Arthur A. Gonty

Management of frontal sinus fractures: a review of 33 cases.

PURPOSE The purpose of this article is to provide an overview of fracture patterns, patient characteristics, and surgical approaches associated with frontal sinus fractures. The short- and long-term complications of frontal sinus fractures treated over a 20-year period are presented. PATIENTS AND METHODS The records of patients admitted to the University of Kentucky Medical Center from 1975 through 1994 with a diagnosis of frontal sinus fracture were reviewed. Fracture patterns were categorized and information collected related to demographics, circumstance of injury, perioperative management, surgical procedures, and complications. Long-term complications were studied by asking patients to return for clinical and radiographic follow-up. RESULTS The average age of patients with frontal sinus fractures was 32 years. Thirty-one of the 33 victims were male. Motor vehicle accidents were the most common cause. Twenty-one patients had anterior table fractures (type I), 11 had combined anterior/posterior table fractures (type II = 9, type IV = 2), and one patient had an isolated posterior table fracture (type III). Short-term postoperative and perioperative complications were minimal. Long-term complications included acute frontal sinusitis (one patient), cosmetic forehead defects (two patients), and encephalitis (one patient). CONCLUSIONS The critical elements to successful frontal sinus fracture repair are precise diagnosis of the craniofacial fracture pattern, appropriate management of the frontonasal duct(s), and prevention of serious brain sequelae. Long-term follow-up of patients with frontal sinus injuries is recommended.

Principles of management of complex craniofacial trauma

Successful treatment of patients with complex craniofacial injuries is heavily dependent on the surgeons appreciation of the associated nonfacial injuries, precise clinical and diagnostic imaging examinations to establish a three-dimensional configuration of the fractured segments, and the application of well-established principles of facial fracture repair. Factors that influence improved treatment outcome are 1) early definitive treatment, 2) anatomic and functional repair of naso-orbito-ethmoidal injuries, 3) wide exposure of fracture segments, and 4) anatomic repositioning and stable fixation of fracture segments in all planes of space.

Aspergillosis of the maxillary sinus: Review of the literature and report of a case

Aspergillosis of the paranasal sinuses is an infrequently reported disease which can occur in two forms: (1) a noninvasive form that can clinically mimic nonspecific chronic sinusitis and (2) an invasive form that can simulate malignant disease of the sinuses. The disease occurs without known predisposing systemic disease. Primary treatment consists of surgical eradication of infected tissue. The question of whether concomitant antifungal chemotherapy should be used in the noninvasive form of aspergillosis has not been definitely resolved. Presented is a review of the literature, the report of a case, and a discussion of possible pathogenic mechanisms.

Chondromyxoid fibroma of the maxilla: Electron microscopic findings and review of the literature

A case of chondromyxoid fibroma of the anterior maxilla is presented. The light and electron microscopic appearances of this tumor are described. A review of chondromyxoid fibromas of the jaws is performed, with a discussion of the appropriate therapy.

Autogenous cancellous-marrow bone grafts in irradiated dog mandibles.

A pilot study was conducted to investigate the osteogenic potential of autogenous cancellous-marrow grafts placed in irradiated tissue. Three dogs received 4,100 rads in ten treatments ooer 32 days. Postirradiation discontinuity mandibular defects were created. These defects were restored with cancellous-marrow autogenous bone supported in position by a titanium mesh basket. Bony union occurred in all the mandibles. The titanium mesh partially eroded through the oral mucosa in two animals. The quantity of new bone formed in the surgical defect varied. Two dogs had complete restoration of the resected mandible. Histologic observations were documented in both the graft area and the surgically uninvolved contralateral side of the mandible.

A preliminary study of reconstruction of the monkey temporomandibular joint with autogenous tissues.

PURPOSE This study investigated the ability of autogenous pericranium-muscle and cranial bone to restore form and function of the temporomandibular joint (TMJ). MATERIALS AND METHODS A right TMJ discectomy, condylectomy, vertical ramus osteotomy with superior repositioning of the proximal fragment, and a cranial bone graft to the mandibular angle were performed in 12 cynomolgus monkeys. Clinical, histologic, and autoradiographic evaluation was done at intervals beginning at 3 days and continuing up to 78 weeks. RESULTS No significant postoperative sequela were identified in any of the monkeys. Jaw mobility and function were restored. Gross morphologic condylar changes were observed. The pericranium-muscle grafts did not differentiate into normal disc-like structures and a cartilage cap did not cover the condyle stump head. CONCLUSIONS The results of this study suggest that the previous TMJ function was restored. However, the histologic changes observed were consistent with advanced degenerative joint disease.