Frontal Sinus Fracture Management: A Single-Center 13-Year Retrospective Analysis

Frontal sinus fractures are complex injuries that require individualized management based on the extent of fracture, involvement of the nasofrontal duct (NFD), and the presence of cerebrospinal fluid (CSF) leakage. Optimal treatment remains controversial, with evolving trends toward selective conservative approaches. This study aimed to evaluate treatment outcomes over a 13-year period using a standardized management algorithm.

A retrospective review was conducted of 201 patients treated for frontal sinus fractures at a tertiary academic center between 2007 and 2020. Fractures were classified according to anterior or posterior wall involvement, and management strategies included conservative observation, open reduction and internal fixation (ORIF), and cranialization. Surgical intervention was indicated based on NFD obstruction, posterior wall involvement, or CSF leakage. Clinical and demographic data, surgical techniques, and complications were analyzed.

Out of 201 patients, 189 underwent surgical treatment. ORIF was performed in 76.2% of cases, and cranialization was required in 17%. The complication rate among surgically treated patients was 10.6%, primarily due to infection and delayed healing, compared to 25% in the conservatively managed group. The majority of fractures resulted from high-energy trauma, particularly traffic accidents, and predominantly affected young male patients.

An individualized, algorithm-guided approach to frontal sinus fracture management leads to favorable outcomes and lower complication rates. Surgical intervention is particularly beneficial in cases with NFD obstruction or CSF leakage. These findings support the role of structured, multidisciplinary decision-making in optimizing treatment strategies for complex craniofacial trauma.