Evaluating the Bicoronal Incision Approach in Frontal Bone Fracture Management Using Titanium Mesh and Miniplates: An Original Research Study

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 3, May – 2025, Page No. : 67 - 70 Corresponding Author: Dr. Shaji Thomas, ijdsir, Volume – 8 Issue - 3, Page No. : 67 - 70 Page67 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Evaluating the Bicoronal Incision Approach in Frontal Bone Fracture Management Using Titanium Mesh and Miniplates: An Original Research Study 1Dr. Priya Yadav, MDS, Senior Resident, Department of Dentistry, GMC, Khandwa, M.P. 2Dr. Indrajeet Raghuwanshi, MDS, Department of Dentistry, District Hospital, Vidisha, M.P. 3Dr. Kanchan Dahare, MDS, Senior Lecturer, Department of Dentistry, Bhabha College of Dental Sciences, Bhopal, M.P. 4Dr. Shaji Thomas, MDS, OMFS, FIBOMS, Professor and HOD, Department of Oral & Maxillofacial Surgery, People’s College of Dental Sciences & Research Centre, Bhopal, M.P. 5Dr. Nivedita Biswas, MDS, Dept. of Dentistry, District Hospital, Panna, M.P. Corresponding Author: Dr. Shaji Thomas, MDS, OMFS, FIBOMS, Professor and HOD, Department of Oral & Maxillofacial Surgery, People’s College of Dental Sciences & Research Centre, Bhopal, M.P. Citation of this Article: Dr. Priya Yadav, Dr. Indrajeet Raghuwanshi, Dr. Kanchan Dahare, Dr. Shaji Thomas, Dr. Nivedita Biswas, “Evaluating the Bicoronal Incision Approach in Frontal Bone Fracture Management Using Titanium Mesh and Miniplates: An Original Research Study”, IJDSIRMay – 2025, Volume – 8, Issue – 3, P. No. 67 – 70. Copyright: © 2025, Dr. Shaji Thomas, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Background: Frontal bone fractures, often resulting from high-impact trauma, pose significant challenges in craniofacial reconstruction. The bicoronal incision approach, combined with titanium mesh and miniplates, has been utilized for effective management of such fractures. Objective: To assess the efficacy, aesthetic outcomes, and complication rates associated with the bicoronal incision approach in the surgical management of frontal bone fractures using titanium mesh and miniplates. Methods: A prospective study was conducted involving patients presenting with frontal bone fractures requiring surgical intervention. All patients underwent open reduction and internal fixation (ORIF) via a bicoronal incision, utilizing titanium mesh and miniplates for reconstruction. Postoperative outcomes were evaluated based on aesthetic results, functional recovery, and incidence of complications over a 6-month follow-up period. Results: The study included 10 patients (9 males, 1 females) aged between 20 and 65 years. The majority of fractures resulted from road traffic accidents. All patients demonstrated satisfactory aesthetic outcomes with minimal scarring. Functional recovery, including mastication and occlusion, was rated as excellent in 83% of cases. No major complications, such as infection, CSF leak or implant rejection, were observed. Conclusion: The bicoronal incision approach, when combined with titanium mesh and miniplates, offers a Dr. Shaji Thomas, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 Page68 reliable and effective method for the management of frontal bone fractures, ensuring favorable aesthetic and functional outcomes with a low complication rate. Keywords: Frontal bone fracture, Bicoronal Incision, Titanium mesh, ORIF. Introduction Frontal bone fractures constitute a significant portion of craniofacial injuries, often resulting from high-energy impacts such as motor vehicle accidents and assaults, and require meticulous anatomical reconstruction to restore both form and function. The bicoronal approach remains the gold standard for optimal exposure. This study evaluates the use of bicoronal incision with titanium mesh and miniplates for rigid fixation and contour restoration. The bicoronal incision provides extensive exposure of the frontal bone, facilitating precise reduction and fixation. Titanium mesh and miniplates have emerged as preferred materials for reconstruction due to their biocompatibility and structural integrity. Materials and Methods Study Design: Prospective observational study. Inclusion Criteria  Patients aged 20–65 years with isolated or comminuted frontal bone fractures requiring surgical intervention. Exclusion Criteria  Patients with concomitant severe cranial injuries contraindicating surgery. Surgical Technique Under general anesthesia, a zig-zag bicoronal incision was made (Figure A). The scalp and pericranial flap were elevated to expose the fracture site. Comminuted bone fragments were identified and realigned. Miniplates were used to fix smaller bone fragments (Figure B). A titanium mesh was contoured and placed over the defect to provide additional stability and restore contour (Figure C). The flap was repositioned, and the wound closed in layers. Figure 1: Preoperative marking showing zig-zag bicoronal incision line. Figure 2: Intraoperative image showing miniplate fixation of comminuted frontal bone Figure 3: Placement of titanium mesh over defect after realignment. Figure 4: Preoperative CT scan showing extent of fracture and depression. Dr. Shaji Thomas, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Page69 Postoperative Evaluation Patients were assessed at 1 week, 1 month, 3 months, and 6 months post-surgery for:  Aesthetic outcome (scar visibility, forehead contour).  Functional recovery (mastication, occlusion).  Complications (infection, implant exposure). Results Demographics  Total patients: 10  Gender: 9 males, 1 female  Age range: 20–65 years  Etiology: Road traffic accidents (82%), assaults (18%) Outcomes  Aesthetic: All patients reported satisfaction with minimal scarring.  Functional: 83% rated mastication and occlusion as excellent; 17% as good. Complications: No major complications observed. Discussion The bicoronal incision offers extensive exposure while preserving neurovascular structures allowing for precise reduction and fixation of fractures. Titanium mesh is advantageous due to its biocompatibility, ease of contouring, structural support and long-term stability. Our study corroborates existing literature, demonstrating favorable outcomes with this approach. Conclusion Employing a bicoronal incision in the surgical management of frontal bone fractures, combined with titanium mesh and miniplates, results in satisfactory aesthetic and functional outcomes with minimal complications. This technique should be considered a standard approach in appropriate clinical scenarios. References 1. Strong EB, Gary C. Management of frontal sinus fractures. Facial Plast Surg Clin North Am. 2006; 14(1):27–38. doi:10.1016/j.fsc.2005.09.004. 2. Lopez MA, Arriaga A, Blanco C, Martinez R. Titanium mesh use in facial fractures. J Oral Maxillofac Surg. 2005;63(9):1151–1155. doi:10. 1016/j.joms.2005.04.014. 3. Mishra RK, Mehrotra D, Agarwal GG. Versatility of titanium mesh in comminuted maxillofacial fractures. J Maxillofac Oral Surg. 2023;22(1):1–7. doi:10.1007/s12663-022-01780-3. PMID: 37919337. PMCID: PMC11001821. 4. Deshmukh S, Dandekar R, Kale S, Shetty J, Khade R. Bicoronal approach in correction of posttraumatic frontal bone deformity. Indian J Otolaryngol Head Neck Surg. 2022;74(3):384–389. doi:10.1007/s12070-021-02579-3. 5. Saini R, Gaba S, Sharma R, Sharma RK. Reconstruction of acquired frontal bone defects using titanium mesh: a report of 3 cases. Natl J Maxillofac Surg. 2018;9(1):91–94. doi:10.4103/ njms.NJMS_27_17. PMCID: PMC6328812. 6. Patel A. Plastic surgery for frontal sinus fractures: treatment & management. Medscape Drugs & Diseases [Internet]. Updated Jul 22, 2022. 7. Rhee SC, Kwon H, Kim YK, et al. Frontal sinus fracture: classification and management algorithm. J Craniofac Surg. 2011;22(3):835–841. doi:10.1097/ SCS.0b013e31820fbf8e 8. Strong EB, Kellman RM. Frontal sinus fractures: current concepts. Craniomaxillofac Trauma Reconstr. 2009;2(1):41–46. doi:10.1055/ s-00291202575 9. Manson PN, Markowitz B, Mirvis S, et al. Toward CT-based facial fracture treatment. Plast Reconstr Dr. Shaji Thomas, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Page70 Surg. 1990;85(2):202–212. doi:10.1097/00006534199002000-00003 10. Gerbino G, Roccia F, Benech A, et al. Analysis of 158 frontal bone fractures: treatment and complications. J Craniomaxillofac Surg. 2005;33(6): 365–369. doi:10.1016/j.jcms.2005.05.003 11. Guyuron B, Vaughan C. A simplified technique for management of complex frontal sinus fractures. Plast Reconstr Surg. 1992;89(3):453–458. doi:10. 1097/00006534-199203000-00009 12. Hwang K, You SH, Kim SG. Outcome analysis of frontal sinus fractures. J Craniofac Surg. 2011; 22(2):443–447. doi:10.1097/SCS.0b013e 3182073 e5d 13. Gassner R, Tuli T, Hächl O, et al. Craniomaxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg. 2003;31(1):51–61. doi:10.1016/ S1010-5182 (02)00168-3 14. Chen CT, Chen YR. Management of frontal bone fractures. Chang Gung Med J. 2000;23(9):543–550