Frontal sinus fractures: some problems and some solutions

Head trauma can result in serious injuries leading to life-threatening situations. Often accompanying these injuries are fractures involving the frontal sinus. Some fractures are subtle and difficult to diagnose, while others are massive and difficult to treat. The experience at this institution in the management of frontal sinus fractures is examined. Particular emphasis is placed on the problematic cases. These include fractures that were nearly overlooked, those that were associated with massive CSF leaks, and those which were extensively comminuted. In treating some of the most severe compound injuries, a frontalis myofascial flap has been used successfully to "plug" the site of CSF leakage. The review will include the types of fractures encountered, associated injuries, errors in diagnosis, the treatment rendered, and the complications which resulted. As encountered in other studies relating to trauma, adequate follow-up has been a serious shortcoming. The protocol presently used in the management of these injuries will be outlined.