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      Obliteración del seno frontal mediante injerto de tibia y plasma rico en plaquetas para el tratamiento de la osteomielitis crónica Translated title: Frontal sinus obliteration using tibial bone graft and platelet-rich plasma for the treatment of chronic osteomyelitis

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          Abstract

          Objetivos. La técnica quirúrgica más eficaz en el tratamiento de la sinusitis frontal crónica complicada con una osteomielitis crónica, incluye la limpieza y legrado del seno, y la obliteración de los espacios muertos y sellado del ostium del seno frontal. Existen varios materiales autólogos y aloplásticos usados para la obliteración sinusal. Material y métodos. Paciente intervenido de un plasmocitoma localizado en el seno frontal, que desarrolló una sinusitis frontal complicada con una osteomielitis crónica con fistulización y supuración cutánea. Se trató mediante un legrado de la cavidad del seno frontal y obliteración con injerto esponjoso de tibia y plasma rico en plaquetas (PRP). Conclusiones. La obliteración tras limpieza y legrado del seno frontal es un tratamiento efectivo para la osteomielitis crónica sinusal. Tras la intervención quirúrgica, se comprobó la desaparición de los síntomas de nuestro paciente. No hubo recidiva de la enfermedad ni complicaciones postoperatorias. El uso de injerto óseo de tibia y PRP puede ser una alternativa eficaz a los materiales existentes para dicha obliteración.

          Translated abstract

          Objetives. The more successfully surgical treatment for the treatment of chronic frontal sinusitis complicated with chronic osteomielitis, is the cleaning and curettage of the sinus with obliteration of the sinus cavity and nasofrontal duct. Several autologous and alloplastics materials are used for this obliteration. Material and methods. We report the case of a patient previously operated on because of frontal sinus plasmocytoma who developed frontal sinusitis with chronic osteomielitis and cutaneous suppuration. He received surgical treatment with frontal sinus curettage and obliteration with tibial bone graft and platelet-rich plasma (PRP). Symptoms disappeared and there were no complications or recurrence. Conclusions. Obliteration of the frontal sinus with tibial bone graft and PRP after sinus cleaning and curettage can be a good alternative in the treatment of chronic frontal sinus osteomielitis.

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          Most cited references37

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          Platelet-rich plasma enhances human osteoblast-like cell proliferation and differentiation.

          Platelet-rich plasma (PRP) is widely used to promote tissue healing. However, there is no concrete evidence for the biological effects of PRP. This study evaluated the biological effects of PRP on the proliferation and differentiation of 2 human osteoblast-like cell lines. Human osteosarcoma cell lines HOS and SaOS-2 were used in this study. PRP was prepared from freshly drawn human venous blood containing a large number of platelets. The MTT assay was used to examine the effects of PRP on osteoblast viability. To evaluate the growth and differentiation, alkaline phosphatase activity was assessed and the expression of procollagen type I, osteopontin, and osteoprotegerin mRNA was measured using semiquantitative reverse transcriptase-polymerase chain reaction. Further, core binding factor alpha 1 (cbfa1/Runx2/AML3/PebpalphaA), a critical regulator of osteoblast differentiation, was also determined. The administration of PRP enhanced the viability of HOS and SaOS-2 cells in a dose-dependent manner. Alkaline phosphatase activity was suppressed during the cell growth phase, but was strongly enhanced when the cells reached confluence. Semiquantitative reverse-transcription polymerase chain reaction analysis showed that PRP enhanced the levels of procollagen type I, osteopontin, osteoprotegerin, and core binding factor alpha 1 (cbfa1) mRNA. These results suggest that PRP has a favorable effect on human osteoblast-like cells, and acts both to enhance bone regeneration and as an activator in wound healing.
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            Osteoplastic frontal sinus surgery with fat obliteration: technique and long-term results using magnetic resonance imaging in 82 operations.

            To evaluate the intraoperative and late complications of osteoplastic sinus surgery with fat obliteration with long-term magnetic resonance imaging (MRI) follow-up. The operative records of all patients who underwent osteoplastic frontal sinus surgery with fat obliteration between January 1, 1986 and December 31, 1997 were reviewed and the postoperative clinical course and magnetic resonance imaging (MRI) scans were analyzed if available. MRI analyses revealed that changes in the distribution of fatty and fibrous tissue, the development of necrosis or oil cysts, recurrences, inflammatory complications, and mucoceles were time-dependent occurrences. Eighty-two operative records were evaluated and 59 patients were followed 1 to 12 years after surgery. Eighty-six MRI scans in 51 patients were available for analysis. The most frequent intraoperative complications were exposure of orbital fat (19.5%), unintentional fracture of the anterior wall (19.5%), incorrect placement of the anterior wall (17%), and dural injury (9.8%). Persistent changes of the frontal contour (embossment, depression) occurred in 10.2% and the esthetic result was unfavorable in 5.1% of the cases. Mucoceles could be detected in 5 of 51 cases (9.8%). The amount of adipose tissue detectable in the last scan was less than 20% in the majority of cases (53%), and more than 60% in only 18% of the cases. The amount of adipose tissue decreased significantly with time (the median half-life was 15.4 mo). Osteoplastic frontal sinus surgery with fat obliteration is very useful and successful in patients in whom the frontal sinus is not accessible via an endonasal approach or the natural drainage cannot be reestablished. MRI is currently the most valuable diagnostic tool to evaluate the frontal sinus after obliteration with adipose tissue. The method has some limitations with regard to detection of small recurrent mucoceles and differentiating vital adipose tissue from fat necroses in the form of oil cysts. In these difficult cases, long-term MRI follow-up is necessary.
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              Complications of frontal sinusitis and their management.

              Because of the anatomic location and venous drainage pattern of the frontal sinus, complications commonly involve intracranial structures but can involve the orbit and adjacent bony and soft tissue structures also. Evaluation of patients by a thorough history and physical examination, culture of purulent discharge or infected bone, and axial and coronal CT scanning with contrast is important for diagnosis and treatment planning. Treatment of complications uniformly involves the use of intravenous antibiotics and appropriate drainage procedures to arrest the infection and allow for resolution of the inflammatory complication. Significant morbidity and mortality from complications can occur despite aggressive medical and surgical treatment.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                neuro
                Neurocirugía
                Neurocirugía
                Sociedad Española de Neurocirugía (Murcia )
                1130-1473
                August 2006
                : 17
                : 4
                : 351-356
                Affiliations
                [1 ] Hospital Universitario Virgen del Rocío Spain
                Article
                S1130-14732006000400007
                10.4321/s1130-14732006000400007
                92c4e4ef-1170-4df4-a97c-393ee7096daa

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                NEUROSCIENCES
                SURGERY

                Surgery,Neurosciences
                Frontal Sinus,Obliteration,Chronic Osteomyelitis,Tibia,Bone graft,Platelet-rich plasma,Seno frontal,Obliteración,Osteomielitis crónica,Injerto óseo,Plasma rico en plaquetas

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