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[Osteomyelitis of the frontal bone (Pott's puffy tumor). A report of 5 patients].

BACKGROUND: Frontal bone osteomyelitis is considered to be rare but it may develop intracranial complications such as subperiosteal abscess that appears as a painful fluctuated forehead tumor (Pott's puffy tumor). METHODS: We reviewed retrospectively the clinical history of those patients showing frontal swelling tumour in our Neurosurgery and Infectious Diseases Departments between July 1994 and December 1997 and whose definitive diagnosis was cranial osteomyelitis. RESULTS: We reported five cases of patients who had been submitted to a neurosurgical operation between 9 months and 27 years ago. The main clinical features were intermittent painful frontal swelling episodes (with or without fever). These episodes were self-limited or limited after short trend of antibiotics. Imaging techniques were necessary for the diagnosis and especially in order to exclude intracranial complications (such as epidural abscess found in two patients). The ascertain diagnosis is made by debriding, histological studies and cultures from the material. Staphylococcus aureus was isolated in three of the patients, Haemophilus influenzae in one patient and Pseudomonas aeruginosa in the other one. All patients were treated with surgery and specific antibiotic therapy during twelve weeks minimum, being definitively cured. CONCLUSIONS: It is not well know the etiopathogenic mechanism concerning this rare disease. We remark the importance of a prompt diagnosis because of the high frequency of intracranial complications as well as combined treatment: surgery and long term antibiotic therapy (not less than 8 weeks), is necessary to cure the disease.

Aged↗

Hemangioendothelioma of the frontal bone in a child.

Hemangioendothelioma is a vascular tumor of endothelial cell origin. It may involve bone or soft tissues and can behave like a benign or malignant tumor. In the literature, there are several case reports on the involvement of the head and neck region, but involvement of the frontal bone is extremely rare. This report presents the case of a 4-year-old boy with the diagnosis of spindle cell hemangioendothelioma of the frontal bone, who was treated by wide surgical resection.

Child, Preschool↗

Usefulness of the galea flap in treatment of extensive frontal bone defects: a study of 14 patients.

We present a technique for treating extensive frontal bone loss after chronic osteitis and subsequent treatment. Unlike the technique usually performed in such cases (exclusion and filling), the frontal sinuses were conserved by isolating them from the reconstructed frontal vault. Isolation was achieved by means of a temporal galea and periosteum flap with a pedicle arising from the superficial temporal vessels. The study concerned 14 patients operated on from two to seven times for osteitis, which persisted in many patients for more than 10 years.

Adolescent↗

Clinical anatomy of the nasal process of the frontal bone (spina nasalis interna).

OBJECTIVES: During endonasal frontal sinusotomy with the sharp spoon, a solid piece of bone is frequently encountered anterior to the neo-ostium. This bone may be referred to as the nasal process of the frontal bone or internal nasal spine (spina nasalis interna). A prominent spina may render an extended sinusotomy difficult and may call for use of the drill. A series of anatomic measurements is presented to illustrate the 3-dimensional anatomy of the spina nasalis and the regional anatomy. METHODS: A maximum endonasal frontal sinusotomy (Draf type I-II procedure, nasofrontal approach type II) was performed on 36 anatomic specimens by means of a sharp spoon. The dimensions of the remaining nasal spine were measured subsequently together with the anterior-posterior diameter of the inferior frontal sinus, the thickness of the anterior frontal sinus wall, and the distance from the neo-ostium to the anterior ethmoidal artery. RESULTS: The individual microanatomy of the medial floor of the frontal sinus showed a wide range of variation. The average height of the individual spine was 10 mm, the maximum depth 6 mm. A correlation was found between the nasofrontal angle of the specimen and the anterior-posterior dimension of the spine: the more acute the angle, the thicker the spine. In three quarters of the cases, the neo-ostium was separated by just one anterior ethmoidal cell from the anterior ethmoidal artery. CONCLUSIONS: The presented investigations provide the surgeon with quantitative data on the individual anatomy of the nasal spine and offer additional information for selecting the appropriate surgical procedure in the individual patient.

Cadaver↗

Congenital frontal bone defect with intact overlying scalp.

An unusual case of a congenital frontal bone defect with intact overlying scalp and intact underlying dura mater is reported. Although spontaneous healing by the intact underlying dura mater by regeneration was expected, it did not occur. Cranioplasty was done for protective and cosmetic purposes. A review of the literature of congenital skull defects shows that spontaneous regeneration does not occur in this rare anomaly.

Child, Preschool↗

Extradural epidermoid tumor of the frontal bone.

The radiologic findings in a case of an extradural diploic epidermoid tumor (ET) of the frontal bone, examined with plain X rays, CT and MRI, are reported. A head injury with traumatic inclusion of epidermis could have been the origin of the tumor. This report stresses the importance of the plain skull X ray in the diagnosis of extradural ET.

Adult↗

Pericranial wrapping of the frontal bone after anterior skull base tumor resection.

BACKGROUND: Classic craniofacial resection and the subcranial approach are well-established techniques for the removal of tumors involving the anterior skull base. These techniques require frontal craniotomy to allow broad exposure of the anterior cranial fossa, a procedure that may be further complicated by local infection and osteomyelitis or because of a reduction in tissue perfusion and direct communication between the osteotomy and the contaminated nasoethmoidal cavity. The authors present a new method for wrapping of the frontal bone segment with a pericranial flap with the intention of preventing these serious complications. METHODS: By means of this new approach, the frontonaso-orbital bone segment is removed, the frontal sinus bone is cranialized, and the frontonaso-orbital segment is repositioned in its original anatomical place following tumor extirpation. Wrapping is accomplished by a double-sided covering of the bone segment with the pericranial flap. This vascularized tissue is guided underneath the bony segment to cover the intranasal surface and then is externalized over the entire frontal area. The frontonaso-orbital segment and its overlying pericranial flap are fixed with the prebent titanium plates. RESULTS: To date, the authors have performed 20 subcranial operations for resection of malignant tumors of the anterior skull base using this technique. None of these patients developed bone flap necrosis or osteomyelitis following radiotherapy. In the authors' hands, the rate of osteoradionecrosis was significantly lower in patients undergoing malignant subcranial tumor resection with pericranial wrapping than in those operated on before the study was activated (0 percent versus 20 percent, respectively; p = 0.056). CONCLUSIONS: Pericranial wrapping is suitable for patients undergoing extirpation of anterior skull base tumors and for whom perioperative radiotherapy is recommended and for patients who have undergone multiple surgical procedures.

Adult↗

Intraosseous lipoma of the frontal bone. A case report.

Intraosseous lipomas are among the most uncommon bone tumors. They arise most often in the appendicular skeleton. There are very few reported cases of intraosseous lipomas within the skull bones. We report a case of intraosseous lipoma of the frontal bone with conventional radiography and CT findings.

Adult↗