Frontal Sinus Fractures: 10-Year Contemporary Experience at a Level 1 Urban Trauma Center

Abstract

Frontal sinus fractures account for 5% to 15% of all facial fractures, and have traditionally been associated with high kinetic energy blunt injury. Surgical management is largely focused on minimizing potentially serious sequelae including frontal sinus dysfunction, CSF leak, and significant cosmetic deformity. An institutional database of 1944 patients presenting with maxillofacial fractures over a 10-year period was queried. Demographics, mechanism of injury, yearly trends, surgical approaches, and follow-up data were examined. A total of 160 (8.3%) patients presented with at least 1 fracture of the frontal sinus anterior table, posterior table, or frontal sinus outflow tract during the study period. The average annual number of cases was 15.9 AE 5.7 per year with a peak of 21.5 AE 4.0 cases during the 2014 to 2015 period and a decline to 8.5 AE 1.5 cases/year from 2016 to 2017. Among those patients with falls, 61.5% (n ¼ 40) were a result of tripping or fainting at a height of <6 ft. 55.6% of fracture types were isolated to the anterior table, but fracture location was not significantly associated with operative intervention. Cases of operative fracture type had a higher rate of both displacement and comminution compared to nonoperative fractures (P < 0.00001). Of all patients presenting with frontal sinus fractures, 75% of cases were managed nonoperatively. However, many patients presented with falls and other seemingly low energy injuries which are not traditionally associated with frontal sinus trauma. These results highlight the need for continued followup even in otherwise low-risk urban populations in order to avoid long term sinus dysfunction.

Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature

“…1 In the past, the majority of frontal sinus fractures were attributed to motor vehicle accidents, [4][5][6] though the advent of airbag technology has reduced this incidence and falls now account for 36-40% of all frontal sinus fractures. 7,8 Males in their 20s to 40s are the most common demographic presenting with this fracture type. 9 It is relatively uncommon in children as the frontal sinus does not fully develop until adolescence.…”

“…9 It is relatively uncommon in children as the frontal sinus does not fully develop until adolescence. 4,5,7,8,10 Approximately one-third of frontal sinus fractures are accompanied by injury to the FSOT. Drainage of the frontal sinus begins in the ostia and continues caudally through the FSOT and to the frontoethmoidal recess.…”

Frontal Sinus Fractures

“…1 Blunt force trauma is the most common mechanism and includes motor vehicle collisions, assaults, falls, and sports-related injuries. [2][3][4] A significant force of between 800 and 2,200 pounds 5 is required to fracture the anterior table of the frontal sinus and as a result concomitant serious injuries are common. 2 The optimal management of frontal sinus injuries is controversial 6 and numerous treatment algorithms 1,4,7-10 have been described, none of which are universally adopted.…”

“…11 Over the last few decades, management of frontal sinus fractures has evolved to a more conservative approach due to improved imaging modalities, growing evidence to support indications when operative intervention is necessary, and increasing utilization of endoscopic techniques to reduce morbidity. 3 The following review describes the indications and most common techniques used in the management of frontal sinus fractures followed by a description of a minimally disruptive pathway that is employed at our center.…”

#facialtraumasurgery: Educational Content of Instagram as a Social Media Source for Facial Trauma Surgery

“…Daily, oral, and maxillofacial or plastic surgeons assess young patients with facial trauma, especially those affected through accidents, sports, and physical injuries 5,6 . Irrespective of health related topics, head and face majorly characterize and signify each individual human character and hence the face or the facial skeleton is commonly posted and shared on social media 7–9 . Thus, it is comprehensible that patients share their medical condition from dental trauma, over facial lacerations and wounds to severe craniofacial and head injuries 10–13 .…”