Primary reconstruction of depressed frontal skull fractures including those involving the sinus, orbit, and cribriform plate

Abstract

✓ Instead of discarding bone as in past practice with depressed skull fractures, fragments were soaked in Betadine, trimmed, reinserted into the skull defect, and covered with flaps of pericranium, muscle, or fascia. Of the 110 patients who had bone replaced, 65 had frontal fractures, which in 33 involved the frontal sinus, cribriform plate, or orbital rim. Fractures involving sinuses were treated by exenterating the sinus and packing it with muscle. The frontal and orbital rim region were reconstructed whenever possible with a mosaic of replaced bone. There were no deaths due to the minimal complications from the procedure. Despite severely macerated, contaminated, and in several instances, infected scalp wounds, most bone fragments have survived, and cranial defects have gradually filled with new bone. The authors believe that immediate bone replacement for depressed frontal fractures with or without orbital, sinus, or cribriform plate involvement is both practical and safe.