Anterior Table Frontal Sinus Fractures Research Articles

Supramuscular upper blepharoplasty approach to orbital roof and/or lower anterior table frontal sinus fractures: A meta-narrative review

BackgroundAn approach to orbital roof fractures (ORFs) and/or lower anterior table frontal sinus fractures (LATFSFs) is a challenging task. The conventional coronal approach (CCA) appears to suit multiple/complex fractures of the upper face, while periorbital transcutaneous incisions (PTIs), e.g. gull wing, open sky, butterfly, and Lynch incisions, often impair aesthetic outcomes. The aims of this paper were to provide an overview of the supramuscular upper blepharoplasty approach (SUBA) to ORFs/LATFSFs. MethodsUsing a meta-narrative review study design, the investigators enrolled published data extracted from PubMed/Medline, Embase, Cochrane Library, and Google Scholar concerning SUBA to ORFs/LATFSFs. Only publications with the highest and most recent level of evidence (LoE) in English, French or German available until 6 May 2022 were included. The LoE were evaluated using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM)’s classification. ResultsIn total, 70 articles were included; however, most contained low LoE. Under general and local anaesthesia, SUBA to ORFs/LATFSFs can be performed safely and appeared to be superior to its submuscular counterpart in terms of fewer risks of adjacent tissue injuries, and speedy operative time (maximal 5 min. in experienced hands). ConclusionsIn contrast to CCA and PTIs, the SUBA is a minimally invasive approach to the ORF/LATFSF with favourable aesthetic outcomes, direct visualisation of the fracture, quick operative time, rare complications, and easy learning.

An Endonasal Incision Adds a Second Vector of Manipulation During Percutaneous Reduction of Fractures Involving the Frontonasal Region.

A case report. To describe a modification of percutaneous reduction of frontal sinus and/or naso-orbito-ethmoid (NOE) fractures, adding an endonasal intercartilaginous incision to provide a second vector of manipulation. Case report with particular attention paid to surgical technique, followed by a brief review of relevant literature. Technique: A Carroll-Girard screw is used to engage the thickest part of the anterior wall of the frontal bone through a stab incision just superior to the frontonasal junction. An endonasal intercartilaginous incision is then made and a Cottle elevator is introduced to manipulate the fracture from the inferior aspect of the frontonasal junction. The percutaneous screw and the endonasal elevator provide perpendicular vectors for manipulation, thereby improving ability to reduce fractures when percutaneous traction alone is not successful. The technique is described here in a patient with anterior table frontal sinus fractures combined with posteriorly displaced Markowitz type 1 NOE fractures. While percutaneous reduction of frontal sinus fractures has been previously described, this report adds a subtle but important modification both in indication and technique for optimizing reduction while maintaining surgical simplicity and minimizing morbidity.

“Bone Mapping/Sketching” in Management of Anterior Table Frontal Sinus Fracture

The aim of this present article was to know the efficacy of bone mapping/sketching in management of anterior table frontal sinus fracture. This prospective clinical study includes 10 patients who reported to department of dentistry, AIIMS Bhopal with anterior table frontal sinus fracture. Sterile plain white paper or a glove cover was used for mapping/sketching. The patients were evaluated for post-operative contour of the fractured frontal sinus defect and any mucocele formation. All the 10 patients had no infection or post-operative mucocele formation and all have excellent aesthetic of the anterior table of the frontal sinus. Bone mapping/sketching should be done in all comminuted fractures of cranio-maxillofacial region.

A Review of Subbrow Approach in the Management of Non-Complicated Anterior Table Frontal Sinus Fracture.

Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are controversial. The subbrow approach enables accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by allowing direct visualization of the fracture. Given the surgical success in reduction and rigid fixation, patient satisfaction, and aesthetic benefits, the transcutaneous approach through a subbrow incision is superior to other reduction techniques used in the management of an anterior table frontal sinus fracture.

Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures.

Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging. Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded. Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%). A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.

Subbrow approach as a minimally invasive reduction technique in the management of frontal sinus fractures.

BackgroundFrontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures.MethodsBetween March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws.ResultsContour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed.ConclusionsThe subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.

Assessment of Endoscopic Role in Management of Facial Fractures

This study evaluates the usefulness of endoscopic repair in certain types of facial fractures (orbital floor, isolated zygomatic arch and isolated anterior table frontal sinus fractures).Endoscopic application in otorhinolaryngology has expanded into many areas including facial plastic surgery and facial trauma (orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures), therefore limiting the use of incisions for exposure. Endoscopically assisted facial bone surgery can be performed with many advantages, including: magnified direct visualization, decreased scarring, avoidance of numbness beyond the incision line, greater acceptability to the patient, decreased complication rate and short hospitalization. For assessment of the value of endoscopy in repair of certain facial fractures, we selected 12 consented patients with either orbital floor fracture, isolated zygomatic arch fracture or isolated anterior table frontal sinus fracture to be involved in our study after stabilizing the general condition. The patients were evaluated preoperatively by an ophthalmologist and all had complete CT study including coronal, axial (both bony and soft-tissue windows), sagital and 3D images. The patients were analyzed for sex, age, time of surgery, pre/postoperative symptoms; including ophthalmic symptoms, facial paraesthesia and aesthetic problems. The results of our endoscopic approach were evaluated esthetically and functionally to be classified into good, fair and poor results. We also classified the level of the surgery according to its difficulty into difficult, average and easy surgical performance.Good results were achieved in 8fractures (42%); fair in 8fractures (42%) and finally 3fractures (16%) with poor endoscopic result. The performed surgery considered easy in 9 (41%) patients, average in 6 (31%) patients and difficult in 4 (21%) patients. All patients had no significant complications. Conclusion: Endoscopic repair appears to be a safe and effective technique for repairing certain types of facial fracture.

A simplified approach for the reduction of specific closed anterior table frontal sinus fractures

We describe a simplified approach to the management of closed anterior table fractures of the frontal sinus. Forty-seven patients were diagnosed with this type of fracture during a 3-year period. Of these, 6 had minimally-invasive periosteal raising of the anterior table through a small perieyebrow skin incision, and access to the fracture was through a small trephine or the edge of the fracture itself. We compared this with the more traditional approach of a coronal flap, which was associated with an increased duration of stay in hospital and the potential for neurological complications. Surgical intervention with a minimally-invasive trephine approach provides good cosmesis, minimal blood loss, intact neurological function, and rapid recovery. This makes it an important technique to consider in carefully selected patients.

Pediatric Frontal Sinus Fracture Conservative Care

We report a case of an 11-year-old patient presenting with a displaced anterior table frontal sinus fracture, resulting in a contour deformity. Fractures of the anterior table that result in contour irregularities may be an indication for operative management. The frontal sinus, however, continues to develop through late adolescence, and our patient's fracture remodeled completely within 1 year from injury, without operative management. This clinical report indicates that displaced anterior frontal sinus fractures in the skeletally immature have the potential to completely remodel with time, and therefore may be successfully managed non-operatively.

Endoscopic Repair of Isolated Anterior Table Frontal Sinus Fractures Without Fixation

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

Transcutaneous Reduction of Frontal Sinus Fracture Using Bony Tapper Device

Frontal sinus fractures are relatively common injuries presenting to trauma units. The optimal treatment of frontal sinus fractures remains controversial. Bicoronal approach is commonly used to obtain full exposure of both frontal bones and to repair any intracranial trauma; however, this approach requires long operative time and could lead to a long-lasting visible scar, alopecia, and paresthesias. In addition, patients have to stay in hospital for several days with this method. Endoscopic approach, less invasive than bicoronal method, has a steep learning curve. In this article, we suggest a simple reduction method in frontal sinus anterior wall fracture using the tapper instrument. Between 2005 and 2011, a transcutaneous reduction of closed anterior table frontal sinus fracture using a tapper instrument was performed in 13 patients. This group consists of 10 men and 3 women, and the mean age was 27.5 years. Under general anesthesia, the point that the tapper would be placed is marked considering the fracture site shown on computed tomographic scan and the clinically depressed area. A 3-mm slit incision was made just above the marked point. After drilling through this incision, the tapper device was applied to the depressed bone segment. Simply pulling out the tapper, the depressed frontal sinus anterior wall segment was reduced. Contour deformities were restored completely in all patients without any recurrent displacement, and all patients were satisfied with the results. There were no complications such as infection and uncontrollable sinus bleeding, but pneumocephalus had occurred in 1 patient owing to the posterior table injury that happened during the tapper-applying procedure. We treated him with preventive antibiotics, and he completely recovered after 1 week. This method has better aesthetic results, shorter operative time, and minimal hospital stay than other surgical approaches. Although it contains minimal risk of posterior wall injury, considering not only surgical results but also patients' satisfaction, the authors suggest that this simple percutaneous reduction method using the tapper instrument would be the treatment of choice in the frontal sinus anterior wall fractures.

Pediatric chronic maxillary atelectasis

Abstract Purpose : Chronic maxillary atelectasis (CMA) is an acquired condition characterized by decreased maxillary sinus volume with inward bowing of one or more antral walls, which may result in ipsilateral hypoglobus or enophthalmos. Its etiology is unclear. There are few reported cases in the pediatric literature. We present a case of CMA in a child with normal pre-disease CT scans, illustrating that this is an acquired condition occurring in the pediatric population. Theoretic mechanisms of pathogenesis are also discussed. Methods : A retrospective medical record review was conducted, as well a literature review to examine similar cases and proposed pathophysiologic mechanisms of the disease. Results : An 11-year-old female was referred to our Otolaryngology clinic for evaluation of frontal headaches. She had a history of right anterior table frontal sinus fracture and right ethmoid fracture after hitting her head on a school desk at age seven. She required frontal sinus obliteration after her initial trauma due to persistent fevers and headaches. Initial maxillofacial CT revealed normal appearing maxillary sinuses. Four years later a repeat CT showed an opacified, hypoplastic left maxillary sinus with inward bowing of medial and lateral walls, as well as a depressed left orbital floor. She was treated with endoscopic left maxillary antrostomy, and later underwent removal of hardware related to her frontal sinus obliteration. Her symptoms resolved after these interventions. Conclusion : Chronic maxillary atelectasis was first described nearly 50 years ago, and sparse literature exists on its impact in the pediatric population. Evidence exists which supports the theory of negative antral pressure leading to the observed anatomic defects. Primary management of the disease is surgical, and involves maxillary antrostomy with uncinectomy. Debate exists as to whether CMA and SSS are distinct entities or different descriptions of disease processes on a single spectrum.

Frontal Sinus Repair Through a Frontalis Rhytid Approach

Frontal sinus fractures have traditionally been repaired through a bicoronal approach. This incision provides a wide exposure, but is not without complications, particularly in the patient with or at risk for hairline recession. We present a series of 15 patients who underwent open reduction and internal fixation of anterior table frontal sinus fractures through a frontalis rhytid forehead incision and their results based on the scar appearance, forehead contour, frontalis function, sensation and fracture reduction. Paresthesias cranial to the incision in the supraorbital or supratrochlear distribution were noted in 12 of the 15 patients with resolution in all except 1 patient who did not regain sensation at 4 months follow-up. In all patients, satisfactory forehead contour and fracture reduction were achieved, as were scar appearance and frontalis function at 4 months follow-up. We thus recommend this approach in the treatment of anterior table frontal sinus fractures, with special consideration for the patient with or at risk for anterior hairline recession.

Single-stage strategy for management of anterior table frontal sinus fractures involving the frontal sinus outflow tract

Treatment of frontal sinus fractures has been controversial for years. The aim of treatment, besides cosmetic restoration, is to create a “safe” sinus especially in those with evidence of injury to the frontal sinus outflow tract. Early and late complications include acute and chronic sinusitis, mucocoele and mucopyocoele formation, brain abscess and osteomyelitis. Osteoplastic flap with frontal sinus obliteration or cranialisation is most commonly performed. With the advent of modern endoscopic and advanced imaging techniques, endoscopic sinus surgery for treatment of diseases of the frontal sinus is ever increasing. In this paper, we describe our successful experience using a single-stage, combined open and transnasal endoscopic technique in management of patients with anterior table frontal sinus fractures involving the frontal sinus outflow tract.

Transcutaneous transfrontal approach through a small peri-eyebrow incision for the reduction of closed anterior table frontal sinus fractures

Transcutaneous or endoscopic approaches are commonly used to reduce closed anterior table frontal sinus fractures. However, transcutaneous approaches cause serious skin sequelae, and endoscopic approaches have a steep learning curve. To resolve these problems, between 2001 and 2008, a transcutaneous transfrontal approach through a small peri-eyebrow skin incision was used in 17 male patients. Postoperative computed tomography scans showed adequate reduction of displaced bone fragments in all cases. No complications related to this procedure, such as uncontrollable sinus bleeding, infection and posterior table and brain injuries, were observed. Follow-ups ranged from 4 to 27 months, with an average of 14 months. Contour deformities were effectively restored and cosmetic results at incision sites were acceptable in all patients. The transcutaneous transfrontal approach through a small peri-eyebrow incision is a safe procedure that can be performed with minimal morbidity and offers good access and excellent aesthetic results. Based on the results obtained, the authors suggest that this method be considered the treatment of choice for the reduction of closed anterior table frontal sinus fractures.

O.445 Functional endoscopic surgery and frontal sinus fractures

Repair of an isolated anterior table frontal sinus fracture traditionally requires a coronal incision, which results in a large scar, alopecia and paresthesias, because of these problems, endoscopic approaches have been attempted. These approaches still involve small incisions at the forehead or behind the hairline so might be better described as endoscopy-assisted surgery. This report describes the reduction of an isolated anterior table frontal sinus fracture in a 14-year-old boy using an endoscopic procedure that involves a transnasal approach with no external incisions. Endoscopic instruments were used under 25 and 70 degrees endoscope guidance. A custom-made latex glove balloon was inserted into the frontal sinus, and then expanded and maintained for 20 days to support the reduced bony fragments. Postoperatively, the reduction was successful. The cosmetic deformity was repaired and there was no postoperative morbidity. This case indicates that endoscopic reduction may be a valuable treatment option for certain types of frontal sinus fractures.

Endoscopic Transnasal Reduction of an Anterior Table Frontal Sinus Fracture: Technical note

Repair of an isolated anterior table frontal sinus fracture traditionally requires a coronal incision, which results in a large scar, alopecia and paresthesias, because of these problems, endoscopic approaches have been attempted. These approaches still involve small incisions at the forehead or behind the hairline so might be better described as endoscopy-assisted surgery. This report describes the reduction of an isolated anterior table frontal sinus fracture in a 14-year-old boy using an endoscopic procedure that involves a transnasal approach with no external incisions. Endoscopic instruments were used under 25 and 70 degrees endoscope guidance. A custom-made latex glove balloon was inserted into the frontal sinus, and then expanded and maintained for 20 days to support the reduced bony fragments. Postoperatively, the reduction was successful. The cosmetic deformity was repaired and there was no postoperative morbidity. This case indicates that endoscopic reduction may be a valuable treatment option for certain types of frontal sinus fractures.

Endoscopic repair of anterior table: Frontal sinus fractures with a medpor implant

Isolated anterior table frontal sinus fractures are commonly repaired through a coronal incision. Endoscopic repair of these injuries has recently been described. This study evaluates the endoscopic repair of isolated anterior table frontal sinus fractures with a Medpor implant. Preinjury photographs of 10 cadaveric heads were obtained. Anterior table frontal sinus fractures were generated in all cadavers. The fractures were documented with postinjury computerized tomography (CT) scans. The fractures were then endoscopically repaired with a Medpor implant. Five cadavers received prefabricated implants generated from the post injury CT data. Five cadavers received a standard implant (0.85 mm sheet) contoured intraoperatively. The success of each repair was documented with post repair CT scans, photographs, and direct transcutaneous visualization. All 10 defects were successfully repaired within 1 to 2 mm. All implants were palpable, but no objective asymmetry could be appreciated photographically or on CT scan. Anterior table frontal sinus fractures can be endoscopically repaired with either a standard 0.85 mm sheet or a prefabricated implant. Clinical application of this technique would be expected to reduce operating time, surgical morbidity, and cost.

Endoscopic‐Assisted Reduction of Anterior Table Frontal Sinus Fractures

In this study, we examined salvage operations after reexploration in head and neck reconstruction and analyzed ways to solve problems. Free flap reconstruction of the head and neck lesion was carried out for 513 cases in our hospital over the past 12 years. Twenty-one cases of reexploration were caused by postoperative thrombosis (4.1%). We could only salvage seven cases (33.3%) of 21 cases from flap thrombosis. All seven cases were included in the category of venous thrombosis, and they were undertaken within 3 days postoperatively. Our results have shown that once thrombosis occurs, there is little possibility of flap salvage, particularly 3 days after operation and in infectious cases. When no flow phenomena are observed and no flap salvage is deemed possible, aggressive treatment such as a second free flap or next pedicle flap should be chosen as soon as possible to avoid any delay in postoperative treatment.

Endoscopic‐Assisted Reduction of Anterior Table Frontal Sinus Fractures

In this study, we examined salvage operations after reexploration in head and neck reconstruction and analyzed ways to solve problems. Free flap reconstruction of the head and neck lesion was carried out for 513 cases in our hospital over the past 12 years. Twenty-one cases of reexploration were caused by postoperative thrombosis (4.1%). We could only salvage seven cases (33.3%) of 21 cases from flap thrombosis. All seven cases were included in the category of venous thrombosis, and they were undertaken within 3 days postoperatively. Our results have shown that once thrombosis occurs, there is little possibility of flap salvage, particularly 3 days after operation and in infectious cases. When no flow phenomena are observed and no flap salvage is deemed possible, aggressive treatment such as a second free flap or next pedicle flap should be chosen as soon as possible to avoid any delay in postoperative treatment.