Surgery After Midfacial Trauma continued from p. 3
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fixation, depending on the degree of comminution, to include the
use of transnasal wires to attain adequate reduction as they assist
with stabilization of small fracture fragments (Fig. 3).
There are several indications to repair frontal sinus fractures
that include correcting any aesthetic deformity, maintaining normal sinus drainage, and preventing intracranial infections or
CSF leakage. If the fracture involves the frontal sinus outflow
tract or if there is posterior table involvement with dural injury,
then cranialization or obliteration of the frontal sinus may be necessary (Fig. 4). Cranialization refers to removal of the posterior
table to create a common intracranial and frontal sinus cavity.
The entirety of the mucosal lining of the frontal sinus must be
stripped off to prevent mucocele formation. Obliteration differs
from cranialization in that the posterior table is not removed and,
instead, the sinus is packed with an inert material such as fat or
muscle to fill the once pneumatized chamber.
Complications can arise from any of the procedures performed for midfacial fracture repair. Some of the more common
complications encountered include inadequate reduction, mal-union, dacrocystitis, mucocele formation, and infection. Imaging
with CT is often indicated to assess for any of these pathologic
states as it has high diagnostic accuracy. The adequacy of reduc-
Imaging with CT is often indicated to assess
for any of these pathologic states as it has
high diagnostic accuracy. The adequacy of
reduction is particularly evident on CT and
comparison with the normal contralateral side
can be helpful.
Fig. 3—Repair of
A patient who
followup after right
type I NOE fracture
tion is particularly evident on CT and comparison with the normal contralateral side can be helpful. MRI is, however, the
preferred modality in the setting of suspected mucocele after
cranialization or frontal sinus obliteration due to the improved
soft tissue characterization.
In conclusion, the use of C T in the postoperative setting after
midfacial fracture repair is commonplace and the ability to distinguish expected procedural changes versus potential complications is critical to the interpreting radiologist.n
1. Reiter MJ, Schwope RB, Theler JM. Postoperative CT of the midfacial skeleton after trauma: review of normal appearances and common complications.
AJR 2017; 209: W238–W248
Fig. 4—Repair of
frontal sinus fracture.
A patient who
presented with frontal
due to anterior-table-only fracture
with involvement of