Current practice in the management of frontal sinus fractures

Abstract

Fractures of the frontal sinus are seen predominantly, although not exclusively, in young men and are usually the result of road traffic accidents or falls. These types of injury may present to either ENT, Maxillofacial, Plastic or Neurosurgery teams, and understanding of a clear management protocol is desirable for each of the specialties. The optimal management of these injuries is becoming more uniformly adopted although some areas of contention still persist. The aim of treatment has always been directed at creating a 'safe sinus' that is not complicated by the late sequelae of infection or mucocele formation. The difficulty lies in being able to predict which patients are likely to develop these complications. The aim of this paper is to evaluate the literature and offer a rationale for the management of these injuries.

Frontal Bone Fractures

“…Approximately one third of frontal bone fractures occur only in the anterior wall, whereas two thirds of such cases also involve the posterior wall and the nasofrontal duct. 8 Although isolated fracture of the posterior wall is extremely rare, 8 this condition has been associated with fractures of the anterior skull base, mostly nasoethmoid and orbital roof fractures. 5 Several studies [5][6][7] also reported that males were more likely to have frontal bone fractures owing to their greater involvement in car crashes, interpersonal violence, alcoholism, and drug abuse.…”

Recurrent Meningitis and Frontal Encephalocele as Delayed Complications of Craniofacial Trauma

“…For complex and complicated lesions, open surgical technique should be preferred. 1,4,5 In the open surgical technique, encephalocele mass can be reached through the anterior wall of the frontal sinus using the osteoplastic flap method or craniotomy may be required for some cases. In the osteoplastic flap technique, using x-ray film to determine the boundaries of the sinus is a safe method as described by Becker.…”

Delayed post-traumatic frontal sinus mucopyocoele presenting with meningitis

“…The use of pericranial flaps is beneficial in this setting although it may delay ossification. Swinson et al (2004) proposed a treatment paradigm for frontal sinus fractures. Importantly, post-trauma patients should receive a life-long follow-up and be properly informed as to the signs and symptoms heralding a muco(pyo)coele (Koudstaal et al,2004;Swinson et al, 2004).…”

“…Swinson et al (2004) proposed a treatment paradigm for frontal sinus fractures. Importantly, post-trauma patients should receive a life-long follow-up and be properly informed as to the signs and symptoms heralding a muco(pyo)coele (Koudstaal et al,2004;Swinson et al, 2004). According to the mucocoele classification proposed by Har-El (2001) the case described here can be regarded as a 3a-type mucopyocoele (that is: a cyst eroding the posterior wall with minor Delayed post-traumatic frontal sinus 503 intracranial extension).…”