Chen Da-Jeng, Chen Chien-Tzung, Chen Yu-Ray, Feng Guan-Ming
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
J Trauma. 2003 Aug;55(2):378-82. doi: 10.1097/01.TA.0000083333.93868.AB.
Classic approaches to frontal sinus fracture involve bicoronal or direct forehead incisions. However, these incisions cause paresthesia, scarring, and even alopecia. In the field of plastic and reconstructive surgery, endoscopically assisted surgery is now widely accepted, particularly for esthetic surgery. It also is applied for the management of midface and lower-face fractures, but rarely for treatment of the frontal area. The authors present their experience with the repair of frontal sinus fractures using the endoscopically assisted method.
The surgery was performed with the patients under general anesthesia. Two slit incisions were placed in the hair-bearing area, through which a 4-mm 30 degrees endoscope was inserted. The subperiosteal dissection was performed toward the fracture site using an endoscopic periosteal elevator. The depressed fracture segments of the anterior table of the frontal sinus were reduced and fixed with microplates to restore the contour of the forehead. Seven consecutive patients received endoscopic correction of frontal sinus depressed fractures.
No patients required conversion conventional bicoronal incisions. Good anatomic reduction of the fracture sites, acceptable surgical scar, and esthetic recontour were obtained in all the patients. The postoperative course was uneventful, without any complications.
The endoscopically assisted method allows feasible reduction and fixation of a frontal sinus fracture. It avoids the complications of traditional methods and yields improved convalescence and esthetic results. It also helps in the diagnosis of unsuspected cerebrospinal fluid leaks. Thus, for anterior table fractures with an intact nasofrontal duct, endoscopically assisted surgery provides an alternative option of treatment.
经典的额窦骨折治疗方法包括双冠状切口或直接前额切口。然而，这些切口会导致感觉异常、瘢痕形成，甚至脱发。在整形和重建外科领域，内镜辅助手术现已被广泛接受，尤其是在美容手术中。它也被应用于面中部和面部下部骨折的治疗，但很少用于额部区域的治疗。作者介绍了他们使用内镜辅助方法修复额窦骨折的经验。
手术在全身麻醉下进行。在有毛发的区域做两个切口，通过这些切口插入一个4毫米30度的内镜。使用内镜骨膜剥离子向骨折部位进行骨膜下剥离。额窦前壁凹陷的骨折段复位并用微型钢板固定，以恢复前额的轮廓。连续7例患者接受了额窦凹陷骨折的内镜矫正。
没有患者需要改为传统的双冠状切口。所有患者骨折部位均获得良好的解剖复位，手术瘢痕可接受，外形重塑美观。术后过程顺利，无任何并发症。
内镜辅助方法能够对额窦骨折进行可行的复位和固定。它避免了传统方法的并发症，提高了康复效果和美观度。它还有助于诊断未被怀疑的脑脊液漏。因此，对于鼻额管完整的前壁骨折，内镜辅助手术提供了一种替代治疗选择。
