Management of frontal sinus fractures: A review of the literature

Abstract

Aim: The aim of this paper is to conduct a literature review on the clinical anatomy of the frontal sinus as it relates to its implication in frontal sinus fractures (FSFs), as well as review the contemporary opinions on the management of these fractures. Materials and Methods: A computerized literature search of PubMed and Medline was conducted for publications on the clinical anatomy and management of FSFs. Search phrases were frontal sinus combined with management, treatment, and anatomy. The Boolean operator 'AND' was used to narrow the searches. Result: FSFs account for 5-15% of all maxillofacial injuries and are associated with 32% of panfacial and maxillary injuries. The FSFs may result from high-velocity impacts, such as motor vehicle accidents and assaults; blunt or penetrating force. The potential for intracranial injuries, esthetic deformities, and late mucocele formation is high. The treatment goals of FSFs are an accurate diagnosis, avoidance of short- and long-term complications, return of normal sinus function, and re-establishment of the premorbid facial contour. Recently, several treatment protocol with greater emphasis on the nasofrontal outflow tract (NFOT) injury are described in the literature, however, controversies still abound on effectiveness of these protocols in reducing the attending complications. Conclusion: The management of FSFs presents a unique and challenging problem for the contemporary surgeons. A clear understanding of corrective techniques is essential when approaching these challenging injuries. Each treatment method has its advocates, and controversies still abound regarding indications, applications, and ultimate success in given situations.