The Reduction and Fixation in Periorbital Bone Fracture via the Supratarsal Fold Incision

For the approach to the supraorbital rim and frontozygomatic suture line, surgeons have used the bicoronal incision or lateral eyebrow incision. However it may leave the scar or alopecia. For the successful surgical repair of the frontal sinus fracture and frontozygomaticomaxillary complex fracture, we reviewed the use of the supratarsal fold incision, and selected cases of the open reduction and fixation of frontal sinus fracture and frontozygomatic suture line fractures. We investigated six cases, two were frontal sinus anterior wall fracture and four were frontozygomaticomaxillary complex fracture. The patients underwent bony reduction via supratarsal fold incision to expose the frontal sinus and frontozygomatic suture line. In all six cases, the supratarsal fold incision provided very satisfactory exposure of lateral orbital wall, frontozygomatic suture line, frontal sinus and supraorbital rim. No patients had post-operative alopecia, scar, ptosis, lagophthalmus and hematoma. The supratarsal fold incision provides excellent approaches to the frontozygomatic suture line and frontal sinus and there was not any post-operative complicaitons. So it may be the option for the approach to the superolateral orbital rim or supraorbital rim for frontal sinus simple fracture and non-comminuted fractures at frontozygomatic suture area.

Correction of Macrocephaly using Sagittal Hinge Flap

Macrocephaly commonly occurs in children with untreated or neglected hydrocephalus, and in most cases this is accompanied with discrepancy between the volume of the brain and the cranial cavity. Macrocephaly usually interferes with head control, seating, locomotion, and social acceptance. So the goals of the reduction cranioplasty lie in reconstruction of the head shape, control of intracranial pressure, obstruction of the growth of the head, which enables to ambulate. However, reports about surgery of macrocephaly are scanty. A 24-month-old girl suffered from hydrocephalus with macrocephaly. Her head circumference was 71cm and couldn't control her head or lie in lateral position. The surgical technique we used was a one-stage operation, using a sagittal hinge flap. This technique includes infracturing with wedge resection of the marginal skull and pushing it inward. The dura mater in the frontal region was plicated, while care was taken to maintain attachment of the superior sagittal sinus, the fixation was done with microplates, screws and wirings. After the operation, she had no air embolism, venous infarction, infection, neurologic deficit and had satisfactory cosmetic results. History of the operation of macrocephaly, tactical considerations and possible risks are discussed with our surgical experience in this publication.