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

Abstract

Objective Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons. Methods Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010–2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques. Results Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14–86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients. Conclusion Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.

Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature

“…A 2021 review of 338 cases in Israel reported an operative rate of 22.8%, 24 while a similar-sized review published in the same year in Egypt reported an operative rate of 46.1%. 25 In congruence with proposed frontal sinus management algorithms and other recent studies, 7,10,14,15,21,26 both fracture displacement and comminution were significantly associated with surgical intervention in our sample. Fractures were more likely to be operative with associated dural tears/CSF leaks and FSOT involvement.…”

Traumatic maxillofacial injuries: Patterns, outcomes, and long‐term follow‐up of a military cohort

“…Previous studies have demonstrated associations between facial fracture sites and associated head injury or TBI. Such associations have been reported for upper face fractures, mostly frontal sinus, 34,35 mandibular fractures, 36 and maxillary Le fort fractures 37 . A link between zygoma and orbital injuries and possible TBI was addressed herein.…”

Incidence, patterns, and management of frontal sinus fractures

“…10 Road traffic accidents were the common cause of frontal fractures in multiple studies and the percentages range from 52-75%. 8,9 The location and configuration of FSF determine the treatment type. It can be treated conservatively with medication prescriptions and follow-up, or surgically with cranialization, obliteration, or internal fixation only.…”

“…There is a high tendency for frontal fractures to involve the male gender, according to studies from different places. Strong et al 8 and Al-Shami et al 9 found that men were involved in 89% and 84% of frontal fractures. Similarly, Johnson et al’s systematic review and meta-analysis showed that 84.1% of frontal fractures occurred in men.…”

“…Road traffic accidents were the common cause of frontal fractures in multiple studies and the percentages range from 52-75%. 8 , 9 …”