Breach of Posterior Wall of Frontal Sinus: Management with Preservation of the Sinus

Freeman, Jacob; Winston, Ken R.

doi:10.1016/j.wneu.2014.12.023

Cited by 20 publications

(19 citation statements)

References 43 publications

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“…6,8,14 The contemporary techniques discussed in various papers still result in a 8.2 to 26.1% complication rate including 3 to 10% rate of CSF leak. 5,7,13,17,22 Furthermore, the contemporary procedures all result in the loss of a normally functioning frontal sinus that can lead to long-term consequences such as mucocele. There are also situations in which the frontal sinus is intentionally breached in the course of a surgical approach; for elective surgeries, the standard for the prevention of complication is significantly higher.…”

Section: Discussionmentioning

confidence: 99%

“…A novel approach to sinus injury repair described by Freeman and Winston advocates for the preservation of the sinus. 7 This addresses the next frontier in frontal sinus repair by allowing for continued function of the disrupted anatomy. The benefits of frontal sinus preservation are somewhat theoretical but include restoration of normal anatomy, drainage pathway for mucous, and avoidance of trapping bacteria in the repair.…”

Section: Discussionmentioning

confidence: 99%

“…The technique involved aggressively removing anterior wall, mucosa, supraorbital rims, and proximal nasal bones [1][2][3][4][5] ; some reports additionally describe removal of the posterior wall. 6,7 The skin is then allowed to heal to the posterior sinus wall or dura if the posterior wall was disrupted secondary to pathology or intervention. This left a severe cosmetic defect that required a difficult subsequent operation to repair.…”

Section: Introductionmentioning

confidence: 99%

“…A single neurosurgical technique for frontal sinus preservation is described only for mildly displaced fractures and continues to be complicated by CSF leak. 7 Described in this article is the compartmentalization method for the preservation of the frontal sinus after traumatic injury or intentional entry. The method focuses on preventing communication between the intracranial and extracranial compartments while allowing for the continued function of the frontal sinus.…”

Section: Introductionmentioning

confidence: 99%

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Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Miller

Weisbrod

Beahm

et al. 2019

J Neurol Surg B Skull Base

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Background Cranialization or obliteration is widely accepted intervention for traumatic or intentional breach of the frontal sinus. These techniques, however, result in the loss of frontal sinus function and have a persistent risk of cerebrospinal fluid (CSF) leak and mucocele. Compartmentalization is an open technique for repair of the frontal sinus using allograft onlay and a vascularized periosteal flap that allows for preservation of frontal sinus function. Objective The main objective of this article is to describe the technique for compartmentalization of the frontal sinus and demonstrate its efficacy and complication rate with an early patient series. Methods Our technique includes the following key components: harvesting of a pedicled periosteal flap, frontal sinus repair through a bifrontal craniotomy with minimal mucosa removal, ensuring the patency of the nasal frontal outflow tract, and separation of the brain from the frontal sinus with a dual layer of periosteum and allograft.All cases of frontal sinus repair using the compartmentalization technique at our institution were reviewed. Charts were reviewed for CSF leak, mucocele, and other complications. Results Twenty-three patients underwent the described frontal sinus repair technique 17 for tumor and 6 for trauma. There were no CSF leaks and no mucoceles. One patient experienced postoperative anemia and a “parameningeal reaction” that were managed with a short course of antibiotics. Conclusions Compartmentalization, due to its sinus preservation and low complication rate, represents a meaningful step forward in neurosurgical technique for open frontal sinus repair. However, long-term outcomes are necessary to fully evaluate risk of mucocele.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Miller

Weisbrod

Beahm

et al. 2019

J Neurol Surg B Skull Base

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“…There still fails to be a consensus on how frontal sinus fractures should be managed, but from the recent literature trends, one thing is clear; there has been a paradigm shift toward observation for asymptomatic isolated posterior table fractures that are minimally or moderately displaced. 61,[63][64][65][66][67]…”

Section: Posterior Table Involvementmentioning

confidence: 99%

Complications of Facial Trauma of the Fronto-orbital Region

Cleveland

Smith²

2017

Facial plast Surg

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Evaluation of a Minimally Disruptive Treatment Protocol for Frontal Sinus Fractures

Patel

Berens

Devarajan

et al. 2017

JAMA Facial Plast Surg

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IMPORTANCE Despite common goals of frontal sinus fracture treatment (restoring forehead contour and creating a safe sinus), there remains significant variability in evaluation and treatment.OBJECTIVE To describe our experience with a minimally disruptive treatment protocol for the treatment of frontal sinus fractures. DESIGN, SETTING, AND PARTICIPANTS Analysis of prospectively collected data from 2010 through 2015 at a level 1 trauma center. All patients with frontal sinus fractures treated with our protocol from January 2010 to December 2015. Patients with poor follow-up and/or incomplete medical records were excluded from analysis. MAIN OUTCOMES AND MEASURESPresence of an aerated frontal sinus and aesthetically acceptable forehead contour. Secondary outcome measures were complications related to frontal sinus fractures.RESULTS A total of 39 patients were treated under our minimally disruptive protocol, and 25 patients were included in the study; 18 (72%) were male and 7 (28%) were female. Their ages ranged from 6 to 62 years. After review, 22 patients had both clinical and radiographic follow-up. No patients underwent immediate frontal sinus repair. Five of 22 patients underwent surgery for indications other than their frontal sinus fracture: 1 of 5 patients underwent immediate surgical repair due to bilateral LeFort fractures, and 4 of 5 underwent delayed surgery due to nasal polyps (1 patient), scar revision (1 patient), and concomitant LeFort fractures (2 patients). Two of 22 patients (9%) underwent frontal sinus repair after outpatient surveillance due to persistent cerebrospinal fluid leak (1 patient) and orbital roof fracture (1 patient). The remaining 20 patients were treated nonoperatively, and 19 of 20 (95%) had spontaneous improvement in opacification and/or contour deformity. Twelve of 20 patients (60%) had improvement or resolution in both. One patient had ongoing partial opacification and deformity at the 3-month follow-up but was asymptomatic and had bony contour that was aesthetically acceptable to the patient. There were no complications. The median of all follow-up was 3 months. CONCLUSIONS AND RELEVANCEFrontal sinus fractures treated nonoperatively had a high rate of spontaneous ventilation and bony autoreduction with aesthetically acceptable frontal bone remodeling. There were no complications in the nonoperative group. The initial results of this study support further study of the safety and efficacy of a minimally disruptive protocol for frontal sinus fractures.LEVEL OF EVIDENCE 4.

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Breach of Posterior Wall of Frontal Sinus: Management with Preservation of the Sinus

Abstract: Many patients with mild to moderately severe breaches of the posterior wall of the frontal sinus can be managed safely and effectively by techniques that preserve the anatomy and function of the frontal sinus.

Cited by 20 publications

References 43 publications

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Complications of Facial Trauma of the Fronto-orbital Region

Evaluation of a Minimally Disruptive Treatment Protocol for Frontal Sinus Fractures

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