated by lumbar drain and bed rest. Similar to other studies we were not able to maintain long term follow-up in the majority of operated cases, not mentioning conserva‐ tively managed cases. Supposedly, had serious complication developed and the patient was still living in Kuwait, he/she would have looked for help in our unit, like other maxillofacial trauma patients, who are usually refused even simple tooth extraction in other facilities other

We recognize the importance of close cooperation with the neurosurgery service in instances of cranio-facial injuries. However, we sometimes run into difficulties when deciding on indications for operative treatment in patients who are in good general condition and without signs of external deformity or CSF leakage. These are mainly patients with type 5 injuries. More

than ours once the patient's trauma history is known to a care provider.

**injuries Operated Died Refused Unfit Transfer Neurosurgeon**

**Disagree**

Petr Schütz\* , Hussein Hassan Hamed Ibrahim and Bashar Rajab

\*Address all correspondence to: petrschutz@yahoo.com

Al-Farwaniya Dental Center, Al-Farwaniya Hospital, Ministry of Health, State of Kuwait

### **References**


[29] Tremolada C, Candiani P, Signorini M, Vigano M, Donati L. The surgical anatomy of the subcutaneous fascial system of the scalp. Annals of Plastic Surgery 1994;32(1):8– 14.

[12] Urken ML, Som PM, Lawson W, et al. The abnormally large frontal sinus. I. A practi‐ cal method for its determination based upon an analysis of 100 normal patients. Lar‐

[13] Manolidis S, Hollier LH Jr. Management of frontal sinus fractures. Plastic and Recon‐

[14] Rohrich RJ, Hollier LH. Management of frontal sinus fractures. Changing concepts.

[15] Harris, L, Marano GD, and McCorkle D. Nasofrontal duct: CT in frontal sinus trau‐

[16] Stanwix MG, Nam AJ, Manson PN, Mirvis S, Rodriguez ED. Critical computed tomo‐ graphic diagnostic criteria for frontal sinus fractures. Journal of Oral and Maxillofa‐

[17] Kennedy DW, Senior BA. Endoscopic sinus surgery: A review. Otolaryngologic Clin‐

[18] Landsberg R, Friedman M. A computer-assisted anatomical study of the nasofrontal

[19] Rohrich RJ, Hollier L. The role of the nasofrontal duct in frontal sinus fracture man‐

[20] Tos M, Mogensen C, Novotny Z. Quantitative histologic features of the normal fron‐

[21] Tiwari P, Higuera S, Thornton J, Hollier LH. The management of frontal sinus frac‐

[22] Laskin D, Abubaker A. Decision Making in Oral and Maxillofacial Surgery. Quin‐

[23] Stevens M, Kline SN: Management of frontal sinus fractures. Journal of Cranio-max‐

[24] Stanley RB Jr, Becker TS. Injuries of the nasofrontal orifices in frontal sinus fractures.

[25] Stanley RB Jr. Management of severe frontobasilar skull fractures. Otolaryngologic

[26] Koudstaal MJ, van der Wal KG, Bijvoet HW, Vincent AJ, Poublon RM. Post-trauma mucocele formation in the frontal sinus; a rationale of follow-up. International Jour‐

[27] Strong EB. Frontal sinus fractures: current concepts. CraniomaxillofacialTrauma&Re‐

[28] Koento T. Current advances in sinus preservation for the management of frontal si‐ nus fractures. Current Opinion in Otolaryngology & Head and Neck Surgery

cial Surgery 2010;68(11):2714-2722. doi: 10.1016/j.joms.2010.05.019.

agement. Journal of Cranio-maxillofacial Trauma 1996;2(1):31–40.

tures. Journal of Oral and Maxillofacial Surgery 2005;63(9):1354-1360.

tal sinus. Archives of Otolaryngology 1980;106(3):143–148.

yngoscope 1987;97(5):602–605.

466 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

ma. Radiology 1987;165(1)195-198.

ics of North America 1997;30(3)313-330.

tenssence; 2007. p74-76.

illofacial Trauma. 1995;1(1):29-37.

Laryngoscope. 1987;97(6):728-731.

Clinics of North America. 1991;24(1):139-150.

nal of Oral and Maxillofacial Surgery 2004;33(8):751-754.

construction 2009;2(3):161-175. doi: 10.1055/s-0029-1234020.

2012;20(4):274-279. doi: 10.1097/MOO.0b013e328355a54a.

region. Laryngoscope 2001;111(12)2135-2130.

structive Surgery. 2007;120(Suppl 2):32S-48S.

Clinics in Plastic Surgery 1992;19(1):219–232.


[59] Cole I, Dan N, Anker A. Bone replacement in head and neck surgery: a biocompati‐ ble alternative. The Australian and New Zealand Journal of Surgery 1996;66(7): 469-472.

[44] Shumrick KA. Endoscopic management of frontal sinus fractures. Otolaryngologic

[45] Smith TL, Han JK, Loehrl TA, Rhee JS. Endoscopic management of the frontal recess in frontal sinus fractures: a shift in the paradigm? Laryngoscope. 2002 May;112(5):

[46] Kim E, Duncavage J. Osteoplastic flap with and without fat obliteration. Operative Techniques in Otolaryngology – Head and Neck Surgery 2010;21(2):134-137. [47] Goodale RL, Montgomery WW. Anterior osteoplastic frontal sinus operation. Five years' experience. Annals of Otology, Rhinology & Laryngology 1961;70(3):860-880. [48] Hardy JM, Montgomery WW: Osteoplastic frontal sinusotomy: An analysis of 250 operations. Annals of Otology, Rhinology & Laryngology 1976;85(4):523-532. [49] Keerl R, Weber R, Kahle G, Draf W, Constantinidis J, Saha A. Magnetic resonance imaging after frontal sinus surgery with fat obliteration. Journal of Laryngology &

[50] Dickinson JT, Cipcic JA, Kamerer DB. Principles of frontal reconstruction. Laryngo‐

[51] Weber R, Draf W, Kahle G, Kind M. Obliteration of the frontal sinus – state of the art

[52] Barone A, Ricci M, Mangano F, Covani U. Morbidity associated with iliac crest har‐ vesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis. Journal of Oral and Maxillofacial Surgery 2011;69(9):2298-2304. doi: 10.1016/j.joms.

[53] Zubillaga Rodríguez I, Lora Pablos D, Falguera Uceda MI, Díez Lobato R, Sánchez Aniceto G. Frontal sinus obliteration after trauma: analysis of bone regeneration for two selected methods. International Journal of Oral and Maxillofacial Surgery 2014l;

[54] Mlynarek AM, Seikaly H. Vascularized anteriorly based pericranial flap for frontal sinus obliteration. Operative Techniques in Otolaryngology – Head and Neck Sur‐

[55] Sailer HF, Grätz KW, Kalavrezos ND: Frontal sinus fractures: Principles of treatment and long-term results after sinus obliteration with the use of lyophilized cartilage.

[56] Peltola MJ, Aitasalo KM, Aho AJ, Tirri T, Suonpää JT. Long-term microscopic and tis‐ sue analytical findings for 2 frontal sinus obliteration materials. Journal of Oral and

[57] Olson NR, Newman MH. Acrylic frontal cranioplasty. Archives of Otolaryngology

[58] Moeller CW, Petruzzelli GJ, Stankiewicz JA: Hydroxyapatite-based frontal sinus ob‐ literation. Operative Techniques in Otolaryngology – Head and Neck Surgery

Maxillofacial Surgery 2008;66(8):1699-1707. doi: 10.1016/j.joms.2007.11.020.

and reflections on new materials Rhinology. 1999;37(1):1-15.

Journal of Cranio-maxillo-facial Surgery 1998;26(4):235-242.

43(7):827-833. doi: 10.1016/j.ijom.2014.02.012.

Clinics of North America 2007;40(2):329–336.

468 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

Otology 1995;109(11):1115-1119.

scope1969;79(6):1019-1074.

2011.01.014.

gery 2009;20(1),88-91.

1969;89(5):774-777.

2010;21(2),147-149.

784-90.

