Jung S Heredero, Aniceto G Sánchez, Rodríguez I Zubillaga, Diaz R Gutiérrez, Recuero I I García
Maxillofacial Surgery Department, 12 de Octubre University Hospital, Madrid, Spain.
Craniomaxillofac Trauma Reconstr. 2009 May;2(2):61-6. doi: 10.1055/s-0029-1202594.
We present the clinical case of a patient with open bilateral frontal sinus fractures who developed a frontal osteomyelitis. A review of the problem and management ascending to the different alternatives for central anterior skull base defects and fronto-orbital reconstruction is also presented. After extensive radical debridement of the necrotic bone, final reconstruction of the skull base was performed by using a rectus abdominis free flap. A custom-made hard tissue replacement implant was used for the fronto-orbital reconstruction. Extensive debridement is required for the treatment of frontal osteomyelitis. An appropriate isolation of the skull base from the upper aerodigestive system must be obtained to prevent continuous infectious complications. Free flaps are especially useful for skull base reconstruction when traditional methods are not available or have failed because of the lack of available tissue for vascularized reconstruction. Custom-made alloplastic implants are a good reconstructive option for large fronto-orbital defects once the infection is gone and vascularized tissue has been transferred.
我们报告了一例双侧开放性额窦骨折患者并发额骨骨髓炎的临床病例。本文还回顾了针对中央前颅底缺损和额眶重建的不同治疗方案及其处理方法。在对坏死骨进行广泛彻底清创后，采用腹直肌游离皮瓣对颅底进行了最终重建。使用定制的硬组织替代植入物进行额眶重建。治疗额骨骨髓炎需要进行广泛彻底的清创。必须对颅底与上呼吸消化道系统进行适当隔离，以防止持续出现感染性并发症。当传统方法不可用或因缺乏用于血管化重建的可用组织而失败时，游离皮瓣对于颅底重建特别有用。一旦感染消除且已转移血管化组织，定制的异体植入物是修复大型额眶缺损的良好选择。
