Koumchev Y, Gozmanov G
Department of Neurosurgery, University of Medicine, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 1994;36(3):53-6.
Along with the neurosurgical difficulties, the management of fronto-orbital fractures poses problems of aesthetical nature, especially those that arise in restoring the trauma-deformed face to its original, or close to original, appearance. The cranioplasty using duracryl to deal with defects secondary to impression fractures affecting the frontal sinuses presents a serious therapeutic problem because of the risk of suppuration. We report 48 patients treated in the Department of Neurosurgery of the University of Medicine, Plovdiv between 1981 and 1990. Particular attention was paid to impression fractures affecting the frontal sinus. In addition to the classic method of surgical management of such fractures, a modification of cranioplasty in the region of the frontal sinus is presented which help to avoid the risk of suppuration. The surgical management was performed in two stages separated by a period of 6 to 12 months from the initial treatment of the wound and fracture. Connective tissue covering forms in this period which isolates the frontal sinus opening to the skull defect. Utmost sparing of this connective tissue during cranioplasty with duracryl is a guarantee of successful treatment.
除了神经外科手术的困难外，额眶骨折的处理还存在美学方面的问题，尤其是在将因创伤而变形的面部恢复到原来或接近原来外观时出现的问题。使用杜拉丙烯进行颅骨成形术来处理因累及额窦的凹陷性骨折而导致的缺损，由于存在化脓风险，这是一个严重的治疗难题。我们报告了1981年至1990年间在普罗夫迪夫医科大学神经外科接受治疗的48例患者。特别关注了累及额窦的凹陷性骨折。除了此类骨折的经典手术处理方法外，还介绍了一种在额窦区域进行颅骨成形术的改良方法，有助于避免化脓风险。手术分两个阶段进行，从伤口和骨折的初始治疗开始，两个阶段间隔6至12个月。在此期间会形成结缔组织覆盖物，将额窦开口与颅骨缺损隔离开来。在用杜拉丙烯进行颅骨成形术时，最大限度地保留这种结缔组织是治疗成功的保证。
