Surgical management of traumatic frontal sinus fractures: Case series from a single institution and literature review

Abstract

Background:Neurosurgeons are frequently involved in the management of patients with traumatic frontal sinus injury; however, management options and operative techniques can vary significantly. In this study, the authors review the current literature and retrospectively review the clinical series at a single tertiary referral center.Methods:After Institutional Review Board approval, the medical records and computed tomographic (CT) imaging of patients whose traumatic frontal sinus fractures were treated surgically at the University of Utah were retrospectively reviewed. Demographic information, mechanism of injury, associated injuries, operative technique, and pattern of injury on CT were analyzed.Results:Between 2000 and 2012, 33 patients underwent successful cranialization of the frontal sinus following traumatic injury. The material used to obliterate the sinus varied. No patients required immediate or delayed reoperation. Nasofrontal outflow tract obstruction, the importance of which has been emphasized in the plastic surgery literature, was apparent on either initial or retrospective review of the available CT imaging in 96%.Conclusions:In this series, we successfully surgically treated 33 patients with frontal sinus fractures. The presence of cerebrospinal fluid leak, nasofrontal outflow tract injury, associated depressed skull fractures, and subsequent formation of communicating pathways and infection must be considered when constructing a treatment plan. The goals of treatment should be: (i) surgical repair of the defect and elimination of the conduit from the intracranial space to the outside and (ii) elimination of any cerebrospinal fluid pressure gradient that may develop across the surgical repair. We present a treatment algorithm focusing on the presence of nasofrontal outflow tract injury/obstruction, cosmetic deformity, and cerebrospinal fluid leak.

Traumatic Frontal Sinus Fractures Management: Experience from High-Trauma Centre

“… 29) FSF are common shared area of interest between neurosurgeons, plastic surgeons, otolaryngologists and maxillofacial surgeons. 8 17 37) Naso-frontal outflow tract (NFOT) obstruction can change the algorithm of treatment. 49) The treatment indications of our institution is based on the fracture type, posterior table integrity, NFOT, head trauma severity, CSF leakage and neurological status.…”

“… 49) The treatment indications of our institution is based on the fracture type, posterior table integrity, NFOT, head trauma severity, CSF leakage and neurological status. 3 25 31 37 44 45) The NFOT is an hourglass-shaped structure, which drains secretions from the FS to the frontal recess which continues as the nasofrontal duct (NFD), which opens into the middle meatus of the nasal cavity. 23) This structure is important to be evaluated early in order to prevent complications in long term follow up like CSF leakage, mucocele and infection.…”

Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy

“…Intracranial infection is one of the common clinical complications after craniotomy, and causes insurmountable obstacles in neurosurgery ( 1 , 2 ). Intracranial infection directly affects the prognosis of patients with high mortality and morbidity rate ( 3 – 5 ). Earlier reports indicate a 2.6 and 0.5% prevalence of intracranial infection after craniotomy in China ( 6 ), and USA, respectively ( 7 ).…”

Modification of periosteal flap as management of cerebrospinal fluid leakage after frontal sinus fracture surgery in moderate traumatic brain injury patients

“…Management of extensive frontal sinus fractures in case of traumatic brain injury (TBI) has been a concern for 100 years. [ 1 ] The surgical techniques for management frontal sinus were derived from the treatment of frontal sinusitis and had many complications. Because of the complications, it remains controversial.…”