Compound frontal sinus injuries with intracranial penetration

Abstract

Extensive trauma to the forehead, resulting in large penetrating wounds of the frontal sinus that extend into the frontal lobes of the brain, has traditionally been treated by frontal sinus ablation. Although this operation eliminates dead space, it leaves the patient with a depressed area in the forehead with little protection for the brain. The success of Nadell and Kline in replacing skull fragments following compound depressed skull fractures yet avoiding infection has spurred us to attempt this technique in penetrating injuries of the frontal sinus. By preserving the anterior frontal sinus wall, we have not only afforded protection for the frontal lobes of the brain, but, at the same time, avoided the cosmetic defect that would be left by an ablation procedure. This procedure has been performed on two patients at our institution. After a two-year follow-up, excellent forehead profile preservation has been achieved and there has been no evidence of bone absorption or infection at any time since surgery.

Frontal Sinus Fracture: A Case Report

“…Changes in mental status as well as nausea or vomiting are suggestive of intracranial injury. It is important to search for cerebrospinal fluid leakage from the nose or directly from lacerations and exposed bone which could signify dural displacement coupled with a posterior table fracture [2] (Figs. 1, 2).…”

“…1, 2). A traumatic CSF fistula of the frontal sinus is a life threatening process deserving urgent attention [2].…”

Cirurgia das fraturas do seio frontal: estudo epidemiológico e análise de técnicas

“…In our diagnostic assessment we used an easy to apply classification (anterior and posterior plates of the frontal sinus, comminuting fracture and related injuries), suggested by Luce (1987) 7 and Donald (1982) 18 . Although being simple, this classification allows us to separate the cases with the greatest potential for complications (posterior plate lesions), which require more complex surgical procedures and medical care, from those which may be managed through simpler surgical approaches, such as the fractures involving the anterior plate of the frontal sinus 3,11,15,21,20 . We believe that clinical observation, supported by ancillary exams (endoscopy, radiographies, CT scans and MRI) shall guide the treatment.…”

“…In less severe injuries, the anterior plate protects the posterior, and the former is usually affected alone. The great impact injuries affect both the plates and the floor with bone fragmentation and derrangement [11][12][13] . By studying craniofacial trauma, Nahum 14 showed that the impact force necessary to cause a frontal sinus fracture is of 360 to 990 Kg (800 to 2,200lb), what is enough to cause other head injuries.…”

“…Even with this concept review and its potential, frontal sinus complications still represent a dilemma for facial trauma surgeons, specially because they are rarely approached by multidisciplinary teams, and this brings about a great variation in handling and repair surgical techniques for these injuries 6,15,19,21 . We must also bear in mind that many of the severe complications such as CSF fistulas and ocular damage may be present regardless of correct handling these injuries 11,17,[19][20][21][22] . Our goal with this paper is to show our experience in caring for patients with frontal sinus fractures, discuss literature data and compare them to the approaches used in our facilities.…”