Digitally Guided Frontal Sinus Fracture Fixation: A Point-of-Care "In-House" Biomodel Protocol with Cyanoacrylate-Assisted Fragment Stabilization.

Background/

Objectives

Frontal sinus fractures are uncommon injuries that may cause persistent aesthetic deformity when the anterior wall is comminuted, as small irregular fragments are difficult to stabilize with conventional osteosynthesis alone.

Methods

We describe a point-of-care digital workflow combining 3D planning/printing and cyanoacrylate-assisted fixation for an isolated comminuted anterior frontal sinus wall fracture. A young adult presented with a depressed forehead contour after assault; computed tomography confirmed at least four displaced fragments.

Results

A two-part 3D-printed biomodel was manufactured in-house to visualize the defect and guide extracorporeal reconstruction. Through a coronal approach, fragments were mobilized and anatomically reassembled using the biomodel as a reference; sinonasal drainage was preserved and sinus obliteration was not required. Because fragment size and geometry limited screw purchase, a modified N-butyl-2-cyanoacrylate adhesive (Glubran 2) was applied as an adjunct to maintain reduction, followed by reinforcement with titanium microplates. Postoperative recovery was uneventful, with immediate restoration of forehead contour and no early complications; postoperative imaging confirmed satisfactory alignment.

Conclusions

This case supports the feasibility of integrating point-of-care 3D biomodeling with cyanoacrylate as a coadjuvant to microplate fixation in selected comminuted frontal sinus fractures to enhance fragment handling and contour restoration.