Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;14(2):162-166.
doi: 10.1177/1943387520952689. Epub 2020 Aug 27.

An Endonasal Incision Adds a Second Vector of Manipulation During Percutaneous Reduction of Fractures Involving the Frontonasal Region

Affiliations

An Endonasal Incision Adds a Second Vector of Manipulation During Percutaneous Reduction of Fractures Involving the Frontonasal Region

Akshay Govind et al. Craniomaxillofac Trauma Reconstr. 2021 Jun.

Abstract

Study design: A case report.

Objective: To describe a modification of percutaneous reduction of frontal sinus and/or naso-orbito-ethmoid (NOE) fractures, adding an endonasal intercartilaginous incision to provide a second vector of manipulation.

Methods: Case report with particular attention paid to surgical technique, followed by a brief review of relevant literature.

Results: Technique: A Carroll-Girard screw is used to engage the thickest part of the anterior wall of the frontal bone through a stab incision just superior to the frontonasal junction. An endonasal intercartilaginous incision is then made and a Cottle elevator is introduced to manipulate the fracture from the inferior aspect of the frontonasal junction. The percutaneous screw and the endonasal elevator provide perpendicular vectors for manipulation, thereby improving ability to reduce fractures when percutaneous traction alone is not successful. The technique is described here in a patient with anterior table frontal sinus fractures combined with posteriorly displaced Markowitz type 1 NOE fractures.

Conclusion: While percutaneous reduction of frontal sinus fractures has been previously described, this report adds a subtle but important modification both in indication and technique for optimizing reduction while maintaining surgical simplicity and minimizing morbidity.

Keywords: Carroll-Girard; NOE; frontal sinus; intercartilaginous incision; percutaneous.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Nineteen-year-old male with marked flattening of the nasal bridge, loss of projection at the nasal root with indentation of the frontonasal junction. There is also mild left-sided telecanthus.
Figure 2.
Figure 2.
Sagittal and 3D views of the maxillofacial CT scan show a fulcrum point in the anterior wall of the frontal sinus (yellow arrows) and posterior displacement of a type 1 NOE fracture (red arrows). CT indicates computed tomography.
Figure 3.
Figure 3.
Placement of Carroll-Girard screw, reduction of fracture using 2 perpendicular vectors, and immediate postreduction result showing favorable forehead and nasal root contour.
Figure 4.
Figure 4.
Postoperative clinical photos and lateral cephalogram showing good projection of the frontonasal region with acceptable scarring.
Figure 5.
Figure 5.
Pinching technique for identification of the site of the intercartilaginous incision. Lower lateral cartilage is pinched between thumb (intranasal) and index finger (extranasal). Thumb palpates superomedially until the inferior aspect of the upper lateral cartilage is felt.

Similar articles

Cited by

References

    1. Strong EB. Frontal sinus fractures: current concepts. Craniomaxillofac Trauma Reconstr. 2009;2(3):161–175. - PMC - PubMed
    1. Kelley P, Crawford M, Higuera S, Hollier LH. Two hundred ninety-four consecutive facial fractures in an urban trauma center: lessons learned. Plast Reconstr Surg. 2005;116(3):42e–49e. - PubMed
    1. Kalavrezos N. Current trends in the management of frontal sinus fractures. Injury. 2004;35(4):340–346. - PubMed
    1. Patel SA, Berens AM, Devarajan K, Whipple ME, Moe KS. Evaluation of a minimally disruptive treatment protocol for frontal sinus fractures. JAMA Facial Plast Surg. 2017;19(3):225–231. - PMC - PubMed
    1. Delaney SW. Treatment strategies for frontal sinus anterior table fractures and contour deformities. J Plast Reconstr Aesthet Surg. 2016;69(8):1037–1045. - PubMed

LinkOut - more resources