Frontal Sinus Injuries Research Articles

Management of frontal sinus trauma: a retrospective study of surgical interventions and complications

BackgroundFrontal sinus injuries are relatively rare among facial bone traumas. Without proper treatment, they can lead to fatal intracranial complications, including meningitis or brain abscesses, as well as aesthetic and functional sequelae. The management of frontal sinus injuries remains controversial, with various treatment methods and outcomes being reported. This article describes the clinical characteristics, surgical methods, and outcomes among 17 patients who underwent surgery for frontal sinus injury and related complications.Case presentationWe retrospectively included 17 patients who underwent surgery for frontal sinus injury and its related complications at the Kangwon National University Hospital between July 2010 and September 2021. Among them, six underwent simple open reduction and fixation of the anterior wall, eight underwent sinus obliteration, and three underwent cranialization. Two patients who underwent sinus obliteration died due to infection-related complications. The patient who underwent cranialization reported experiencing chronic headache and expressed dissatisfaction regarding the esthetic outcomes of the forehead. Except for these three patients, the other patients achieved satisfactory esthetic and functional recovery.ConclusionActive surgical management of frontal sinus injuries is often required owing to the various complications caused by these injuries; however, several factors, including the fracture type, clinical presentation, related craniomaxillofacial injury, and medical history, should be considered while formulating the treatment plan. Surgical treatment through the opening of the frontal sinus should be actively considered in patients with severely damaged posterior wall fractures and those at risk of developing infection.

Frontal Sinus Fractures: An Evaluation of Patient Demographics, Mechanisms of Injury, Classification, and Management Strategies in Patients Referred to a Trauma Center, From 2014 to 2019.

This retrospective study aimed to present demographic data, mechanisms of injury, anatomical locations, and management strategies in patients with frontal sinus fractures. The study included 91 patients with frontal sinus fractures attending the Rajaee Hospital of Shiraz between 2014 and 2019. The data recorded for each patient included age, sex, injury mechanism, fracture classification, associated craniofacial fractures, nasofrontal duct injury, cerebrospinal fluid leak, and treatment approach. The mean age of patients was 31.0±14.0 years, with male predominance (95.6%). Car crashes represented the most frequent mechanism of frontal sinus fracture, involving 31 subjects (34%). Isolated anterior and posterior table fractures were seen in 32 (35.2%) and 5 (5.5%) patients. Fifty-four patients (59.3%) presented both tables' involvement. Frontal sinus injuries occurred frequently (74.7%) with other facial fractures. Nasofrontal duct injury was found in 7 patients (7.7%), and 13 (14.3%) exhibited cerebrospinal fluid leakage. Fifty patients (55%) were treated with observation alone; 16 (17.5%) underwent sinus preservation, 12 (13.2%) experienced sinus obliteration, and 13 (14.3%) endured cranialization. Fisher's exact test revealed no significant association between the classification of fracture and the mechanism of injury (P=0.591). However, a significant association was observed between the fracture classification and the treatment applied (P=0.023). Frontal sinus fractures were most often caused by car crashes in young adults. Combined anterior and posterior table fractures were more commonly found than isolated anterior or posterior table involvement. Most frontal sinus fractures were treated conservatively without DDS surgical operation.

A Case Report of A Mid-Front Head Injury Using Starry Sky Surgical Approach of the Face

A 20-year-old male was referred to the Department of oral and maxillofacial surgery, Trinity Hospital, Aizawl-Mizoram on July 4th,2022 with a history of Road traffic accident (RTA). The patient was unconscious and was taken to the operation theatre and had multiple facial injuries. A frontal bone fracture with frontal sinus injury was noticed and a starry sky approach was used under GA. Overall, the starry sky approach shows very less scars and very less complications and proves to be the right approach in frontal bone fracture involving the midline.

Frontal Sinus Fractures.

Management of frontal sinus fractures is controversial with no universally accepted treatment protocol. Goals of management are to correct aesthetic deformity, preserve sinus function when it is deemed salvageable, prevent sequela related to the injury, and minimize complications associated with intervention. Studies suggest that frontal sinus injuries, including disruption of the nasofrontal outflow tract (NFOT), can be managed nonoperatively in many cases. Advances in the utilization of endoscopic techniques have led to an evolution in management that reduces the need for open procedures, which have increased morbidity compared with endoscopic approaches. We employ a minimally disruptive protocol that treats the majority of fractures nonoperatively with serial clinical and radiographic examinations to assess for sinus aeration. Surgical intervention is reserved for the most severely displaced and comminuted posterior table fractures and unsalvageable NFOTs utilizing endoscopic approaches whenever possible.

Case Report: A Rare Case of Penetrating Trauma of Frontal Sinus with Anterior Table Fracture

Head injury is common component of any road traffic accident injury. Injury involving only frontal sinus is uncommon and unique as its management algorithm is changing over time with development of radiological modalities as well as endoscopic intervention. Frontal sinus injuries may range from isolated anterior table fractures causing a simple aesthetic deformity to complex fractures involving the frontal recess, orbits, skull base, and intracranial contents. Only anterior table injury of frontal sinus is rare in penetrating head injury without underlying brain injury with history of unconsciousness and questionable convulsion which is new to existing literature.

Current Trends in the Management of Frontal Sinus Injuries

Frontal sinus injuries make up only 5% to 15% of facial skeletal fractures. These injures are the result of high-force trauma often associated with assault or motor vehicle accidents. The majority of patients are young males aged 20-30 years old with no racial disparity. Management of anterior table (AT) fractures, posterior table (PT) fractures, and fractures with frontal sinus outflow tract (FSOT) involvement vary from conservative approaches to more invasive sinus obliteration and cranialization techniques. The aim of this study is to describe the current surgical techniques utilized by various surgical subspecialists who manage craniomaxillofacial injuries for the treatment of frontal sinus injuries.

CLINICAL OUTCOMES OF SURGICAL APPROACHES IN THE FRACTURES OF THE FRONTAL SINUS

Frontal sinus fractures occur from trauma to the part of the frontal bone that overlies the sinus, often from motor vehicle accidents and falls. The hallmarks of a frontal sinus fracture are a frontal depression in the anterior table of the bone. Additionally, clear fluid leaking from the nose may indicate that fractures to the posterior table have torn into the dura mater, creating a cerebrospinal fluid leak.
 Total 20 cases of the patients undergoing the surgery for frontal sinus injuries were evaluated in the present study was planned in Department of Oral & Maxillofacial Surgery, Buddha Institute of Dental Sciences & Hospital. The patients were divided in two groups. Group A includes the 10 cases in which care was taken in first 10 days. Group B includes the 10 cases in which care was taken after 10 days.
 The data generated from the present study concludes that fractures of the frontal sinuses are more and more frequent and serious. They involve the vital, functional and aesthetic prognosis of patients, and must therefore require a safe method of management with ways of starting allowing both good security and better exposure.
 Keywords: Craniofacial Trauma, Frontal Sinus Surgery, Cranialization, Exclusion of Sinus, etc.

Frontal Bone Fractures and Frontal Sinus Injuries: Treatment Paradigms.

Background:Timely, expeditious and appropriate management of Frontal bone fractures and associated Frontal Sinus (FS) injuries are both crucial as well as challenging. Treatment options vary considerably, depending upon the nature, extent and severity of these injuries as well as operator skill, expertise and experience. In cases of posterior table fractures of the Frontal Sinus, literature reports have in general, propounded direct visualization and exploration of the sinus via a bifrontal craniotomy, followed by sinus cranialization.Aims and Objectives:To review the standard protocols of management of Frontal bone fractures and Frontal Sinus injuries. To assess the efficacy of a more conservative approach in the management of outer and inner table fractures of the FS.Materials and Methods:Contemporary and evolving management protocols and changing treatment paradigms of different types and severities of frontal bone fractures and frontal sinus injuries, have been presented in this case series. A useful Treatment Algorithm has been proposed to efficiently and effectively manage these injuries.Results:In the present case series, effective and satisfactory results could be achieved in cases of significantly displaced inner and outer table fractures of the Frontal sinus by a more conservative protocol comprising of open reduction and internal fixation carried out via the existing scar of injury, without having to resort to the more radical intracranial approach and sinus cranialization. Nevertheless, presence of complicating factors such as cerebrospinal fluid rhinorrhea, evidence of meningitis or the development of encephalomeningocoeles necessitated the standard protocol of sinus exploration and its cranialization or obliteration.Conclusion:Management protocols of Frontal Sinus injuries vary, based on aspects such as the timing of presentation and intervention, degree of injury sustained, concomitant associated Craniomaxillofacial injuries present, presence of complicating factors or Secondary/Residual deformities & Functional debility, and need to be decided upon on a case to case basis.

Management of Frontal Sinus Injuries.

Purpose:The purpose of the present study is to report an overview of fracture patterns and surgical approaches for 15 patients who were treated in our Indhira Gandhi Institute of Dental Sciences, Pondicherry, India from 2010 to 2015.Method and Material:Fifteen people were included in the study, which were diagnosed with anterior table fracture of the frontal sinus and were randomly admitted in our institution. All patients were evaluated preoperatively with axial and coronal computed tomography scans before operating. The parameters used to classify the patients were age, mode of injury, associated injury, and details of fracture, surgical approaches, fixation, and conservative management.Results:Analysis of 15 patients based on parameters showed that the ages of patients varied between 22 and 36 years due to road traffic accident as the common etiology. There were associated fractures in the maxillofacial region seen in 11 patients and the rest were isolated frontal sinus fractures. Conservative management was opted in six patients and for others, surgical approach to the fracture site was done through existing laceration and by bicoronal approach. Three of the cases showed comminuted fracture of anterior and posterior table. The overall contour of the frontal bone was good in all the patients. None of the patients required any immediate reoperation or developed any delayed abscess or mucocele formation.Conclusion:Decision-making regarding the best time to treat, the surgical approach and the technique depends on the severity and the extent of the fracture and associated complications. Our protocol was to follow up and observe the undisplaced fractures and operate anterior wall defects. If there was a fracture involvement of posterior frontal wall, treatment can be planned along with neurosurgical consultation and then operate depending on the associated complications.

Secondary Reconstruction of Frontal Sinus Fracture.

Fractures of frontal sinus account for 5%–12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

Surgical management of traumatic frontal sinus fractures: Case series from a single institution and literature review.

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.

Traumatic Brain Injury in a Rural and an Urban Tanzanian Hospital—A Comparative, Retrospective Analysis Based on Computed Tomography

In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania. HLH has 350 beds and one CT scanner. The urban Aga Khan Hospital is a private hospital with 80 beds and one CT scanner. This was a retrospective study. Data of 248 patients at HLH and of 432 patients at Aga Khan Hospital with TBI could be collected. The prevalence of TBI was significantly higher in the rural area compared to the urban area (34.2% vs. 21.9%, P < 0.0001). TBI due to violence was noted to occur more frequently at HLH, whereas road traffic accidents were more frequent at the Aga Khan Hospital. The number of patients showing a normal CT result was significantly higher in the urban area (53.0% vs. 35.9%, P < 0.0001). Bone fractures (35.9% vs. 15.7%, P < 0.0001) and pneumocephalus (6.9% vs. 0.9%, P < 0.0001) were diagnosed significantly more frequently in the rural survey. Soft tissue swelling (11.6% vs. 1.2%, P < 0.0001) and frontal sinus injuries (7.4% vs. 0.4%, P < 0.0001) were observed significantly more often in the urban setting. This study documents the burden of TBI and the differences in TBI-related CT diagnoses and their incidence between urban and rural areas in Eastern Africa. These results are important as they demonstrate that patients with severe TBI are not a primarily urban concern. Management of TBI should be included in the training curricula for health personnel alike irrespective of whether their workplace is primarily urban or rural.

It Takes Two to Tango: Activation of Cortex and Lumbosacral Circuitry Restores Locomotion in Spinal Cord Injury

In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania.HLH has 350 beds and one CT scanner. The urban Aga Khan Hospital is a private hospital with 80 beds and one CT scanner. This was a retrospective study. Data of 248 patients at HLH and of 432 patients at Aga Khan Hospital with TBI could be collected.The prevalence of TBI was significantly higher in the rural area compared to the urban area (34.2% vs. 21.9%, P < 0.0001). TBI due to violence was noted to occur more frequently at HLH, whereas road traffic accidents were more frequent at the Aga Khan Hospital. The number of patients showing a normal CT result was significantly higher in the urban area (53.0% vs. 35.9%, P < 0.0001). Bone fractures (35.9% vs. 15.7%, P < 0.0001) and pneumocephalus (6.9% vs. 0.9%, P < 0.0001) were diagnosed significantly more frequently in the rural survey. Soft tissue swelling (11.6% vs. 1.2%, P < 0.0001) and frontal sinus injuries (7.4% vs. 0.4%, P < 0.0001) were observed significantly more often in the urban setting.This study documents the burden of TBI and the differences in TBI-related CT diagnoses and their incidence between urban and rural areas in Eastern Africa. These results are important as they demonstrate that patients with severe TBI are not a primarily urban concern. Management of TBI should be included in the training curricula for health personnel alike irrespective of whether their workplace is primarily urban or rural.

Current advances in sinus preservation for the management of frontal sinus fractures

This review summarizes the current advances in sinus preservation techniques with endoscopic sinus surgery for the well tolerated and effective management of frontal sinus fractures. Advances in computed tomography (CT) imaging can now reproduce higher quality reformatted images, creating excellent diagnostic coronal, axial, and sagittal image views that provide a better evaluation of the frontal sinus outflow tracts (FSOTs). The FSOTs are pivotal in determining which technique is used in the management of frontal sinus fractures. Several recent studies have proposed sinus preservation protocols using endoscopic management of the frontal outflow tract as a viable alternative to frontal sinus obliteration. Among those protocols, extended endoscopic sinus frontal surgery with reconstruction of the frontal outflow tracts has been demonstrated to be well tolerated and effective. It can be used in conjunction with frontal sinus trephinations as well as to treat complications. Modified treatment protocols have been developed based on thorough clinical examination and CT imaging in an attempt to provide a practical and safe protocol for the management of frontal sinus injuries. Conservative care and sinus preservation with or without endoscopic surgery can be done in selected cases with good result. The importance of preserving the frontal sinus is gaining acceptance in the evidence-based literature.

Surgical therapy of midline skull defect accompanied with frontal sinus injury

To investigate the surgical therapy of midline skull defect accompanied with frontal sinus injury. 11 cases with midline skull defect accompanied with frontal sinus injury were treated. Free temporal fascia was transplanted to close the top of frontal sinus after curettage of the frontal sinus wall. Then titanium prostheses were used to repair the skull defects at the same stage in 10 patients. 1 patient received skull defect repair at the second stage operation. Good results were achieved in 10 cases. The titanium prosthesis had to be taken out in one case due to frontal sinusitis and the anastomosis of frontal sinus and nasal cavity was performed. In patients with midline skull defect accompanied with frontal sinus injury, free temporal fascia could be used to close the top of frontal sinus after curettage of frontal sinus wall. If there is no infection or mild infection in frontal sinus, the skull defect repair could be performed in the same stage. If there is severe frontal sinusitis, the defect repair should be done at the second stage.

Are Facial Injuries Caused by Stumbling Different From Other Kinds of Fall Accidents?

The aim of this prospective study was to evaluate and compare the epidemiology and pattern of maxillofacial injuries caused by stumbling and other kinds of falls. We evaluated all patients with facial injuries due to stumbling or falls who presented to Besat Hospital in Hamedan, Iran, during the 2.5-year study period and analyzed the acquired data. Of 2990 patients with facial injuries who were referred to Besat Hospital during the study period, 733 (24.5%) were injured by stumbling, and 246 (8.2%) were injured by falls. The male-to-female ratios in the stumbling and falls groups were 2:1 and 1.86:1, respectively. Although the rate of soft tissue injuries was the same in both groups, the rate of bone fractures was higher in fall accidents (1.6:1). In stumbling accidents, the most common type of bone fracture was nasal fracture, followed by dentoalveolar, mandibular, and zygomatic fractures. In falls, nasal fractures were the most common type of bone fracture, followed by zygomatic, mandibular, and dentoalveolar fractures. All of the Le Fort I, II, and III fractures, nasal-orbital-ethmoid, and frontal sinus injuries occurred in fall accidents. The rate of associated injuries in falls was higher than stumbling accidents. We concluded that the incidence, age distribution, rate, and pattern of bone fractures and the frequency and type of associated injuries in stumbling accidents were significantly different from that of fall accidents. For a good program planning to prevent and manage facial injuries, we recommend separate evaluation of stumbling and fall accidents.

Frontal sinus injuries: analysis of 22 fractures treated at the Mutual Security Hospital

Frontal sinus injuries: analysis of 22 fractures treated at the Mutual Security Hospital

Sinus Preservation Management for Frontal Sinus Fractures in the Endoscopic Sinus Surgery Era: A Systematic Review

We systematically reviewed the existing literature supporting the efficacy and safety of sinus preservation management for frontal sinus fractures in the modern era of endoscopic frontal sinus surgery. A systematic review of the English literature for the targeted objective was conducted using the PubMed database between January 1995 and August 2008. The PubMed database was queried using two major search terms of frontal sinus fracture or frontal sinus injury along with manual review of citations within bibliographies. Citations acquired from the primary search were filtered and relevant abstracts were identified that merited full review. Articles were identified that included any cohort of patients with frontal sinus fractures involving the frontal sinus outflow tract or posterior wall with sinus preservation management. A total of 231 citations were generated, and 56 abstracts were identified as potentially relevant articles. Sixteen articles merited full review, with seven articles meeting inclusion criteria for sinus preservation. There were 515 total patients in the studies with 350 patients managed with frontal sinus preservation. Similar short-term complications and effectiveness were found between fractures managed with sinus preservation and those with traditional management. Sinus preservation appears to be a safe and effective management strategy for select frontal sinus fractures. More transparent reporting of management strategies for individual cases or cohorts is needed. A standardized algorithm and categorization framework for future studies are proposed. Longer-term follow-up and larger prospective studies are necessary to assess the safety and efficacy of sinus preservation protocols.

Critical Computed Tomographic Diagnostic Criteria for Frontal Sinus Fractures

Diagnosis and treatment of frontal sinus fractures (FSFs) have progressed over the previous 30 years. Despite advances in computed tomography, there is no current diagnostic uniformity with regard to classification and treatment. We developed a statistically valid treatment protocol for FSFs based on injury pattern, nasofrontal outflow tract (NFOT) injury, and complication(s). These data outlined predictable injury patterns based on specific computed tomographic findings critical to the diagnosis and ultimate treatment of this potentially fatal injury. A retrospective review was conducted on patients with FSF from 1979 to 2005 under institutional review board approval. All computed tomographic scans were reviewed by the authors and fractures categorized by location, displacement, comminution, and degree of NFOT injury. One thousand ninety-seven patients with FSF were identified, 87 expired and 153 had inadequate data, leaving a group of 857 patients. Simultaneous displacement of anterior-posterior tables constituted the largest group (38.4%). NFOT injury occurred in most patients (70.7%) and was strongly associated with anterior (92%) and posterior (88%) table involvement (comminuted 98%). Sixty-seven percent of patients with NFOT injury had obstruction. Five hundred four patients (59.6%) had surgery with 10.4% complications and 353 patients were observed with 3.1% complications. All but 1 patient with complications had NFOT injury (98.5%). Predictable patterns of injury based on specific computed tomographic data play a pivotal role in classification and surgical management of potentially fatal frontal sinus injuries. Radiologic diagnosis of NFOT injury in FSFs, particularly obstruction, plays a decisive role in surgical planning.

Complications of Frontal Sinus Fractures With Emphasis on Chronic Craniofacial Pain and Its Treatment: A Review of 43 Cases

Frontal sinus fractures constitute 5% to 12% of all facial fractures. The optimal management of frontal sinus fractures is controversial but involves preserving the function of the nasofrontal ducts when feasible. We reviewed the postoperative complications of a series of 43 patients treated surgically for frontal sinus fractures. The data from 43 patients treated from 2000 to 2006 were reviewed. The information reviewed included patient age and gender, mechanism of injury, type of frontal sinus injury, associated facial injuries, treatment method, and complications. The institutional review board approved the present study. The average patient age was 32.5 years; 36 were men and 7 were women. Of the 43 patients, 23 (53.5%) had had anterior table fractures and 20 (46.5%) had had both anterior and posterior table fractures. Postoperative complications occurred in 7 patients (16.3%). Of these 7 patients, 2 experienced continued headache and pain and required surgical removal of infected hardware, 3 also experienced frequent headaches and pain in the frontal-temporal region, 1 had a post-traumatic deformity, and 1 developed periorbital cellulitis and abscess formation within the frontal sinus. Frequent headaches and complaints of continued pain were the most common complications experienced by our series of patients. We also reviewed treatment strategies for postoperative follow-up and treatment of chronic pain.