Our Approach to Complex Frontal Sinus Fractures with Review of the Literature

Abstract

Development of frontal sinus injury treatment algorithms is ongoing and there is currently no established treatment paradigm for such injuries. Depending on the extent of injury, frontal sinus fractures may be treated non-surgically or surgically with variability of treatment parameters. A 23-year-old male patient underwent superior orbit reconstruction with plating, frontal sinus exenteration, obliteration, and cranialization after suffering comminuted frontal sinus fractures with underlying epidural hematoma and nasofrontal duct displacement. A pericranial flap with muscle flap and povidone-iodine-soaked hemostatic foam was used to obliterate the frontal sinus after cranialization and exenteration with no immediate or follow-up postoperative complications. A review of the recent literature was performed which found six studies containing 81 patients who underwent frontal sinus obliteration using a pericranial flap. Frontal sinus obliteration with a pericranial flap over the past 10 years throughout the literature resulted in an adverse event rate of 7.4% with complications such as CSF leak, infection, and continuously draining forehead wounds. Further work toward an established treatment algorithm for frontal sinus fracture management and studies investigating the outcomes of different materials used in frontal sinus obliteration may reduce poor outcomes for patients.