Appropriate Pathways and Surgical Approaches in the Fractures of the Frontal Sinus

Abstract

Fractures of the frontal sinus are part of the fractures of the border between the facial and the cranial regions.They cause both aesthetic and vital problems, but also functional, requiring rapid and global care in a multidisciplinary setting. The document provides a descriptive and cross sectional study with prospective data collection, conducted in the department of Maxillofacial and Aesthetic Surgery of the Mohammed 6 Teaching Hospital of Marrakech, describe describe 18case operated for frontal sinus fractures over a 2-year period. The ideal time of repair was beyond the 72nd hour, at best between the 8th and 15th days after the reduction of cerebral and facial edema and the exclusion of any lesions that require emergency intervention. Our indications were mainly influenced by aesthetic deformities, impaction and embarrure fracture of ethmoidal and orbital roofs with clinical expression, obliteration of the naso-frontal duct, posterior wall displacement predicting dura mater laceration, and by the time to management. The coronal approach was the most indicated with 83, 33% of the cases. We realized sinus exclusion in 72.22%, cranialization in 22.77%, and repair of dura mater injuries in 27.77%. The sequelae found in 27.77%, were essentially functional and aesthetic.

Frontal Sinus Fractures: Management at the Yalgado Ouedraogo University Hospital Centre (Burkina Faso)

“…The approach can be made through the traumatic wound (tans-cicatricial), as was the case in the present study in 25% of patients. This frequency was higher than that reported by Mabika et al [16] and Mahran et al [5], who reported frequencies of respectively 16.7% and 8.5% of cases. The trans-cicatricial approach allows easy, direct and non-invasive exposure of the frontal sinuses, but has the disadvantage of scarring which can be minimised by respecting the skin tension lines [8].…”

“…A total of 102 cases of frontal sinus fractures were reported, giving an annual average of 34 cases. This average is higher than that reported by Mabika et al [16] and Mahran et al [5], who reported respective averages of 12 and 25.6 cases per year. The high frequency of frontal sinus fractures in this study could be explained by the fact that the data were collected in two departments (maxillofacial and neurosurgery) and by the predominance of RTAs (90.20%) frequently involving drivers of two-wheeled machines (98.20%) without helmets.…”

“…The high frequency of frontal sinus fractures in this study could be explained by the fact that the data were collected in two departments (maxillofacial and neurosurgery) and by the predominance of RTAs (90.20%) frequently involving drivers of two-wheeled machines (98.20%) without helmets. Mabika et al [16] and Mahran et al [5] also found that RTAs predominated in 72.22% and 49% of cases respectively. In developed countries, on the other hand, the incidence of frontal sinus fractures has declined over the last 20 years thanks to improved living standards and the use of public transport [17].…”

“…On the other hand, Mahran et al [5], Bell et al [21] and Schultz et al [4] reported a predominance of anterior wall fractures (Type I of Ioannides et al) with frequencies of 53%, 59.5% and 89.7% respectively. Mabika et al [16], on the other hand, reported the predominance of type IV frontal fratures according to Ioannides et al [10]. The type of injury varied from one author to another.…”

“…However, for Bellamy et al [15], a delay of more than 48 hours was associated with a high risk of complications. There is no consensus among authors as to the ideal delay for surgical intervention, since it is thought to be related to the type of injury [6] [15] [16]. Indeed, correction of anterior table fractures should be delayed by at least 7 to 10 days following the trauma to allow resolution of swelling and clear delineation of the frontal deformity [6].…”