Endoscopic‐Assisted Reduction of Anterior Table Frontal Sinus Fractures

Steiger, Jacob D.; Chiu, Alexander G.; Francis, David O.; Palmer, James N.

doi:10.1097/01.mlg.0000238076.32276.da

Cited by 33 publications

(21 citation statements)

References 11 publications

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“…Curettes and balloons can then be used to perform fracture reduction. 16 Endoscopic camouflage allows for restoration of the frontal contour in the absence of fracture reduction. Endoscopic camouflage is a useful technique that has been advocated by Kellman and Strong.…”

Section: Endoscopic Management Of Fracturesmentioning

confidence: 99%

Managing the Frontal Sinus in the Endoscopic Age: Has the Endoscope Changed the Algorithm?

Kellman

Goyal

2014

Craniomaxillofacial Trauma & Reconstruction

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In comparison to most other craniomaxillofacial fractures, management of fractures involving the frontal sinus seems to be more complex than merely obtaining an ideal reduction of the bony injuries. Multiple articles on the management of these fractures suggest that a great deal of controversy persists, despite many years of surgical experience. 1-7 The controversy persists because these injuries have a propensity to develop significant delayed complications, sometimes years after an excellent reduction with a good cosmetic repair has been accomplished. 8 Whether or not to explore rather than observe a nondisplaced or minimally displaced fracture, and what procedure to perform if exploration is considered remain controversial. Furthermore, how severe must displacement/disruption be to require exploration and/or repair, whether or not a transient cerebrospinal fluid (CSF) leak requires exploration and/or repair, and whether or not the sinus should be obliterated and/or cranialized also remain areas of great controversy in the literature and among experienced surgeons. The question posed in this article is whether or not the advent of endoscopic approaches has changed or should change the approaches/algorithms used in the management of these challenging fractures. It is the opinion of the authors that the answer is "yes," and this article will discuss and illustrate some of the ways in which the endoscope offers new and hopefully better options for the management of these cases. Why Is Management of the Frontal Sinus so Challenging?First and foremost, it is believed that avoiding frontal sinus complications seems to hinge on proper functioning of the nasofrontal duct (NFD), which would then allow drainage of the mucus produced in the sinus into the nasal cavity. (Note that anatomical studies raise question as to whether or not the NFD is a "true duct" in the majority of humans. Therefore, it will be referred to as the "frontal sinus outflow tract" [FSOT].) Fractures that involve the floor of the frontal sinus create significant risk of FSOT injury/disruption. Numerous authors have attempted to determine which fractures are most likely to predict an NFD injury and the best known algorithm for this was developed by Robert Stanley over 20 years ago. 2,3 He found that involvement of the supraorbital rims and nasoethmoid complex (NOE, also known as nasoorbital ethmoid [NOE] fractures) had the highest association with FSOT injury, followed by fractures that involved the AbstractManagement of fractures involving the frontal sinus seems to be more complex than merely obtaining an ideal reduction of the bony injuries. Multiple articles on the management of these fractures suggest that a great deal of controversy persists despite many years of surgical experience. The question posed in this article is whether or not the advent of endoscopic approaches has changed or should change the approaches/ algorithms used in the management of these challenging fractures. It is the conclusion of these authors that endoscopic techniques...

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Section: Endoscopic Management Of Fracturesmentioning

confidence: 99%

Managing the Frontal Sinus in the Endoscopic Age: Has the Endoscope Changed the Algorithm?

Kellman

Goyal

2014

Craniomaxillofacial Trauma & Reconstruction

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“…Endoscopic approaches for traumatic or iatrogenic frontal sinus injury have been steadily evolving since the first case series was reported by Woodworth in 2005. 23 Shortly after a case series describing the reduction in anterior table fractures with a transnasal or trephine-assisted endoscopic approach was reported by Steiger et al 24 They reported five patients treated over 2 years all of whom noted good cosmetic repair with continued sinus function. Over the next decade, advancements in materials for fracture reduction and CSF leak repair allowed for posterior table repair.…”

Section: Discussionmentioning

confidence: 99%

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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“…Although a bicoronal incision offers adequate exposure, it requires a longer operative time and hospital stay. It has severe disadvantages, including a long scalp scar, alopecia, and temporal hollowing caused by extensive dissection [4,5,10,11,20]. The main problem for the isolated anterior wall fracture is the aesthetic deformity of the forehead, which seldom causes functional complications; therefore, if the surgical approach leaves more severe deformities, as described above, it should not be considered the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Subbrow Approach as a Minimally Invasive Reduction Technique in the Management of Frontal Sinus Fractures

et al. 2014

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BackgroundFrontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures.MethodsBetween March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws.ResultsContour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed.ConclusionsThe subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.

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Endoscopic‐Assisted Reduction of Anterior Table Frontal Sinus Fractures

Cited by 33 publications

References 11 publications

Managing the Frontal Sinus in the Endoscopic Age: Has the Endoscope Changed the Algorithm?

Managing the Frontal Sinus in the Endoscopic Age: Has the Endoscope Changed the Algorithm?

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

Subbrow Approach as a Minimally Invasive Reduction Technique in the Management of Frontal Sinus Fractures

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