title: How to make the blockage between the nasal cavity and intracranial space using a four-layer sealing technique.
abstract: BACKGROUND
  Craniofacial surgery for facial advancement or correction of severe craniofacial malformations such as orbital hypertelorism, Crouzon's disease, and Apert's syndrome may carry great risk. Postoperative infection after craniofacial surgery is a life-threatening complication. Ascending infection via nasofrontal communication in frontofacial monobloc advancement, intracranial Le Fort III osteotomy, correction of hypertelorism (intracranial approach), and acute trauma of cribriform plate can lead to life-threatening meningitis and meningoencephalitis.
  
  
  METHODS
  A four-layer sealing technique for the closure of nasofrontal communication using Gelfoam, galeopericranial flap, rib bone graft, and Tissel is a very effective method. Until the rib bone graft is taken up, Gelfoam is used to temporarily block bony defects and prevents displacement of the rib bone graft. The authors used galeoperiosteal flap for the sufficient blood supply to the rib bone graft. Tissel is used as a biologic adhesive and for blockage of the surrounding gaps.
  
  
  RESULTS
  There were no cases of cerebrospinal fluid rhinorrhea, epidural abscesses due to nasofrontal ascending infection, or meningitis, and no cases underwent débridement due to necrosis of the frontal bone flap. This indicated that the blockage of nasofrontal communication was successful in this series. Moreover, postoperative cosmetic outcomes were satisfactory.
  
  
  CONCLUSIONS
  This study indicated that the blockage using the Gelfoam, galeopericranial flap, rib bone graft, and Tissel application was effective for the thorough management of nasofrontal fistula and the prevention of recurrent episodes.
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, South Korea. lyh2374@snu.ac.kr
authors.forename: Yoonho
authors.initials: Y
authors.lastname: Lee
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000601:surgery; D005145:Face / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005624:Frontal Bone; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D009296:Nasal Cavity; D010027:Osteotomy; D011183:Postoperative Complications / Q000517:prevention & control*; D012272:Ribs / Q000637:transplantation; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics