Endoscopically Assisted Removal of Frontal Hardware and Sequestrum

Osteosynthesis using plates and screws in treatment of craniofacial disorder is well established. The implant may then be regarded as a foreign body once its role is completed. Potential complications such as infection, delay union, as well as palpable plates or screws may follow after insertion of the hardware. The inherent properties of magnification and illumination of endoscope provide an ideal environment for removal of forehead hardware and sequestrum when causing symptoms. A consecutive 9 patients (5 male and 4 female including 4 children)received the endoscopically assisted procedure for removal of frontal hardware (8) and sequestrum (1). The average of time interval between initial reconstructive surgery and secondary endoscopic procedure was 9.8 months. All patients had smooth course of removal of the hardware and sequestrum without conversion to traditional open methods. Complications were not seen during the period of follow-up. The patients and their families were happy with their forehead contour and cosmetic results. The endoscope assisted method allows magnified vision, avoidance of neurovascular bundles injury, minimal tissue disturbance, and better convalescence. It provides a good alternative method for removal of hardware and sequestrum in the frontal region.