Management of Frontal Sinus Fractures

Abstract

Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. There is no single algorithm for the choice of management, but appropriate treatment depends on an accurate diagnosis using physical examination, computed tomography data, and the findings of intraoperative exploration. The amount and location of fixation and the need for frontonasal duct and sinus obliteration or elimination of the entire sinus depend on the anatomy of the fracture in general and the extent of involvement of the anterior wall of the sinus, the frontonasal duct, and the posterior wall in particular. This article discusses an algorithm for frontal sinus fractures that was obtained from the literature and modified according to the authors' experience. The decision-making process presented by the authors has withstood the test of time over a period of more than 20 years in their practice and has been proven to be safe and efficacious in treating frontal sinus fractures of all types.

Tratamiento y complicaciones de las fracturas de seno frontal

“…8), lo que también ha sido propuesto por Yavuzer. 16 En caso de asociar una lesión del conducto nasofrontal, se puede completar con obliteración del seno u optar por cranealizarlo. Una actitud similar se puede tomar en casos fracturas no conminutas con fístu-la de LCR.…”

A clinically applicable reporting system for the diagnosis of facial fractures

“…The anatomical portion of the frontal sinus that is involved, the approximate number of comminuted pieces, and a description of the overlying soft-tissue should be provided. Comminution into the frontal bone and/or involvement of the frontonasal duct should be evaluated and mentioned when present 9,25 .…”

“…A number of classification systems have been devised for specific types of facial fracture, including frontal sinus fractures 25 , orbital fractures, nasal fractures 18,24 , nasoethmoid orbital fractures 5,10,17 , zygomatic arch fractures 8,11 , zygomaticomaxillary complex fractures 4 , palatal fractures 7 , mandibular condyle fractures 14,23 and pterygofacial (Le Fort) fractures 2,13,16 . These are generally very coherent, but each is limited to the portion of the facial skeleton of concern.…”

Textbook of Plastic and Reconstructive Surgery

“…Any haematoma or ecchymosis over the glabellar region, as well as bony contours or crepitus locally, should raise the suspicion of sinus injury. Pneumatisation of the frontal sinus is not complete until late adolescence, making fractures rare before this stage (Yavuzer et al, 2005). The frontal bone is the strongest bone of the craniofacial skeleton and requires between 360 and 1000 kg to fracture; however, this is easily achieved in an RTA (Nahum, 1975).…”

“…As illustrated in Figure 9.1, concomitant injuries are common: 75% of fractures have regional pathology and 20% are associated with a CSF leak (Yavuzer et al, 2005). If CSF leakage is suspected, the following diagnostic procedures may be performed:…”