PMC7082611_01
A and B - Initial clinical aspect of the patient showing suppuration, edema and inflammation in the right frontotemporal region, involving the eyeball. Note the presence of suture attaching to the free pectoral graft previously performed.
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Physical examination revealed lower eyelid ptosis and right eyelid eversion, right frontotemporal region with graft with hyperemic borders, necrotic appearance and purulent secretion to manual manipulation, with stench and pain on palpation, as well as bone exposure in the back region, on the right side (Fig. 1).
A and B - Computed tomography in three-dimensional reconstruction showing lesion in the right frontotemporal region (red arrows). C - Axial section of tomographic examination indicating destruction of the right orbital cavity (red arrow).
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Cranial tomography suggested loss of continuity of the internal bone table along the dura-mater in the frontal and right temporal region, with the aspect of bone sequestrum, besides fracture of the bones of the nose, confirming the clinical suspicion of craniofacial osteomyelitis (Fig. 2).
A - Exposure of the surgical. B - Bone sequestrum removed and sent for culture and antibiogram. C - Planning for graft removal in supraclavicular area. D - Operated region after bone sequestrum removal. E - Graft positioned and suture performed.
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Necrotic bone was sent for culture and antibiogram tests (Fig. 3).
A - Five days postoperative clinical aspect. B - Seven days postoperative clinical aspect.
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The patient presented satisfactory postoperative response (Fig. 4).
A - Clinical aspect of the patient 12 months after surgery. B - Tomographic appearance 12 months after surgery.
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During all returns, the patient's only complaint was aesthetic due to the right lower eyelid ptosis (Fig. 5A). Skull tomography performed 12 months after hospital discharge showed no particularity, and there were no new osteolytic areas (Fig. 5B).