Comparison of complications following frontal sinus fractures managed with exploration with or without obliteration over 10 years

Abstract

Two hundred twelve patients were treated for facial or skull trauma at the West Virginia University Hospital between the years 1977 and 1987. Sixty-six of these patients had frontal sinus or nasofrontal duct trauma. Follow-up information was obtained on 64 of these patients through clinic visits, chart review, questionnaires to patients and physicians, and telephone calls to the patients. Follow-up greater than 1 year was obtained on 52 patients. Sixty-four patients were managed either with a frontal sinus obliteration or with an open exploratory procedure. The incidence of complications occurring in the past 10 years after each of these procedures is compared. Because the indications for each procedure vary somewhat, data is presented on fracture etiology, associated injuries, specific fracture location, fracture displacement, severity of injury, and associated cerebrospinal fluid leaks.

Delayed development of frontal mucocele after fronto-orbital advancement in a child with craniosynostosis

“…Because 67% to 100% of mucoceles occur several years or decades after surgery, some authors have recommended that patients who have received frontal sinus trauma or surgery should be followed up for at least 5 to 10 years or for their remaining lifetime [2,6,7,19]. Classical treatment of mucoceles consists of transcranial removal of the mucocele by an obliteration procedure that is still recommended especially for patients who have progressive- ly aggravating neurologic symptoms, wide adhesion of mucocele with neural contents, and intracranial abscess.…”

Cirurgia das fraturas do seio frontal: estudo epidemiológico e análise de técnicas

“…In our diagnostic assessment we used an easy to apply classification (anterior and posterior plates of the frontal sinus, comminuting fracture and related injuries), suggested by Luce (1987) 7 and Donald (1982) 18 . Although being simple, this classification allows us to separate the cases with the greatest potential for complications (posterior plate lesions), which require more complex surgical procedures and medical care, from those which may be managed through simpler surgical approaches, such as the fractures involving the anterior plate of the frontal sinus 3,11,15,21,20 .…”

“…In fracture cases and when there are cranioencephalic complications, we recommend conservative measures such as the prescription of antibiotics that trespasses the blood-brain barrier, the use of intra-vascular expander (dextran) and 30° head elevation until proper diagnosis and management 8,13,21 . In severe lesions, such as CSF fistulas communicating the brain with potentially contaminated cavities (nose), lesions in the orbital cone and optical nerve, the patients should be operated upon in the first 72 hours after the injury, since the early diagnosis and treatment of these complications reduce both morbidity and mortality [11][12][13]18,19,23 . Even then, it is not uncommon for these patients to develop meningitis, fistulas, intrarrhachidian abscesses, longer hospital stay and the need for two or more surgeries 17,18,22 .…”

“…In severe lesions, such as CSF fistulas communicating the brain with potentially contaminated cavities (nose), lesions in the orbital cone and optical nerve, the patients should be operated upon in the first 72 hours after the injury, since the early diagnosis and treatment of these complications reduce both morbidity and mortality [11][12][13]18,19,23 . Even then, it is not uncommon for these patients to develop meningitis, fistulas, intrarrhachidian abscesses, longer hospital stay and the need for two or more surgeries 17,18,22 . Another common sequel in these cases depends on the type of injury (cribiform plate fracture) or the type of surgery, which is permanent anosmia 10,18 .…”

“…For some authors, the most common cause of frontal mucocele are frontal sinus and nasofrontal duct injuries 17,18 . Others believe the nasofrontal duct obstruction in frontal sinus injuries is less frequent that what has been described in previous papers, thus changing so far established concepts as to the need for mucosal cauterization, curettage and even frontal sinus obliteration 17,19,20 .…”