Posttraumatic Frontal Bone Osteomyelitis

We present the clinical case of a patient with open bilateral frontal sinus fractures who developed a frontal osteomyelitis. A review of the problem and management ascending to the different alternatives for central anterior skull base defects and fronto-orbital reconstruction is also presented. After extensive radical debridement of the necrotic bone, final reconstruction of the skull base was performed by using a rectus abdominis free flap. A custom-made hard tissue replacement implant was used for the fronto-orbital reconstruction. Extensive debridement is required for the treatment of frontal osteomyelitis. An appropriate isolation of the skull base from the upper aerodigestive system must be obtained to prevent continuous infectious complications. Free flaps are especially useful for skull base reconstruction when traditional methods are not available or have failed because of the lack of available tissue for vascularized reconstruction. Custom-made alloplastic implants are a good reconstructive option for large fronto-orbital defects once the infection is gone and vascularized tissue has been transferred.