Lviv clinical bulletin 2013, 1(1): 23-28

https://doi.org/10.25040/lkv2013.01.023

Frontal Sinus Fractures: Current Strategy of Diagnostics and Treatment

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Ya. Vares1, V. Gorak2, A. Filiplsky1

1Danylo Halytsky Lviv National Medical University

2Prince Lev 1st Lviv Сity Communal Polyclinic

Introduction. Frontal sinus fracture, despite rather low frequency of their occurrence, is one of the most complex problems of modern cranio-maxillofacial surgery, and strategies for their treatment are controversial. The complex anatomical structure of the sinus, the proximity of vital organs (brain, eyeball, nasal cavity), the need to attract the special diagnostic equipment, high risk of intra- and postoperative complications – only some factors that emphasize the severity of damage, determine its prognosis and require the multidisciplinary approach to the diagnostic and treatment process of the specified category of the patients. Frontal sinus fractures occur in 5.0-15.0 % of all cranio-maxillofacial injuries and may vary from isolated anterior table fractures to complex fractures involving the sinus, orbits, skull base and intracranial content.

The aim of this work was to generalize the literature data and personal experience of the surgical treatment of patients with traumatic fractures of the frontal sinus.

Materials and methods. The professional literary analysis reports and case histories of 18 patients (17 men and 1 woman aged 18-45 years) with the fractures of the frontal sinus that were treated in the department of maxillofacial surgery, neurosurgery and otorhinolaryngology of Lviv Regional Clinical Hospital and Lviv City Emergency Hospital during 2005-2011.

Results. Among the most common complications of fractures of the anterior wall of the frontal sinus are aesthetic defects, paresthesia of the lobar region, chronic sinusitis. Fractures of the deeper structures, which are accompanied by the aggressive surgical tactics, can lead to persistent diplopia or loss of vision, threatening inflammatory complications in the form of meningitis and brain abscess.

Computer tomography with three-dimensional reconstruction today is the standard in the diagnosis of fracture of the frontal sinus. Axial projections provide the information on the state of the anterior and posterior sinus walls, the coronal – allows the visualization of its bottom and the vaults of the ocular fossa, and the sagital – the nose-frontal cavity and the natural sinus duct visualization.

Regardless of a severity of the trauma all fractures require a thorough diagnostics, including a multiplanar computed tomography and endoscopic revision of the sinus cavity, allowing to choose the most  appropriate  treatment  strategy  and  to  minimize  the patient’s morbidity.

Conclusions. Proposed by the World Association of cranio-maxillofacial osteosynthesis the science-based and clinically proven algorithms for the diagnosis and treatment of fractures of the frontal sinus allow to provide the quality medical care to patients under the conditions of any location and combination of traumatic injury.

Reference

  1. Vares YaE, Philipska TA, Philipsky AV. Our Experience is the Use of Fibrin-enriched Platelets in Maxillofacial Surgery. Ukrainian Morphological Almanac. 2008;6(2):179. (Ukrainian)
  2. Anon JB, Rontal M, Zinreich SJ et al. Anatomy of the paranasal sinuses. New York: Thieme Medical Publishers, 1996. p. 22-34.
  3. Bell RB, Dierks EJ, Brar P, Potter JK, Potter BE. A protocol for the management of frontal sinus fractures emphasizing sinus preservation. J Oral Maxillofac Surg. 2007;65(5):825-839. https://doi.org/10.1016/j.joms.2006.05.058
  4. Donald PJ. Frontal sinus ablation by cranialization. Report of 21 cases. Arch Otolaryngol. 1982;108:142-146. https://doi.org/10.1001/archotol.1982.00790510014003
  5. Gonty AA, Marciani RD, Adornato DC. Management of frontal sinus fractures: a review of 33 cases. J Oral Maxillofac Surg. 1999;57(4):372-379. https://doi.org/10.1016/S0278-2391(99)90270-7
  6. Кalavrezos N. Current trends in the management of frontal sinus fractures. Injury. 2004;35(4):340-346. https://doi.org/10.1016/S0020-1383(03)00095-0
  7. Kim KK, Mueller R, Huang F, Strong EB. Endoscopic repair of anterior table frontal sinus fractures with a Medpor implant. Otolaryngol Head Neck Surg. 2007;136(4):568-572. https://doi.org/10.1016/j.otohns.2006.02.041
  8. Manolidis S, Hollier LH. Management of frontal sinus fractures. Plast Reconstr Surg. 2007;120(7 Suppl 2):32-48. https://doi.org/10.1097/01.prs.0000260732.58496.1b
  9. Rodriguez ED, Stanwix MG, Nam AJ, St Hilaire H, Simmons OP, Christy MR et al. Twenty-six-year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques. Plast Reconstr Surg. 2008;122(6):1850-1866. https://doi.org/10.1097/PRS.0b013e31818d58ba
  10. Scafati T. Anchor screw, a valuable technique in facial and cranio-maxillofacial surgery. J Craniomaxillofac Surg. 2005;33(5):331-333. https://doi.org/10.1016/j.jcms.2005.04.007
  11. Smith TL, Han JK, Loehrl TA, Rhee JS. Endoscopic management of the frontal recess in frontal sinus fractures: a shift in the paradigm. Laryngoscope. 2002;112(5):784-790. https://doi.org/10.1097/00005537-200205000-00004
  12. Strong EB. Frontal sinus fractures: current concepts. Craniomaxillofac Trauma Reconstr. 2009;2(3):161-175. https://doi.org/10.1055/s-0029-1234020
  13. Wallis A, Donald PJ. Frontal sinus fractures: a review of 72 cases. Laryngoscope. 1988;98(6):593-598. https://doi.org/10.1288/00005537-198806000-00002
  14. Zapala J, Saif F, Moskala M, Krupa M. Results of multidisciplinary treatment of frontal sinus fractures. Neurol Neurochir Pol. 2006;40(5):376-385.