Management of frontal sinus fractures

Frontal sinus fractures are relatively uncommon maxillofacial injuries, making up only 5 to 12 percent of all facial fractures. Associated intracranial, ophthalmologic, and other maxillofacial injuries are very common because of the force of injury required to fracture the frontal bone. High-resolution computed tomography of the frontal region in multiple planes is essential for predicting the degree of frontal injury, associated injuries, and the type of procedure indicated. Exploration of the frontal sinus with reduction alone is reserved for a small minority of very simple fractures. Most frontal sinus fractures will require the obliteration of the sinus. This is achieved in the majority of instances with preservation of the posterior wall. Those with more extensive injuries and the presence of a cerebrospinal fluid leak will require frontal sinus cranialization after repair of the dural injuries. In rare instances, primary bone grafts will be required. In both cranialization and obliteration procedures, the nasofrontal ducts must be managed appropriately to avoid complications. Newer techniques involving endoscopic image-guided surgery may offer an alternative for a small subset of patients with frontal sinus injury.