title: Transcutaneous reduction of frontal sinus fracture using bony tapper device.
abstract: OBJECTIVE
  Frontal sinus fractures are relatively common injuries presenting to trauma units. The optimal treatment of frontal sinus fractures remains controversial. Bicoronal approach is commonly used to obtain full exposure of both frontal bones and to repair any intracranial trauma; however, this approach requires long operative time and could lead to a long-lasting visible scar, alopecia, and paresthesias. In addition, patients have to stay in hospital for several days with this method. Endoscopic approach, less invasive than bicoronal method, has a steep learning curve. In this article, we suggest a simple reduction method in frontal sinus anterior wall fracture using the tapper instrument.
  
  
  METHODS
  Between 2005 and 2011, a transcutaneous reduction of closed anterior table frontal sinus fracture using a tapper instrument was performed in 13 patients. This group consists of 10 men and 3 women, and the mean age was 27.5 years. Under general anesthesia, the point that the tapper would be placed is marked considering the fracture site shown on computed tomographic scan and the clinically depressed area. A 3-mm slit incision was made just above the marked point. After drilling through this incision, the tapper device was applied to the depressed bone segment. Simply pulling out the tapper, the depressed frontal sinus anterior wall segment was reduced.
  
  
  RESULTS
  Contour deformities were restored completely in all patients without any recurrent displacement, and all patients were satisfied with the results. There were no complications such as infection and uncontrollable sinus bleeding, but pneumocephalus had occurred in 1 patient owing to the posterior table injury that happened during the tapper-applying procedure. We treated him with preventive antibiotics, and he completely recovered after 1 week.
  
  
  CONCLUSIONS
  This method has better aesthetic results, shorter operative time, and minimal hospital stay than other surgical approaches. Although it contains minimal risk of posterior wall injury, considering not only surgical results but also patients' satisfaction, the authors suggest that this simple percutaneous reduction method using the tapper instrument would be the treatment of choice in the frontal sinus anterior wall fractures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Anna
authors.initials: A
authors.lastname: Yoo
authors.forename: Seok-Chan
authors.initials: SC
authors.lastname: Eun
authors.forename: Rong-Min
authors.initials: RM
authors.lastname: Baek
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed