Frontal sinus fractures account for about 5% of all facial trauma. Fractures of the posterior wall may result in cerebrospinal fluid (CSF) leak and meningitis, while obstruction of the outflow tract can cause sinusitis and mucocele formation. However, there are no agreed national guidelines for the treatment of fractures of the frontal sinus and naso-orbitoethmoid complex. The authors described their experience in the multidisciplinary management of the above fractures in Oxford University Hospitals. The multidisciplinary craniofacial trauma team comprising of ENT, oral and maxillofacial and neurosurgical teams devised a management protocol where they advised patients with displaced posterior wall fractures and patients with naso-frontal outflow tract obstruction without posterior sinus wall fracture to undergo transcranial cranialisation. The authors prospectively followed up all patients who presented to their unit with the fractures described above between November 2005 and December 2014. A total of 91 patients were broadly divided into three main groups: patients who had cranialisation (Group 1), patients who are suitable for cranialisation but were treated conservatively due to their co-morbidities (Group 2) and patients with undisplaced fractures and normal outflow tract which were treated conservatively (Group 3). The authors reported an 8% complication rate for Group 1 patients such as raised intracranial pressure, frontal lobe abscess, osteomyelitis of the craniotomy and mucocele development. The main complication for patients in Group 3 was pansinusitis that was treated successfully with endoscopic sinus surgery. A minority of patients were in Group 2 and the authors had to intervene with a few patients due to frontal sinus infection and also persistent CSF leak. The authors reported significantly fewer complications for patients who met the operative criteria and were treated with cranialisation compared to those treated conservatively. They advocate using a standardised management protocol and also a multidisciplinary management of the frontal sinus fracture.
A multidisciplinary approach to the management of frontal sinus fracture
Reviewed by Wai Sum Cho
Outcomes of treatment of fractures of the frontal sinus: review from a tertiary multispecialty craniofacial trauma service.
