Background: Recently developed endoscopic browlifting techniques and instrumentation are being used for treatment of anterior table frontal sinus fractures. Potential endoscopic treatment options include fracture reduction with or without plating and fracture repair with hydroxyapatite bone cement (HA). Objective: To evaluate the efficacy of miniplates and HA for repair of anterior table fractures. Methods: Frontal sinus fractures were generated in 11 cadavers. Standard endoscopic brow-lifting techniques were used to visualize the fracture from above. A 1-cm Lynch incision was used to apply instrumentation from below. Fractures were repaired with either miniplate reduction or HA recontouring. Results: All fractures were exposed without difficulty. Miniplates were applied in 5 specimens: 1 specimen had a complete reduction, 2 specimens had partial reductions, and 2 specimens had incomplete reductions. Bone cement was applied in 9 specimens: 4 specimens were rated as excellent and 5 specimens as good. Conclusions: Frontal sinus fractures can be successfully exposed and repaired with an endoscopic technique. Endoscopic miniplate reduction of frontal sinus fractures can be accomplished. However, it is challenging, and success rates vary depending on fracture comminution. Endoscopic HA recontouring offered the best results, with good or excellent outcomes in all specimens.

Published reports ofnail gun inj uries to the head and neck are rare. We describ e the cases of three patients who sustained nail gun injuries to the head and who were mana ged at our institution. All patients were treated succe ssf ully and all recovered with minimal morbidity. Any physician who is call ed on to manage a nail gun injury to the head or neck should understand that most likely the patient will hav e sustained a surprisingly limited am ount of tissue injury, owin g to the relatively low velocity ofthe projectile compared with that delivered by f irearms. Computed tomography and selectiv e angiography can pla ya vital role in assessin g the integrity of relevant vascular stru ctures. Moreover, catheter an giography with embolization can be a most useful nonsurgical adjun ct to control the extent of vascular injury. Introd uction Penetrating trauma to the head and neck caused by a nail fired from a nail gun is a unique, uncommon, and usually nonfatal injury. The use of nail guns in the con struction industry gained popularity dur ing the 1990s and is now widespread. HThis technology has significantly increa sed productivity, lowered costs , and reduced repetitive stress injuries associated with using a hammer.' However, the growing popularity of these tools has been accompanied From the Ear, Nose, and Throat Departm ent, Phoenix (Ariz.

No abstract