Endoscopically assisted repair of frontal sinus fracture

Classic approaches to frontal sinus fracture involve bicoronal or direct forehead incisions. However, these incisions cause paresthesia, scarring, and even alopecia. In the field of plastic and reconstructive surgery, endoscopically assisted surgery is now widely accepted, particularly for esthetic surgery. It also is applied for the management of midface and lower-face fractures, but rarely for treatment of the frontal area. The authors present their experience with the repair of frontal sinus fractures using the endoscopically assisted method.

The surgery was performed with the patients under general anesthesia. Two slit incisions were placed in the hair-bearing area, through which a 4-mm 30 degrees endoscope was inserted. The subperiosteal dissection was performed toward the fracture site using an endoscopic periosteal elevator. The depressed fracture segments of the anterior table of the frontal sinus were reduced and fixed with microplates to restore the contour of the forehead. Seven consecutive patients received endoscopic correction of frontal sinus depressed fractures.

No patients required conversion conventional bicoronal incisions. Good anatomic reduction of the fracture sites, acceptable surgical scar, and esthetic recontour were obtained in all the patients. The postoperative course was uneventful, without any complications.

The endoscopically assisted method allows feasible reduction and fixation of a frontal sinus fracture. It avoids the complications of traditional methods and yields improved convalescence and esthetic results. It also helps in the diagnosis of unsuspected cerebrospinal fluid leaks. Thus, for anterior table fractures with an intact nasofrontal duct, endoscopically assisted surgery provides an alternative option of treatment.