Treatment of Frontal Sinus Fractures According to Fracture Patterns

Ha, Ju Ho; Kim, Yong Ha; Nam, Hyun Jae; Kim, Tae Gon; Lee, Jun Ho

Abstract

PURPOSE: Frontal sinus fractures are relatively less common than other facial bone fractures. They are commonly concomitant with other facial bone fractures. They can cause severe complications but the optimal treatment of frontal sinus fractures remains controversial. Currently, many principles of treatment were introduced variously. The authors present valid and simplified protocols of treatment for frontal sinus fractures based on fracture pattern, nasofrontal duct injury, and complications.
METHODS
A retrospective chart review was performed on 36 cases of frontal sinus fractures between January, 2004 and January, 2009. The average age of patients was 33.7 years. Fracture patterns were classified by displacement of anterior and posterior wall, comminution, nasofrontal duct injury. These fractures were classified in 4 groups: I. anterior wall linear fractures; II. anterior wall displaced fractures; III. anterior wall displaced and posterior wall linear fractures; IV. anterior wall and posterior wall displaced fractures. Also, assessment of nasofrontal duct injury was conducted with preoperative coronal section computed tomographic scan and intraoperative findings. Patients were treated with various procedures including open reduction and internal fixation, obliteration, galeal frontalis flap and cranialization.
RESULTS
12 patients are group I(33.3 percent), 14 patient were group II(38.8 percent), group III, IV were 5 each(13.9 percent). Frontal sinus fractures were commonly associated with zygomatic fractures(21.8 percent). 9 patients had nasofrontal duct injury. The complication rate was 25 percent(9 patients), including hypoesthesia, slight forehead irregularity, transient cerebrospinal fluid leakage.
CONCLUSION
The critical element of successful frontal sinus fracture repair is precise diagnosis of the fracture pattern and nasofrontal duct injury. The main goal of management is the restoration of the sinus function and aesthetic preservation.