Management of frontal sinus fractures: a review of 33 cases

The purpose of this article is to provide an overview of fracture patterns, patient characteristics, and surgical approaches associated with frontal sinus fractures. The short- and long-term complications of frontal sinus fractures treated over a 20-year period are presented.

The records of patients admitted to the University of Kentucky Medical Center from 1975 through 1994 with a diagnosis of frontal sinus fracture were reviewed. Fracture patterns were categorized and information collected related to demographics, circumstance of injury, perioperative management, surgical procedures, and complications. Long-term complications were studied by asking patients to return for clinical and radiographic follow-up.

The average age of patients with frontal sinus fractures was 32 years. Thirty-one of the 33 victims were male. Motor vehicle accidents were the most common cause. Twenty-one patients had anterior table fractures (type I), 11 had combined anterior/posterior table fractures (type II = 9, type IV = 2), and one patient had an isolated posterior table fracture (type III). Short-term postoperative and perioperative complications were minimal. Long-term complications included acute frontal sinusitis (one patient), cosmetic forehead defects (two patients), and encephalitis (one patient).

The critical elements to successful frontal sinus fracture repair are precise diagnosis of the craniofacial fracture pattern, appropriate management of the frontonasal duct(s), and prevention of serious brain sequelae. Long-term follow-up of patients with frontal sinus injuries is recommended.