EVALUATION OF CRANIALIZATION TECHNIQUE IN T HE TREATMENT OF FRONTAL SINUS FRACTU RES

Frontal sinus fractures are of surgical importance because of the microbial flora covering the frontal air sinus and it's proximity with the duramater and brain. There is an increased risk of meningitis when fracture of the posterior wall of the frontal sinus is associated with a dural tear. In this condition, communication occurs between the contaminated space of the air sinus and the intracranial space, which may be concurrent with cerebrospinal fluid (CSF) leakage. Non-depressed fracture of the posterior wall of the frontal sinus per se generally doesn't warrant surgical repair, but in some cases when conservative therapy fails to manage CSF leakage and when there is severe injury to the posterior wall of the sinus or to the sinus drainage duct, surgical treatment is warranted. Cranialization is the surgical procedure for such patients in whom communication between the frontal air sinus and outside space is cut off and the air sinus space is integrated with the intracranial space. In this study, we evaluated 29 patients with frontal region fracture who underwent cranialization performed by a single surgery team. Of these patients, 89.7% were male and 10.3 % were female. The most common cause of injury was found to be vehicle accident trauma (65.5%). These patients were also seen to have concurrent iJ1iuries involving the brain parenchyma, cranial nerves (II and III), and pneumocephalus. Post-operative complications included rhinorrhea, CSF leakage from the wound, meningitis and superficial infection of the site of surgery. All these complications improved with conservative therapy. In general, in cases of severe injuries to the posterior wall of the frontal air sinus with nasofrontal duct injury, cranialization is an appropriate procedure. In these patients, in order to reduce complications it is essential that particular attention be paid to the repair of the damaged duramater and to the closure of the nasofrontal duct.