Combined otolaryngological and neurosurgical approach in treating sinus fractures

Frontal sinus injury in patients with closed head trauma is significant. Fractures of the anterior and posterior table as well as injury to the nasofrontal duct system requiring exploration, and often times obliteration of the frontal sinus, are not uncommon. Some patients present with frontal sinus damage along with intracranial pathology that requires craniotomy for treatment of the intracranial problem. In these patients, the neurosurgeon typically performs a bifrontal scalp flap to expose the cranium. A bone flap that transects the superior margin of the frontal sinus is then elevated and removed. This allows direct visualization of the anterior and posterior sinus walls and both nasofrontal ducts, subsequently facilitating reduction of fractures, debridement, and obliteration or ablation, if necessary, without creating another bone flap. The surgeon gets an overall picture of the sinus without the added trauma associated with the creation of an osteoplastic flap.