Reconstruction of post-traumatic sinus osteomyelitis.

Area of Science:

• Neurosurgery
• Infectious Disease
• Plastic Surgery

Background:

• A patient presented with a complex medical history including a World War II Anzio Beachhead injury to the fronto-nasal area, which was previously repaired with a lucite cranioplasty.
• The patient developed a staphylococcal infection involving the remaining left frontal sinus, manifesting as a fistulous tract near the orbital ridge.

Observation:

• A bone scan indicated increased activity, consistent with osteomyelitis.
• The initial treatment involved intravenous oxacillin.
• Surgical intervention included removal of the lucite prosthesis via a bilateral osteoplastic coronal flap approach with fat obliteration of the frontal sinus.

Findings:

• Following initial treatment, the patient was discharged after 48 days of intravenous oxacillin.
• Readmission was necessary for a secondary cranioplasty using a preformed tantalum plate.
• The tantalum plate's nasal flange caused a significant deformity, preventing the patient from wearing eyeglasses.

Implications:

• The case highlights the challenges in managing late-onset infections and implant-related complications after complex craniofacial trauma and reconstruction.
• Reconstruction of the tantalum implant and associated nasal deformity required a subsequent surgical procedure using a W-shaped incision.
• This case underscores the importance of considering long-term implant integrity and patient functional outcomes in reconstructive surgery.