Current trends in the management of frontal sinus fractures

The majority of frontal sinus fractures are sustained by young male adults involved in vehicle accidents. Treatment of these fractures is of paramount importance because of the anatomical relationship of the sinus with the brain and the delicate periorbital region. The optimal treatment of frontal sinus fractures remains controversial. However, most authors would accept an open exploration and obliteration of the sinus in the presence of a depressed or displaced anterior wall fracture or injury to the nasofrontal duct. A successful obliteration requires meticulous extirpation of the frontal sinus mucosa, removal of the inner cortex of bone and permanent occlusion of the nasofrontal duct. If the posterior wall is involved, a concomitant dural tear is a common phenomenon. The main goal in this case is the restoration of the dural integrity and the isolation of the intracranial contents from the outer environment. Devastating complications such as meningitis, encephalitis or brain abscess are quite uncommon nowadays. Nevertheless, late development of invasive mucoceles is not a rarity and therefore long-term follow-up is mandatory.     

Algorithms for the management of frontal sinus fractures: A retrospective study

The aim of this study was to evaluate the long-term results and to evaluate the validity of the treatment algorithm that can be safely applied in dfrontal sinus fractures. All patients were evaluated in terms of late-term contour deformity and further craniometric analysis for measurement of maximum amount of displacement, fracture surface area (mm²) and the maximum angulation of the fracture (degree) were done. 125 patients (101 male, 24 female) with frontal sinus fractures with an average age of 22.4 years (range,17–66 years) were reviewed. All patients with isolated anterior table fractures without displacement were followed up on conservative basis. 33 patients with anterior table fractures with displacement and 39 patients with anterior and posterior table fractures were also followed on conservative basis without surgical intervention. The cut-off value of the maximum amount of displacement was confirmed to be 4.5 mm in prediction of late-term contour deformities (p < 0.001). The maximum amount of displacement was decreased by an average of 1.8 mm at late-term. Apart from the standard protocols, within the limitations of the study it seems that isolated anterior table fractures with a maximum amount of displacement of less than 4.5 mm can be treated conservatively without leading to contour deformities. CSF leakage in the acute setting might not always require cranialization and this may spontaneously resolve within 10 days. Cranialization should be considered whenever CSF leakage lasts longer than 10 days.     

Management of the entered frontal sinus

The opening of the frontal sinus is a common occurrence in surgical practice. It may involve many surgical disciplines. The complications that may derive from incorrect treatment of an opened frontal sinus are potentially fatal. Unfortunately, the treatment of patients with injured frontal sinus is not uniform and standardized. Here, we describe our technique of treatment. We propose our treatment modality on the basis of our personal experience, which has been excellent in the past 20 years, that is from the time of the techniques introduction and routine application.