Indications and Complications in Conservative Versus Surgical Management of Frontal Sinus Fractures

Frontal sinus fractures (FSF) can lead to significant complications that are dependent on FSF injury severity and management. The authors aimed to identify patient and fracture characteristics that favor conservative versus surgical management and to compare complications between these approaches. A retrospective cohort study was conducted from 2018 to 2022. Our primary outcome was the frequency of indications for conservative versus surgical management for FSF. Our secondary outcome was the incidence of complications after FSF management. Descriptive statistics, χ2 and Fisher exact tests were performed. Of 201 FSF patients, the majority were managed conservatively [149 (74.1%)]. Patients managed with open reduction and internal fixation (ORIF) were more likely to have a >2 mm displaced anterior table fracture [36 (69.2%), 39 (26.2%), P<0.001], >2 mm displaced posterior table fracture [20 (38.5%), 16 (10.7%), P<0.001], posteriorly displaced posterior table fracture [10 (19.2%), 10 (6.7%), P=0.014], frontal sinus outflow tract (FSOT) injury [16 (30.8%), 11 (7.4%), P<0.001], cerebrospinal fluid leak [18 (34.6%), 8 (5.4%), P<0.001], or pneumocephalus adjacent to the fracture [32 (61.5%), 63 (42.3%), P=0.023]. Patients managed with ORIF were more likely to develop scalp numbness [11 (21.2%), 14 (9.4%), P=0.032] than patients managed conservatively. The authors' findings indicate that the majority of FSF were managed conservatively, with more complex cases involving displaced fractures, FSOT injuries, cerebrospinal fluid leaks, or pneumocephalus adjacent to fracture being more likely to require ORIF. These findings provide insight into the indications of ORIF versus conservative management of FSF.