Figure 6: Case 3: 69-year-old female with a frontal soft tissue and bone defect after resection of a high-grade squamous cell carcinoma of the frontal sinus and filling with PMMA spacer
a: Frontal soft tissue and bone defect. b: CT scan. c: Intraoperative finding. d: Resected necrotic frontal bone together with the PMMA spacer. e: Communication with the nasal cavity. f: Formed PMMA spacer with Vancomycin. g: Wound closure with visor flap and parietal undermining. h: Postoperative anterior view. i: Postoperative parietal view. j: Endoscopic view of the PMMA spacer. k: Second surgery. Planning for bilateral upper lid flaps to close the nasal cavity. l: Removal of PMMA spacer. m: Transplanted bilateral upper lid flaps. n: Visor flap. o: Split thickness skin grafting of the donor site. p: Postoperative side view. q: Skin necrosis frontal. r: Template of the planned flap with the removal of the whole frontal aesthetic unit. s: Lateral arm flap before harvesting. t: Transplanted flap; the lower part was deepithelized and turned over to close the nasal cavity. u: Sutured flap; no spacer was used at this surgery. v: Donor site. w: Postoperative anterior view six months postoperative. x: Postoperative side view six months postoperative. y: Endoscopic view with closed communication to the frontal region.