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30-year retrospective review of frontal sinus fractures: The Charity Hospital experience
C Xie1, N Mehendale, D Barrett
1Department of Otolaryngology/Head and Neck Surgery, Division of Plastic & Reconstructive Surgery, Louisiana State University Medical Center, 2020 Gravier Street, Suite A, New Orleans, LA 70112, USA.
Background And Objectives:
The optimal method of treating frontal sinus fractures has remained undetermined. The purpose of this retrospective review is to compare the mechanism of injury, diagnostic techniques, methods of fracture management, complications, and long-term results in different types of frontal sinus fractures.
Methods And Materials:
Over 4,000 records of patients with frontal bone or skull fractures, treated during a 30-year period in an academic nonprofit tertiary Level I trauma center, were considered. From these, the authors selected 150 patients with frontal sinus fractures--with complete records and adequate follow-up time--and conducted a retrospective review.
Results And/Or Conclusions:
For anterior fractures, observation alone had a high rate of complications (18.2%). Reconstruction with obstruction of the nasofrontal ostia by vascularized tissue was found to be the best treatment, followed by osteogenesis (9.1%) or obliteration (7.7%). Cranialization was the safest form of management for posterior table fractures that were either comminuted or involved the nasofrontal ostia. The preferred obliteration materials were vascularized flaps, cancellous bone, temporalis muscle, and fat; hydroxyapatite cement was a good alloplastic alternative.
