We report the case of a 40-year-old transgender female with a frontal abscess presenting
several weeks following a motor vehicle crash from which she suffered multiple facial
fractures. The patient had multiple right sided facial fractures, including a medial
orbital wall fracture and a right sphenoid fracture extending into the superior orbital
roof. CT also demonstrated notable hemorrhage in the right frontal lobe. Communication
with the ethmoid sinuses likely provided a conduit for bacterial spread through the
orbit and into the intracranial and subdural spaces. We discuss the surgical approach
for evacuation of the abscess and reconstruction of the skull base with repair of
cerebrospinal fluid leak ([Figs. 1] and [2]).
Fig. 1 Three-dimensional reconstruction of CT of the face which reveals the complex facial
fractures as well as the right-sided orbital fractures.
Fig. 2 Intraoperative picture showing dural tear at the anterior skull base overlying the
orbital roof fracture.
