Reconstruction of Comminuted Frontal Bone Fractures by Rib Graft or Titanium Mesh: Assiut University Hospital Experience

Abstract
Background: Frontal bone fractures are one of the common craniofacial fractures [1]. These fractures usually associated with serious complications, such as cerebrospinal rhinorrhea with potential ascending infection, meningeal and intracranial lacerations, obstruction of the lacrimal drainage and nasal airway and oculomotor dysfunction.
Aim of Work: To compare the outcome of reconstruction of comminuted frontal bone fractures by rib graft and titanium mesh.
Patients and Methods: This study was carried out on 40 patients with comminuted frontal bone fractures and subdivided into 2 groups, group (I) reconstruction of comminuted frontal bone fractures by rib graft and group (II) reconstruction of comminuted frontal bone fractures by titanum mesh.
Results: Group I: The patients were hospitalized for an average of 12 days.
Patients generally showed remarkable neurologic improve-ment during their hospital stays, considering the tremendous force of impact. No delayed CSF leaks had occurred at the time of the most recent follow-up (range: 6 months). Good cosmetic results (satisfactory to the evaluating physician and the patient or family) with no gross surface deformities were obtained in 16 patients (80%). Group II: The patients were hospitalized for an average of 12 days.
Patients generally showed remarkable neurologic improve-ment during their hospital stays, considering the tremendous force of impact. No delayed CSF leaks had occurred at the time of the most recent follow-up (range: 6 months). Good cosmetic results (satisfactory to the evaluating physician and the patient or family) with no gross surface deformities were obtained in 18 patients (90%).
Conclusion: Autogenous bone grafts such as iliac or rib require a second surgical site. This may lead to donor site morbidity, inability to obtain adequate bone for large defect. The advantages of employing titanium Mesh consist, not only in the optimal stabilization of the fracture, but also in its excellent biocompatibility and in the minimal inflammatory reactions it provokes, as well as the ease with which it adapts to different shapes; furthermore, titanium produces only minimal artifacts on MRI and CT. Disadvantages include infection, limitation of growth and it may fracture and requires time for shaping and curing. The risk of infection may be reduced by adding antibiotic and using it under sterile condi-tions, beneath well-vascularized skin.