Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures

Abstract

Lack of large patient cohorts and follow-up limits generalizability of frontal sinus fracture research, and the ability to develop national guidelines of management. Evidence-based literature shows growing support for conservative management and sinus preservation. Improvements in frontal sinus fracture classification schemes, surgical technique, and patient selection direct this treatment paradigm shift.

Frontal Sinus Fractures: Evidence and Clinical Reflections

“…8 Consequently, a contemporary shift in paradigm secondary to less-severe injury patterns has resulted in the adoption of conservative approaches that preserve the sinus, such as nonsurgical management of posterior table fractures and endoscopic repair of NFOT and/or posterior tables fractures. [9][10][11][12][13] Although valuable, the utility of these reports are unclear, given that the majority of these reports are underpowered, heterogenous, and often contradictory.…”

Complications of Facial Trauma of the Fronto-orbital Region

“…There still fails to be a consensus on how frontal sinus fractures should be managed, but from the recent literature trends, one thing is clear; there has been a paradigm shift toward observation for asymptomatic isolated posterior table fractures that are minimally or moderately displaced. 61,[63][64][65][66][67]…”

“…Though there are a large variety of ways to reconstruct anterior table defects, it is important to remember that the least invasive and most cosmetic method that can satisfactorily reduce the defect is usually the method of choice. 65,77,[86][87][88][89]…”

Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature

“…Frontal sinus fractures account for 5-15% of maxillofacial fractures. [1][2][3] Often the result of high-energy trauma, frontal sinus fractures constitute damage to the anterior table, posterior table, frontal sinus outflow tract (FSOT), or a combination of these 3 structures. The anterior table of the frontal sinus forms part of the forehead, brow, and glabella, while the posterior table forms part of the anterior cranial fossa.…”

“…The primary goal in managing frontal sinus fractures is to establish a “safe” sinus, meaning the reconstructed sinus carries no increased risk of obstruction or infection than that of the sinus pre-trauma. 3 Maintaining a barrier between the sinus and intracranial contents, restoring frontal sinus outflow, and preserving the cosmetic appearance of the forehead are all components of successful treatment. 12,13 The AO outlines 4 options for frontal sinus fracture repair: observation, open reduction internal fixation (ORIF), obliteration, and cranialization.…”