Complex forehead & cheek bone fracture reconstruction with abnormal tear flow correction

A 27-year-old man from Kolkata reported to our hospital seeking expert craniofacial reconstruction. He had met with a vehicular accident few months back and suffered fracture of the forehead, cheek bones & lower jaw. He underwent initial surgery elsewhere. He had a gross skull defect with a depression in his left forehead. He also complained of continuous tears running down his face from his left eye.

3D CT scan revealed fracture of the frontal bone on the left side. Due to the traumatic injury, a defect in the nasolacrimal duct caused epiphora or abnormal tear flow. The normal flow of tears from the eye to the nose was damaged.

Craniofacial surgeon Dr. S.M. Balaji skillfully performed the complex reconstruction. A cortical bone graft was harvested from the rib and used to reconstruct the left forehead. Miracle protein rhBMP-2 was placed on the bone graft to stimulate new bone formation.

The defect in the nasolacrimal duct was corrected with DCR or Dacryocystorhinostomy. The ostium was opened with rongeurs, bone adjacent to nasolacrimal sac was removed. A new direct communication was created between the nasolacrimal sac & the nasal mucosa by placing a silicone tube to enable the tears to drain into the nose. Complete craniofacial defect was corrected successfully.

Preoperative 3DCT scan view showing fractured frontal bone involving supraorbital rim with commuited fracture of nasal bone on the left side

Cortical graft harvested from the ribs for frontal bone reconstruction

Bicoronal flap raised and costal grafts were fixed with the frontal process with mini bone screws and stabilised

Bone graft was covered with miracle protein rhBMP-2 to induce new bone formation

DCR was performed by creating new communication between nasolacrimal sac and nasal mucosa with silicone tube