TRANSVERSE GLABELLAR FLAP FOR OBLITERATION ISOLATION OF THE NASOFRONTAL DUCT FROM THE ANTERIOR CRANIAL BASE/

Management of fractures involving the nasofrontal duct region of the f rontal sinus has focused on preserving function when possible or oblit erating the sinus and duct when fracture patterns potentiate ductal ob struction and possible transcranial seeding of bacteria. When frontal sinus preservation is in doubt, controversy surrounds the use of crani alization versus obliteration, and the method of obliteration. Periope rative and late postoperative infections are uncommon, but their occur rence jeopardizes an often complex reconstruction and can be life thre atening. This paper describes the design and indications for a pedicle d transverse glabellar muscle flap for obliteration of the nasofrontal duct, thereby isolating the anterior cranial base from the aerodigest ive system. This vascularized muscle flap utilizes the corrugator supe rcilii and procerus muscles, which are introduced into the sinus via a small, surgically created window in the superomedial orbital wall wit hout disturbing the central facial aesthetic contours. Six patients wi th comminuted fractures at the nasofrontal duct level associated with displaced posterior frontal sinus fractures have been treated with the transverse glabellar flap. Follow-up ranges from 8 to 30 months. Ther e have been no early or late postoperative complications. The transver se glabellar flap is a reliable and versatile method of partitioning t he upper aerodigestive tract from the anterior cranial base with vascu larized tissue, thus minimizing the risk of infectious complications. The resulting donor site deformity is more acceptable than that seen w ith the traditional pedicled galeal frontalis flap.