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Skull Osteomyelitis Developed on the Frontal Bone and Subsequent Reconstruction Strategies
In-Mo Yoon1, Junghyun Lee, Soyeon Jung
1Department of Plastic and Reconstructive Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Purpose:
Osteomyelitis of the frontal bone, which accompanies the soft-tissue infection, is rare but may be fatal. The origin of infection is commonly associated with sinusitis; however, it is hard to localize. Once it develops, treatment strategies need to include eradication of infected tissue, radical wide debridement, and reconstruction planning. In addition, the use of antimicrobial agents is another crucial part of the treatment.
Methods:
Two patients had recurrent infections in the frontal area. The skin and soft tissues were cicatricial, with recurrent inflammation and infection. Computed tomography was performed to evaluate the bony structure, and bone infection was identified. Subsequently, magnetic resonance imaging was performed to reveal osteomyelitis. All the hard and soft tissues were severely infected. Surgical approach with coronal incision included wide debridement and frontal bone reconstruction. Microbiologic cultures were performed during the eradication procedure. One received autologous bone grafting in a single-stage procedure with the eradication and reconstruction. The other had early eradication and delayed reconstruction with titanium mesh.
Results:
No recurrence of infection was observed during 6 months of follow-up. Patients were satisfied with the forehead contour subjectively. Only minor numbness and paresthesia were reported over the scalp.
Conclusions:
Frontal bone osteomyelitis is an uncommon but potentially severe condition. Early surgical intervention, including eradication, is important to minimize the infection's expansion. Reconstruction planning is also critical for restoring the forehead contour. This report presents 2 treatment options for frontal bone osteomyelitis.
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