title: Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures.
abstract: BACKGROUND
  Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging.
  
  
  METHODS
  Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded.
  
  
  RESULTS
  Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%).
  
  
  CONCLUSIONS
  A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; †Division of Plastic and Reconstructive Surgery, University of Kansas School of Medicine, Kansas City, KS; and ‡Division of Plastic Surgery, Temple University/Saint Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Justine C
authors.initials: JC
authors.lastname: Lee
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
authors.forename: Hamid
authors.initials: H
authors.lastname: Abdollahi
authors.forename: Alex G
authors.initials: AG
authors.lastname: Lambi
authors.forename: Clifford T
authors.initials: CT
authors.lastname: Pereira
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000009:adverse effects; D015331:Cohort Studies; D004388:Dura Mater / Q000293:injuries; D005004:Ethmoid Bone / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000293:injuries* / Q000601:surgery; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D009296:Nasal Cavity / Q000293:injuries; D061646:Operative Time; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications; D012887:Skull Fractures / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D060053:Transplant Donor Site / Q000601:surgery; D055815:Young Adult