Postsurgical predictive theoretical thickness (PTT) of frontal sinus anterior wall as key point in surgical management of frontal bossing: proposal of a new analytic method.

BACKGROUND

Frontal bossing is a malformation characterized by peculiar prominent forehead, and commonly it can be associated with cranial synostosis and endocrine disorder; however, nonsyndromic conditions are described as well.Literature controversies on proper frontal bossing surgical treatment showed evidence of 2 main surgical procedures: frontal bone reshaping and bone en bloc mobilization.A decision-making criterion between these 2 techniques has never been described in literature.

METHODS

In this paper, the authors introduce their brand-new analytic method for decision-making between bur shaping and en bloc mobilization in frontal bossing treatment, and describe a successful case of a nonsyndromic frontal bossing patient, treated with their unconventional surgical technique.

RESULTS

Our analytic method indicated that bur shaping was not indicated in this particular case: aggressive remodeling of excessive thin wall could lead to sinus perforation, which could turn into unsatisfied aesthetic and functional outcome.So we planned for a bilateral orbitofrontal en bloc reposition, followed by internal rigid fixation. No postoperative complications occurred. Postoperative CT scan revealed good bone repositioning and recovery.

CONCLUSIONS

The authors explained their analytic method based on careful presurgical CT-scan measurements for decision-making between bur shaping and en bloc mobilization.