Fractures of the posterior wall of the frontal sinus: non-surgical management and complications.

BACKGROUND: treatment of frontal sinus fractures remains controversial. If the posterior wall is fractured and there is cerebrospinal fluid leak, treatment seeks to restore the integrity of the dura and isolate the intracranial contents through the obliteration of the nasofrontal duct and cranialization. Another group supports nonoperative management CSF leakage is produced. The purpose is to avoid complications of meningitis, fistula and late sequelae. The difficulty lies in predicting which patients will develop complications. The aim of this study is to identify complications in patients with posterior wall fracture of the frontal sinus treated nonsurgically. METHODS: an observational, cross-sectional, retrospective study was conducted with 20 patients with posterior wall fractures of the frontal sinus treated nonsurgically at the Hospital de Traumatología y Ortopedia Lomas Verdes, Service of Maxillofacial Surgery from January 2007 to October 2009. RESULTS: twenty patients with posterior wall fractures of the frontal sinus were included. There were 17 males and 3 females. Fractures were divided into groups according to their degree of movement and presence of cerebrospinal fluid fistula. Postoperative complications were cerebrospinal fluid fistula and frontal abscess. CONCLUSIONS: nonsurgical treatment has proven to be an option, although not free from complications, the most common being CSF fistula and abscess. Future comparative studies should be carried out to define therapeutic strategies usibg clinical monitoring and long-term imaging.

[OsiriX, a useful tool for processing tomographic images in patients with facial fracture]. / OsiriX, visor DICOM útil para procesar imágenes tomográficas de fracturas faciales.

BACKGROUND: OsiriX, a Mac OS X-based open source program, is presented as a useful tool to process tomographic images for diagnosis and preoperative planning in patients with facial fractures. METHODS: CT scans were performed on 124 patients with facial fractures treated at the Department of Maxillofacial and Reconstructive Surgery of the Hospital de Traumatología y Ortopedia "Lomas Verdes" in Mexico City. Information obtained was recorded in DICOM format in CDs and processed in a Macintosh laptop with OsiriX software, doing multiplanar and 3D reconstructions. Surgical findings were compared to the images obtained by the software. RESULTS: Of the surgical findings, 96.5% matched with the OsiriX images. Only 3.5% of the OsiriX images were not consistent because of distortion or artifacts in the CT due to firearm projectiles and Erich arch bars near the involved area. CONCLUSIONS: Based on the results obtained, the authors consider that the OsiriX software is a useful tool for diagnosis and preoperative planning in patients with facial fractures. Furthermore, it prevents the loss of information due to the process of image selection by the radiology staff.

OsiriX, visor DICOM útil para procesar imágenes tomográficas de fracturas faciales / OsiriX, a useful tool for processing tomographic images in patients with facial fracture

Introducción: El programa de código abierto OsiriX para MAC OS X® se presenta como una herramienta útil en el manejo de imágenes tomográficas para el diagnóstico y planificación preoperatoria en pacientes con fracturas del esqueleto facial. Material y métodos: Se realizó tomografía axial a 124 pacientes con fracturas faciales en el Servicio de Cirugía Maxilofacial y Reconstructiva del Hospital de Traumatología y Ortopedia Lomas Verdes. La información tomográfica en formato DICOM fue grabada en discos compactos y analizada en una computadora portátil Macintosh® con el programa OsiriX. Se realizó reconstrucción multiplanar y tridimensional y se compararon los hallazgos transoperatorios con la imágenes. Resultados: El 96.5 % de las imágenes coincidió con las reconstrucciones en el programa; solo 3.5 % presentó algún grado de discordancia por distorsiones en el estudio, secundarias a la presencia de proyectiles de arma de fuego y arcos férula de Erich. Conclusiones: Basados en los resultados, el programa OsiriX es una herramienta útil para el diagnóstico y planificación preoperatoria en pacientes con fracturas faciales. Además, evita la pérdida de información en el proceso de selección de las imágenes por el personal de radiología.

BACKGROUND: OsiriX, a Mac OS X-based open source program, is presented as a useful tool to process tomographic images for diagnosis and preoperative planning in patients with facial fractures. METHODS: CT scans were performed on 124 patients with facial fractures treated at the Department of Maxillofacial and Reconstructive Surgery of the Hospital de Traumatología y Ortopedia "Lomas Verdes" in Mexico City. Information obtained was recorded in DICOM format in CDs and processed in a Macintosh laptop with OsiriX software, doing multiplanar and 3D reconstructions. Surgical findings were compared to the images obtained by the software. RESULTS: Of the surgical findings, 96.5% matched with the OsiriX images. Only 3.5% of the OsiriX images were not consistent because of distortion or artifacts in the CT due to firearm projectiles and Erich arch bars near the involved area. CONCLUSIONS: Based on the results obtained, the authors consider that the OsiriX software is a useful tool for diagnosis and preoperative planning in patients with facial fractures. Furthermore, it prevents the loss of information due to the process of image selection by the radiology staff.