Secondary Reconstruction of Frontal Sinus Fracture

Abstract

Fractures of frontal sinus account for 5%–12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

Removal of intraosseous hemangioma in frontal bone under direct vision through a small incision

“…Cranialization, the procedure for patients in whom communication between the frontal air sinus and the outside space is blocked, and the air sinus space is integrated with the intracranial space, may be necessary when removing bone tumors involving the frontal sinus [ 10 , 11 ]. Postoperative complications after frontal sinus mass excision, including cerebrospinal fluid leakage, rhinorrhea, meningitis, and wound infection may occur in cases of frontal sinus cavity mucosal tearing or injury to the posterior wall of the frontal sinus or nasofrontal duct [ 12 - 14 ]. Cranialization is essential for preventing these complications.…”

“…All patients undergoing reconstructive surgery of the frontal sinus can develop delayed complications [ 12 ]. Therefore, patients must fully understand the complications that may occur and visit the hospital as soon as possible in such cases.…”

Surgical Approaches to the Orbit: Transpalpebral

“…When debriding a frontal sinus in the setting of osteomyelitis, dead space must be obliterated with a well-vascularized flap such as the temporalis muscle. 10…”

Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches

“…Depending on patient preferences and the degree of anterior table displacement, delayed intervention may be appropriate. A variety of soft tissue fillers including collagen, hyaluronic acid, poly-L-lactic acid, and fat injectables are an option to restore forehead contouring 2728…”

“…A variety of soft tissue fillers including collagen, hyaluronic acid, poly-L-lactic acid, and fat injectables are an option to restore forehead contouring. 27,28 The choice of approach of incision to depends on not only the severity of the anterior table fracture, but also patient and surgeon preference. In general, mildly displaced fractures of large segments of the anterior table are best approached with less invasive techniques such as percutaneous screw reduction, trephination, or purely endoscopic approaches.…”