Titanium mesh repair of the severely comminuted frontal sinus fracture

Background: Severely comminuted frontal sinus fractures are difficult to co ntour and immobilize. Frequently, plates or wires are inadequate in fixatin g all fragments together, resulting in less than optimal outcomes. Advancem ents in the development of biomaterials have now made titanium mesh a new o ption for the repair of severely comminuted fractures. Methods: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were redu ced and immobilized using a simple algorithm: (1) Isolated anterior table f ractures were repaired with reduced bony fragments attached to titanium mes h. (2) Anterior table fractures with nasofrontal duct involvement were repa ired by sinus obliteration and anterior wall reconstruction with reduced bo ny fragments attached to titanium mesh. (3) Anterior and posterior table fr actures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. Results: Of the 14 patients treated, 12 were available for postoperative ev aluation. Parameters such as nasal function, cranial nerve V and VII functi on, cosmesis, and complications (hardware extrusions, sinusitis, meningitis , osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospi nal fluid leak) were evaluated. All patients had good function of the super ior division of cranial nerves V and VII. Two patients (16%) had minor woun d infections, which resolved under treatment with antibiotics. All had exce llent cosmetic results as measured by postreduction radiographs and persona l and family perceptions of forehead contour. Conclusion: Titanium mesh reconstruction of severely comminuted frontal sin us fractures has few complications while providing excellent forehead conto ur and cosmesis.