Frontal Sinus Fractures

Abstract

OverviewTreatment of the frontal sinus and its associated pathology is a controversial and highly debated topic in craniomaxillofacial trauma. A lack of consensus exists in the current literature regarding the preferred management of frontal sinus fractures, with contradictory and radically different approaches often made based solely on anecdotal evidence. Most clinical recommendations are derived from singlecenter retrospective case series with small sample sizes and selection bias. Indeed, there are striking differences between regional and international institutions pertaining to indications for treatment, timing of repair, types of operations performed, use of autogenous versus alloplastic materials, guidelines for prophylactic antibiotics, and appropriate length of follow-up. This chapter attempts to collate the available evidence into a clear and concise format in order to provide clarity to an otherwise confusing domain of fracture management. Our goal is to present a simple treatment strategy that has proven to be safe and reliable in the management of frontal sinus fractures. Anatomy and PhysiologyThe frontal sinus is located within the frontal bone deep to the supraciliary ridge. It is relatively small with an average volume of 5 cm 3 and is considered a tripartite structure consisting of a resilient anterior wall, an intervening airfi lled cavity, and a weaker posterior wall (see Fig. 19.1 ). The average height of the frontal sinus is 24.3 mm (range 5-66 mm), and its average length is 29 mm (range 17-49 mm). The anterior wall (range 2-12 mm) is substantially thicker than the posterior wall (range 0.1-4 mm) with an average thickness of 4 mm. Each sinus cavity is typically described as an inverted pyramid sitting on its point with characteristic scalloping along its borders: easily visualized on plain radiographs due to multiple incomplete septations arising from the sinus walls. The boundaries of the sinus fl oor include the orbital roof laterally and the cribriform plate medially separated for a short distance by the fovea ethmoidalis. The intersinus septum is an extension of the