Experience in the Management of Frontal Sinus Fractures

Abstract

International guidelines for frontal sinus fractures, dealing with the indication of surgical treatment, obliteration of the frontal sinus, drainage, and cranialization, may differ.In this work, we describe our experience with frontal traumas, analyzing indications, type of treatment, and outcomes by reviewing all data of 112 patients treated for frontal fractures at the Department of Maxillo-Facial Surgery, Università degli studi di Roma Sapienza.We reviewed all clinical and surgical records of patients with traumatic frontal injury treated from 1997 to September 2008. Patients presenting displaced fractures of the anterior wall of the frontal sinus were treated through skin laceration, if existing, or through a coronal approach and fixed with rigid internal devices. Patients with fracture of the posterior wall of the frontal sinus underwent frontal sinus cranialization with galea pericranium pedicled flap to prevent eventful septic complications.Follow-up controls documented that 98 of 112 patients showed no neurologic impairment, no symptoms of cerebrospinal fluid leak, and no other complications after 6 months and 1 and 5 years when follow-up was possible.In the international literature, there is wide agreement about indications dealing with displaced fractures of the anterior wall, although there is a lively debate about posterior wall treatment. In our 10-year experience, the protocol we carried out showed satisfying outcomes, in particular, on the morphofunctional recovery and aesthetic results.

Cerebrospinal fluid fistula prevention and treatment following frontal sinus fractures: a review of initial management and outcomes

“…Data from additional smaller patient series are consistent with these general principles; that is, disruption of the posterior table, CSF fistulas, and nasofrontal tract obstruction all indicate a need for obliteration and cranialization. 5,8,[10][11][12]20,24,27 Illustrative Cases…”

“…22,27 Due to the complex nature of these lesions, an intracranial approach is recommended in most instances to allow for adequate evaluation and exploration.…”

Place and role of titanium mesh in reconstruction of the frontal bone after trauma

“…Da bi se izbegao razvoj mukokele ili neke od navedenih postoperativnih sekvela, operativno zbrinjavanje mora u sebe da uključi kompletno sagledavanje stanja izazvanog traumom i mesta frakturnog loma. Bezuslovno je uklanjanje sluznice čeonog sinusa iz svih recezusa, repozicioniranje kominutivnih fragmenata kostiju u prvobitnu anatomsku poziciju, rekonstruisanje nasofrontalnog kanala, a ako je njegovo oštećenje traumom toliko da je tehnički neizvodljiva njegova anatomska restitucija, onda učiniti njegovo zatvaranje mašću i fasciom latom, perikranijalnim pediklom ili aloplastičnim materijalom [11].…”

10 maxillofacial traumaMaxillofacial Trauma

“…The presence of a small CSF leak does not preclude conservative treatment, as most small leaks will resolve with conser vative management in 7 to 10 days. 45 Comminuted or depressed anterior table fractures can result in significant facial deformity and require surgical reduction and fixation.…”