Therapeutic problems in fronto-orbital fractures

Along with the neurosurgical difficulties, the management of fronto-orbital fractures poses problems of aesthetical nature, especially those that arise in restoring the trauma-deformed face to its original, or close to original, appearance. The cranioplasty using duracryl to deal with defects secondary to impression fractures affecting the frontal sinuses presents a serious therapeutic problem because of the risk of suppuration. We report 48 patients treated in the Department of Neurosurgery of the University of Medicine, Plovdiv between 1981 and 1990. Particular attention was paid to impression fractures affecting the frontal sinus. In addition to the classic method of surgical management of such fractures, a modification of cranioplasty in the region of the frontal sinus is presented which help to avoid the risk of suppuration. The surgical management was performed in two stages separated by a period of 6 to 12 months from the initial treatment of the wound and fracture. Connective tissue covering forms in this period which isolates the frontal sinus opening to the skull defect. Utmost sparing of this connective tissue during cranioplasty with duracryl is a guarantee of successful treatment.