Endoscopic Repair of Isolated Anterior Table Frontal Sinus Fractures

Abstract

Background: Recently developed endoscopic browlifting techniques and instrumentation are being used for treatment of anterior table frontal sinus fractures. Potential endoscopic treatment options include fracture reduction with or without plating and fracture repair with hydroxyapatite bone cement (HA). Objective: To evaluate the efficacy of miniplates and HA for repair of anterior table fractures. Methods: Frontal sinus fractures were generated in 11 cadavers. Standard endoscopic brow-lifting techniques were used to visualize the fracture from above. A 1-cm Lynch incision was used to apply instrumentation from below. Fractures were repaired with either miniplate reduction or HA recontouring. Results: All fractures were exposed without difficulty. Miniplates were applied in 5 specimens: 1 specimen had a complete reduction, 2 specimens had partial reductions, and 2 specimens had incomplete reductions. Bone cement was applied in 9 specimens: 4 specimens were rated as excellent and 5 specimens as good. Conclusions: Frontal sinus fractures can be successfully exposed and repaired with an endoscopic technique. Endoscopic miniplate reduction of frontal sinus fractures can be accomplished. However, it is challenging, and success rates vary depending on fracture comminution. Endoscopic HA recontouring offered the best results, with good or excellent outcomes in all specimens.

Endoscopic Transnasal Reduction of an Anterior Table Frontal Sinus Fracture: Technical note

“…Endoscopic-assisted repair of a frontal sinus fracture was first described by GRAHAM and SPRING in 1996 2 ; they did not use internal fixation in that case. Using a cadaveric model, STRONG et al 11 demonstrated a repair via a modified brow lift approach using plates or hydroxyapatite cement for cosmetic deformities. Instead of fracture reduction, an endoscopic-assisted fracture camouflage technique has been demonstrated using Medpor 1 sheeting 10 .…”

“Bone Mapping/Sketching” in Management of Anterior Table Frontal Sinus Fracture

“…Due to better understanding of frontal sinus fracture management and expertise development in endoscopic sinus surgery, the management has become much more conservative [2]. The endoscopic fracture reduction according to some surgeons is technically challenging [3]. Displacement, contour defect and comminuted anterior table warrant reduction and stabilization of these fracture fragments.…”

Endoscopically assisted reduction of anterior table frontal sinus fractures

“…Single outer table fractures include 18e43% of frontal sinus fractures (Wallis and Donald, 1988;Wilson et al, 1988;Lappert and Jesse, 1998;Strong et al, 2003;Gabrielli et al, 2004;Metzinger et al, 2005). The other patients represent more extensive trauma, with involvement of anterior wall, frontal recess and posterior wall, making, according to the literature, a conventional bicoronal approach necessary (Wallis and Donald, 1988;Wilson et al, 1988;Chen et al, 2003;Cunningham and Haug, 2004;Metzinger et al, 2005;Yavuzer et al, 2005).…”

“…Treatment of the single outer table fractures has a mainly aesthetic goal and carries a low risk of long term morbidity (Wallis and Donald, 1988;Lappert and Jesse, 1998;Gonty et al, 1999;Chen et al, 2003;Schon et al, 2003;Strong et al, 2003;Metzinger et al, 2005;Pham and Strong, 2006;Shumrick, 2006;Steiger et al, 2006;Strong and Kellman, 2006). However this procedure is also traditionally approached with a bicoronal incision.…”