Related Experiment Video
Updated: Apr 18, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures
Justine C Lee1, Brian T Andrews, Hamid Abdollahi
1From the *Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; †Division of Plastic and Reconstructive Surgery, University of Kansas School of Medicine, Kansas City, KS; and ‡Division of Plastic Surgery, Temple University/Saint Christopher's Hospital for Children, Philadelphia, PA.
Background:
Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging.
Methods:
Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded.
Results:
Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%).
Conclusions:
A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.
