Resident Manual of Trauma to the Face, Head and Neck

The otolaryngic procedure regarding the frontal sinus injury is made easy by virtue of the extensive craniotomy needed for controlling the intracranial injury. The initial step in the procedure is to ensure all the bony fragments from the anterior wall of the frontal sinus have been saved. These are divested of dirt and soaked in Betadyne ® until the end of the procedure. The posterior wall of the sinus is completely removed, so that the cavity of the frontal sinus is now in continuity with the anterior cranial fossa. This is begun with a double-action rongeur and is finished off with a cutting bur (Figure 3.6). The frontal sinus mucosa is now completely stripped out with an elevator from the floor and remaining anterior wall, such that the remaining sinus cavity is com- pletely divested of mucosa. Total removal of all mucosal remnants of the sinus is ensured by removing 1–2 millimeters of bone with a cutting burr (Figure 3.7). Figure 3.6 Cranialization procedure—Brain is

debrided, dura is patched, and posterior wall remnants are removed with double-action rongeur.

Figure 3.7 Cranialization procedure—Removal of the remaining posterior wall of the frontal sinus produces cranialization.

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