Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases

Chen, Kuang-Te; Chen, Chien-Tzung; Mardini, Samir; Tsay, Pei-Kwei; Chen, Yu-Ray

doi:10.1097/01.prs.0000227738.42077.2d

Cited by 98 publications

(83 citation statements)

References 34 publications

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“…Other clinical findings are summarized in Table 2. The patients' neurological presentation varied widely; the mean Glasgow Coma Scale score was 9.8 (range [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Results Patient Populationmentioning

confidence: 99%

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Archer¹,

Sun

Bonney³

et al. 2016

JNS

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OBJECT This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. METHODS Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. RESULTS Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients’ mean age was 33 years (range 11–79 years). The mean overall length of follow-up was 14 months (range 5–45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)—1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. CONCLUSIONS Extensive anterior skull base fractures often require aggressive treatment to provide the greatest long-term functional and cosmetic benefits. Several vascularized tissue flaps can be used, either alone or in combination. Vascularized flaps are an ideal substrate for cranial base repair. Dual and triple flap techniques that combine the use of various anterior, lateral, and nasoseptal flaps allow for a comprehensive arsenal in multilayered skull base repair and salvage therapy for extensive and severe fractures.

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Section: Results Patient Populationmentioning

confidence: 99%

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Archer¹,

Sun

Bonney³

et al. 2016

JNS

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“…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…”

Section: Resultsmentioning

confidence: 99%

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

Castro

Walcott

Redjal

et al. 2012

FOC

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Frontal sinus fractures are heterogeneous, and management of these fractures is often modified based on injury pattern and institutional experience. The optimal initial treatment of frontal sinus fractures is controversial. Treatment strategies are aimed at correcting cosmetic deformity, as well as at preventing delayed complications, including CSF fistulas, mucocele formation, and infection. Existing treatment options include observation, reconstruction, obliteration, cranialization, or a combination thereof. Modalities for treatment encompass both open surgical approaches and endoscopic techniques. In the absence of Class I data, the authors review the existing literature related to treatment strategies of frontal sinus fractures, particularly as they relate to CSF fistulas, to provide recommendations based on the best available evidence.

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“…Primero se debe estabilizar el paciente (ABCDE) y la prioridad en el tratamiento es el manejo de forma multidisciplinar (Cirugía Maxilofacial, Neurocirugía, Otorrinolaringología (ORL) y Oftalmología) (17,18).…”

Section: Manejo De Fracturasunclassified

“…El manejo inadecuado del seno frontal, de la mucosa y del receso frontal llevará a complicaciones obstructivas y complicaciones patológicas (26). La participación de la pared posterior se asocia más comúnmente con daño a las estructuras posteriores del globo (neuropatía óptica traumática, parálisis del nervio motor ocular común y lesiones del quiasma óptico (18).…”

Section: Complicacionesunclassified

Manejo de trauma frontal. Revisión de literatura y reporte de casos

Neira

Eslava

2010

Rev. Med.

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ResumenDesde la época de Reidel (1898) han sido considerables los avances en el manejo del trauma frontal; sin embargo, el tratamiento para este trauma sigue siendo controvertido y si por alguna circunstancia el manejo no es el adecuado, se pueden presentar serias complicaciones. En este articulo se reportan siete casos manejados por el servicio de Cirugía Oral y Maxilofacial del Hospital Militar Central (HMC) de Bogotá, Colombia, y se hace una revisión de la literatura sobre manejo de fracturas de seno frontal y las diferentes técnicas utilizadas, especialmente en la obliteración del receso frontal con los materiales autógenos o aloplásticos disponibles y las complicaciones más frecuentes.Palabras clave: receso frontal, cranealización, desfuncionalización, obliteración, mucocele MANAGEMENT OF FRONTAL TRAUMA. REVIEW LITERATURE AND REPORT OF CASES AbstractSince the work of Reidel (1898), there have been considerable advances in the management of frontal trauma. However, the treatment for this trauma is still controversial, so if given the case of inappropriate management, it can imply serious complications. In this article seven cases handled by the service of Oral Surgery and Maxilofacial of the Central Military Hospital (HMC) of Bogotá-Colombia are reported. A literature review was prepared on managing fracture of frontal sinus and the different technologies used, especially in the frontal recess obliteration with available autogenous or alloplastic materials and the most frequent complications.Key words: frontal recess, cranialization, defunctionalization, obliteration, mucocele ABORDAGEM DE TRAUMA FRONTAL. REVISÃO DA LITERATURA E RELATO DE CASOS ResumoDesde o tempo de Reidel (1898) tem havido avanços consideráveis na abordagem de trauma frontal; porem, o tratamento para o trauma ainda é controverso e se por algum motivo, a abordagem não é adequada, complicações graves podem ocorrer. Neste trabalho nós relatamos sete casos tratados pelo Serviço de Cirurgia Bucomaxilofacial do Hospital Militar Central (HMC) de Bogotá, Colômbia, e uma

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Frontal Sinus Fractures: A Treatment Algorithm and Assessment of Outcomes Based on 78 Clinical Cases

Cited by 98 publications

References 34 publications

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

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

Manejo de trauma frontal. Revisión de literatura y reporte de casos

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