Secondary Reconstruction of Frontal Sinus Fracture

Fractures of frontal sinus account for 5%–12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

Craniotomy in traumatic frontal sinus fracture cerebrospinal fluid leaks / 中国基层医药

Objective To assess the craniotomy in traumatic frontal sinus fracture cerebrospinal fluid( CSF) leaks.Methods Clinical data of 12 traumatic frontal sinus fracture CSF leaks from January 2010 to December 2014, who treated by craniotomy and conservation treatment was invalid were reviewed.Combined typical clinical presenta-tion and basicranial thin-layer computed tomography(CT),made qualitative diagnosis and localization.Craniotomy by bilateral coronary incision and epidural approach was performed.Repairation was mainly for the endocranium and the basicranium.Bone cement was used to reconstruct the osseous defect of the frontal sinus,and then with pedicle periosteal flap coverage.Dural defects was fixed with autogenous fascia.After operation,staying in bed and using anti-biotic for 7-14 days were required,while mannital or lumbar-drainage as needed.Results All 12 cases got posi-tive preoperative CT results.Craniotomy was performed,succeeded without reoperation.None of intracranial infection happened,while 1 case suffered from anosphrasia.Followed up for 3 -12 months, none CSF leaks relapsed. Conclusion Craniotomy by coronary incision,dispose the endocranium and the basicranium for the patients who suf-fered from frontal sinus fracture CSF leaks while conservation treatment is invalid,can obtain satisfied result.

Extended Application of Endoscopic Repair for Frontal Sinus Fractures

PURPOSE: The coronal approach for repair of frontal sinus fractures is associated with significant adverse sequelae including a long scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. To minimize these complications, an endoscopic approach for repair of frontal sinus fractures was developed. The authors now present the results of an endoscopy-assisted approach for the treatment of frontal sinus fractures. METHODS: From 2002 to 2009, five patients with frontal sinus fracture underwent endoscopic repair. Two slit incisions were placed in the scalp, and one or two stab incisions directly over the fractures were placed in the forehead. After subperiosteal dissection, fracture segments were reduced under direct vision and fixed with microplates or fibrin glue. RESULTS: All patients had good cosmetic results and remained free of sinus complaints. There were no perioperative complications reported. CONCLUSION: Endoscopic repair of frontal sinus fractures is an efficacious technique that significantly reduces patient morbidity. A relatively wide range of anterior table fractures can be reduced using an endoscope. In cases of complicated comminuted fractures, fibrin glue helps to achieve satisfactory endoscopic reduction. Endoscopic repair is an alternative treatment for various anterior table fractures of the frontal sinus.

Treatment of Frontal Sinus Fractures According to Fracture Patterns

PURPOSE: Frontal sinus fractures are relatively less common than other facial bone fractures. They are commonly concomitant with other facial bone fractures. They can cause severe complications but the optimal treatment of frontal sinus fractures remains controversial. Currently, many principles of treatment were introduced variously. The authors present valid and simplified protocols of treatment for frontal sinus fractures based on fracture pattern, nasofrontal duct injury, and complications. METHODS: A retrospective chart review was performed on 36 cases of frontal sinus fractures between January, 2004 and January, 2009. The average age of patients was 33.7 years. Fracture patterns were classified by displacement of anterior and posterior wall, comminution, nasofrontal duct injury. These fractures were classified in 4 groups: I. anterior wall linear fractures; II. anterior wall displaced fractures; III. anterior wall displaced and posterior wall linear fractures; IV. anterior wall and posterior wall displaced fractures. Also, assessment of nasofrontal duct injury was conducted with preoperative coronal section computed tomographic scan and intraoperative findings. Patients were treated with various procedures including open reduction and internal fixation, obliteration, galeal frontalis flap and cranialization. RESULTS: 12 patients are group I(33.3 percent), 14 patient were group II(38.8 percent), group III, IV were 5 each(13.9 percent). Frontal sinus fractures were commonly associated with zygomatic fractures(21.8 percent). 9 patients had nasofrontal duct injury. The complication rate was 25 percent(9 patients), including hypoesthesia, slight forehead irregularity, transient cerebrospinal fluid leakage. CONCLUSION: The critical element of successful frontal sinus fracture repair is precise diagnosis of the fracture pattern and nasofrontal duct injury. The main goal of management is the restoration of the sinus function and aesthetic preservation.

Treatment of Frontal Sinus Fractures According to Fracture Patterns

PURPOSE: Frontal sinus fractures are relatively less common than other facial bone fractures. They are commonly concomitant with other facial bone fractures. They can cause severe complications but the optimal treatment of frontal sinus fractures remains controversial. Currently, many principles of treatment were introduced variously. The authors present valid and simplified protocols of treatment for frontal sinus fractures based on fracture pattern, nasofrontal duct injury, and complications. METHODS: A retrospective chart review was performed on 36 cases of frontal sinus fractures between January, 2004 and January, 2009. The average age of patients was 33.7 years. Fracture patterns were classified by displacement of anterior and posterior wall, comminution, nasofrontal duct injury. These fractures were classified in 4 groups: I. anterior wall linear fractures; II. anterior wall displaced fractures; III. anterior wall displaced and posterior wall linear fractures; IV. anterior wall and posterior wall displaced fractures. Also, assessment of nasofrontal duct injury was conducted with preoperative coronal section computed tomographic scan and intraoperative findings. Patients were treated with various procedures including open reduction and internal fixation, obliteration, galeal frontalis flap and cranialization. RESULTS: 12 patients are group I(33.3 percent), 14 patient were group II(38.8 percent), group III, IV were 5 each(13.9 percent). Frontal sinus fractures were commonly associated with zygomatic fractures(21.8 percent). 9 patients had nasofrontal duct injury. The complication rate was 25 percent(9 patients), including hypoesthesia, slight forehead irregularity, transient cerebrospinal fluid leakage. CONCLUSION: The critical element of successful frontal sinus fracture repair is precise diagnosis of the fracture pattern and nasofrontal duct injury. The main goal of management is the restoration of the sinus function and aesthetic preservation.

Small Incision and Dual-Top Screws for Treatment of Simple Depressed Anterior Frontal Sinus Fractures

PURPOSE: Fracture of the frontal sinus accounts for 5-15% of all facial fractures. Only anterior table fracture occupies one third of the frontal sinus fracture. Conventional coronal approach is the standard treatment, but this method is very aggressive, especially in patient with simple, depressed, anterior frontal sinus wall fracture. We introduce new, simple technique for these patients, using small incision and Dual-top screws. METHODS: A 27-year-old male patient was introduced to our department under the impression of fracture of frontal sinus, involving only anterior table. Under general anesthesia, 1.5cm-sized, small incision was made on the suprabrow area. We reduced fractured fragment with two dual-top screws and 25G wires. Fixation was not necessary RESULTS: The operation took about forty minutes, and the patient discharged 2 days after the operation. Postoperative 2 months follow up CT shows maintenance of reduction site. Gross depression of the forehead and visible scar was not observed. CONCLUSION: Although the indication of this procedure is limited, less aggressive, simple and very effective to the patient with simple. depressed, anterior frontal sinus fracture.

Management of Frontal Sinus Fracture according to the Type and Severity of the Fracture : Analysis of 23 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Frontal sinus fracture can have serious consequences due to proximity of the sinus to the intracranial cavity and the potential for serious combined injuries. Management of the Fractures depends on the type and severity of the fracture and the presence of associated injuries. In this article, we present an overview of fracture treatment options, and offer a simple algorithm for management based on the type and severity of the facture. PATIENTS AND METHODS: Twenty-three patients with frontal sinus fractures were analysed. All patients were male, with the mean age of 31. The average follow-up length was 13 months. Of 23 patients, 8 patients had anterior wall fractures and 15 patients had anterior and posterior wall fractures. Their types of fracture, combined injuries, surgical methods, surgical results, and complications were analysed. RESULTS: Six patients had conservative management and 17 patients had surgery. Of 17 patients who had surgery, 6 patients had only repair of the fracture, 3 patients had repair of the fracture with sinus obliteration, and 8 patients had repair of the fracture with cranialization of the frontal sinus. The most common associated injury was fractures of other facial bones (83%), especially the orbit. Traumatic optic neuropathy was the most common complication associated with the frontal sinus fracture or its accompanying injuries. CONCLUSION: Frontal sinus fractures were safely managed with repair of the fracture, sinus obliteration, or with sinus cranialization which was used irrespective of type and severity of fractures.

Clinical Study of Frontal Sinus Fractures: A Review of 14 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of frontal sinus fractures has increased as traffic and industrial accidents have increased. However, they are still uncommon compared to other facial traumas because of the arch configuration and the thickness of the anterior wall of the frontal sinus. Accurate evaluation is highly recommended in cases of frontal sinus fractures because they are likely to result in serious complications, including frontal sinusitis, meningitis, and mucocele. In this paper, we reviewed 14 cases of frontal sinus fractures and investigated the clinical characteristics and treatment results. MATERIALS AND METHODS: A retrospective review was performed on 14 patients with frontal sinus fractures who had been treated in our department from June, 1995 to August, 1997. RESULTS: Eleven patients were treated with surgery, including osteoplastic frontal sinus surgery with fat obliteration (5 patients), open reduction and internal fixation of the anterior wall (4 patients), and cranialization (2 patients). Three patients were treated with conservative methods. There were no complications such as infection, meningitis, and mucocele formation in the patients who underwent surgery for an average follow-up period of 19 months. CONCLUSION: Our results show that an aggressive approach is justified for treatment of frontal sinus fractures.

Treatment of frontal sinus fracture

Although frontal sinus fractures were less common than other facial bone fractures, there have been an increase in frequency. When frontal sinus fracture has developed, depressed anterior wall fracture causes severe deformity and posterior wall fracture may be associated with severe neurosurgical complications. As the importance of external feature increased due to the improvement of life quality and social life style, so accurate diagnosis and appropriate treatment become more important for the prevention of deformity. Mucocele which is one of the most common complication of frontal sinus fracture results in cosmetically serious deformity due to inappropriate treatment Therefore, systematic classification of the fracture and reliable methods of treatment according to the types of fractures are necessary. There has not been any uniform treatment modality according to the types of the frontal sinus fracture. We present the result of 24 patients who were treated at the department of plastic and reconstructive surgery in Yeungnam University Medical Center from Apr. 1994 to Apr. 1996. Anterior wall fracture was reduced by mosaic fixation, mucosal stripping and nasofrontal duct obliteration. Posterior wall fractures were treated by cranialization and naso frontal duct obliteration reinforced with galeal flap. There were no reoperation and the results were good in terms of both function and cosmetics without any major complications.

Treatment of frontal sinus fracture

Although frontal sinus fractures were less common than other facial bone fractures, there have been an increase in frequency. When frontal sinus fracture has developed, depressed anterior wall fracture causes severe deformity and posterior wall fracture may be associated with severe neurosurgical complications. As the importance of external feature increased due to the improvement of life quality and social life style, so accurate diagnosis and appropriate treatment become more important for the prevention of deformity. Mucocele which is one of the most common complication of frontal sinus fracture results in cosmetically serious deformity due to inappropriate treatment Therefore, systematic classification of the fracture and reliable methods of treatment according to the types of fractures are necessary. There has not been any uniform treatment modality according to the types of the frontal sinus fracture. We present the result of 24 patients who were treated at the department of plastic and reconstructive surgery in Yeungnam University Medical Center from Apr. 1994 to Apr. 1996. Anterior wall fracture was reduced by mosaic fixation, mucosal stripping and nasofrontal duct obliteration. Posterior wall fractures were treated by cranialization and naso frontal duct obliteration reinforced with galeal flap. There were no reoperation and the results were good in terms of both function and cosmetics without any major complications.