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Summary

Orbitofrontal craniotomy with direct orbitotomy gives broad surgical access to the anterior cranial fossa and orbit. Indications for this combined technique vary and are dependent on the location and nature of the lesion. This technique can also be used for orbital decompression in severe cases of Graves’ orbitopathy. A complete clinical history with imaging is critical for preoperative planning. Postoperatively, close monitoring of vision and neurological status is critical to identifying and preventing complications.

Background

Pott's puffy tumour is a rare complication of sinusitis. This osteomyelitis can affect the outer and inner tables of the frontal sinus. The treatment of Pott's puffy tumour combines medical and surgical approaches. Surgical approaches have traditionally been open, but endoscopic techniques have been adopted recently in select cases. The bony defect from debridement can be left alone, or closed with autografts or allografts.

Objective

To describe a technique for the reconstruction of a large skull vault after the debridement of extensive osteomyelitis of the anterior cranial vault.

Methods

Modified distraction osteogenesis is used in the cranial vault, to induce new bone formation. This is customarily used to lengthen long bones. The advantages of this technique include avoiding autologous grafts or alloplastic cranioplasty in the infected surgical bed, and allowing primary closure.

Results

Early post-operative imaging results have been encouraging, with no reported complications.

Conclusion

Modified distraction osteogenesis is a novel technique in the primary reconstruction of calvarial bone.

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Chapter 9 - Combined Orbitofrontal Craniotomy and Direct Orbital Decompression

Summary

Pott's puffy tumour: innovative technique in calvarial reconstruction

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Chapter 9 - Combined Orbitofrontal Craniotomy and Direct Orbital Decompression

Summary

Pott's puffy tumour: innovative technique in calvarial reconstruction