Background: Brow bone injuries are an uncommon type of facial fracture. They are typically associated with high impact injuries to the forehead. The thin bones overlying the frontal sinus are typically shattered over most of the underlying air cavities. Inward displacement occurs and an external contour deformity results which is particularly obvious in men due to their naturally more prominent brow bones.
Brow bone fracture repair is done by the use of small plates and screws which requires direct access in more severely displaced bone segments. This is the only way to restore the convex shape of the brow bones as the plates help serve as arched suspensions. When older wire fixation techniques were only available lack of restoring adequate brow bone projection was common.
Should inadequate brow bone projection occur restoration can be done using a variety of techniques. Bone cements are a good choice but require an open coronal scalp incision and are difficult to get down into the frontonasal junction underneath a tight scalp flap. Custom implants made from the patient’s 3D CT scan offers a very accurate and assured method of brow bone augmentation with the potential to be placed through much smaller scalp incisions.
Case Study: This middle-aged male had a history of a motorcycle accident over two decades ago. Amongst numerous facial injuries were extensive brow bone fractures which were repaired by multiple wires through a coronal scalp incision. While the bones went on to heal uneventfully he was left with very flat brow bones and a depressed upper nasal bridge. (low radix)
Using a 3D CT scan a custom brow bone implant design was done to recreate a brow bone prominence (and probably add a little more than he originally had) and build up the upper nose.
Under general anesthesia the front edge of his original scalp scar was opened just inside the temporal lines. Using an endoscopic technique fourteen wire ligatures were removed. The forehead flap was dissected down onto the nose, along the superior orbital rims and along the lateral orbital rims down to the frontozygomatic suture. A single midline screw was preplaced into the implant which was then inserted and positioned under endoscopic guidance. Once midline and the proper low position was assured, a small screwdriver was inserted in a percutaneous manner at the glabella and the implant screwed down into place.
The custom brow bone implant is the most effective method for creating or restoring brow bone projection. Its design features must take into consideration the location and amount of maximal horizontal projection, how far the implant should extend onto the nose and lateral orbital rims as well as the location of the brow bone break in men.
Case Highlights:
1) Brow bone fractures and wire fixation repair are prone to causing brow bone recession.
2) A custom brow bone implant can restore brow bone protrusion and radix nasal height.
3) Endoscopic dissection and placement can be done for most custom brow bone implants.
Dr. Barry Eppley
Indianapolis, Indiana