PubMed · 14819266
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M F A MONTAGU. 1951. The Wallbrook frontal bone.. https://doi.org/10.1002/ajpa.1330090103
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Cranioplasty of cranial bone defects can generally be accomplished with autogeneous bones as well as with nonbiological materials. Autologous living-bone grafts are ideal but require sacrifice of donor bone, and synthetic materials might have possible exposure of the materials, delayed infection, and/or allergic reaction. The authors report cranioplasty with a bone graft after auto-purification by subcutaneous preservation of the contaminated bone fragment. A 47-year-old man was given a frontal cranioplasty with a split parietal bone and rib. Epidural abscess ensued, and debridement was performed to control the infection. The largest bone fragment was subcutaneously preserved in the chest wall and reused for cranioplasty. Subcutaneous preservation of bone is a promising strategy for cranioplasty after neurosurgery. The condition of the bone fragment can be inferred from the condition of the site at which it is preserved. If the bone flap is contaminated, it can be purified by the patient's immune system.
Associated cranial abnormalities with spinal dysraphism are not uncommon. We came across an unusual case of a 1-year-old male child with spinal dysraphism having lumbar meningomyelocele, who also had split cord malformation (hemicord with intervening bony spur) with lipoma of one of the hemicord and filum terminale. The patient also had communicating hydrocephalus without Chiari malformation and also near-total frontal bone agenesis. Single photon emission computed tomography scanning of brain revealed normal perfusion. In the first stage of repair, the patient had postoperative CSF leak for which ventriculo-peritoneal shunt was performed. This constitutes a rare anomaly associated with spinal dysraphism.
Fractures of the orbitozygomatic complex represent one of the most common injuries of the facial skeleton. Repair of the fractures often requires multiple surgical access points and the necessity for skin incisions. As surgeons attuned to aesthetics, we strive to minimize the signs of injury and treatment. We propose an approach designed to treat orbitozygomatic fractures without the use of skin incisions. The objective of this article is to outline the surgical technique designed by the senior author (PRL) to address the zygomatico-frontal fracture component of orbitozygomatic complex fractures through an upper lid lateral transconjunctival approach. Relevant anatomy and technique is described. The combination of previously described lower lid transconjunctival and gingivobuccal sulcus incisions with this new upper lid lateral transconjunctival approach provides adequate access for rigid fixation of all major components of orbitozygomatic fractures without skin incisions.