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.