Abstract
Background:Neurosurgeons are frequently involved in the management of patients with traumatic frontal sinus injury; however, management options and operative techniques can vary significantly. In this study, the authors review the current literature and retrospectively review the clinical series at a single tertiary referral center.Methods:After Institutional Review Board approval, the medical records and computed tomographic (CT) imaging of patients whose traumatic frontal sinus fractures were treated surgically at the University of Utah were retrospectively reviewed. Demographic information, mechanism of injury, associated injuries, operative technique, and pattern of injury on CT were analyzed.Results:Between 2000 and 2012, 33 patients underwent successful cranialization of the frontal sinus following traumatic injury. The material used to obliterate the sinus varied. No patients required immediate or delayed reoperation. Nasofrontal outflow tract obstruction, the importance of which has been emphasized in the plastic surgery literature, was apparent on either initial or retrospective review of the available CT imaging in 96%.Conclusions:In this series, we successfully surgically treated 33 patients with frontal sinus fractures. The presence of cerebrospinal fluid leak, nasofrontal outflow tract injury, associated depressed skull fractures, and subsequent formation of communicating pathways and infection must be considered when constructing a treatment plan. The goals of treatment should be: (i) surgical repair of the defect and elimination of the conduit from the intracranial space to the outside and (ii) elimination of any cerebrospinal fluid pressure gradient that may develop across the surgical repair. We present a treatment algorithm focusing on the presence of nasofrontal outflow tract injury/obstruction, cosmetic deformity, and cerebrospinal fluid leak.
Highlights
In trauma patients, frontal sinus fractures are common and account for 5–15% of all facial fractures
We identified 33 patients who underwent operative repair of frontal sinus fractures during the study period [Table 1]
This was not used as a criterion in this series, given the data of subsequent complications reported in the literature, we evaluate for nasofrontal http://www.surgicalneurologyint.com/content/6/1/141 outflow tract (NFOT) obstruction in patients with frontal sinus fractures
Summary
Frontal sinus fractures are common and account for 5–15% of all facial fractures. The most common cause of frontal sinus fractures is high‐velocity blunt force trauma.[8,21,23,24,25,34] The management of frontal sinus fractures varies among specialties. Neurosurgical complications may present acutely or may have a delayed presentation. Delayed complications include brain abscess and mucocele formation. Mucocele formation, which may result from obstruction of the frontal sinus egress or direct trauma to the frontal sinus mucosa, may progress to a mucopyocele.[13]. Neurosurgeons are frequently involved in the management of patients with traumatic frontal sinus injury; management options and operative techniques can vary significantly. The authors review the current literature and retrospectively review the clinical series at a single tertiary referral center
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