Summary:
A 30-year old man suffered a frontobasal injury type I, according to Escher an extensive
high frontobasal fracture. According to the classification of gunshot wounds it was an open
intracranial injury with damage of the dura mater caused by a slow projectile with low energy. The
projectile struck the frontal region where it caused a lacerated skin wound. The patient was not
unconscious. He attended for definite treatment only on the 8th day after the injury. He had no
complaints, did not have an apparent cosmetic defect and did not have obvious liquorrhoea not even
after provocation manoeuvres. Superficial examination could have led to quite incorrect conserva-
tive treatment. Only CT examination revealed a comminuted fracture of the anterior and posterior
wall of the frontal sinuses with intracranial impression of the fragments. Except for a minor
pneumocephalus there were no signs of brain damage. Examination of the nasal secretion for beta
transferrin revealed nasal liquorrhoea. Indication for surgery was a bone fragment detected by CT
which penetrated the brain about 1 cm deep, and nasal liquorrhoea detected by laboratory tests.
This finding threatened to be a late life endangering complication. The patient was submitted to
surgery on the 13th day after the injury. A bicoronary section was done and access to intracranium
was made via the bone defect - cranialization of the frontal sinuses, plastic operation of the dura
mater by a free pericranial flap and plastic operation of the anterior wall of the sinuses by a bone
graft from the external lamina of the calva. The surgical finding confirmed the serious character of
the injury and the necessity of a surgical approach.
Key words:
injury of the frontal sinus, nasal liquorrhoea, cranialization, calvar graft.
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