Frontal Sinus Fractures: An Evaluation of Injury Parameters and Operative Variables on Surgical Outcomes

Frontal sinus (FS) injuries carry high morbidity; however, currently, there is no universally agreed-upon treatment approach for frontal sinus and frontobasal trauma.

This study sets out to evaluate surgical outcomes in frontal reconstruction, looking at how fracture patterns and operative variables impact complication rates.

This was a retrospective cross-sectional study which identified a cohort of 137 patients between the years 2015 and 2022 who sustained frontal sinus fractures at a level one major trauma centre in Central London. The electronic patient record (EPR) and pre-operative computed tomography (CT) were analysed to assess the following factors: patient demographics, injury parameters, surgical technique, and complications. Statistical tests included Pearson's chi square for categorical variables/nominal data. Mann-Whitney U and Kruskal-Wallis H tests were also used to analyse continuous variables.

Overall, 12 of the 91 patients who were treated surgically had major complications (n = 12, 13.2%). In total, 5.5% (n = 5) had return to theatre (RTT) for cerebrospinal fluid (CSF) leaks, 5.5% for infection and 2.2% (n = 2) for haematoma or bleeding. FS fracture complexity was predictive of RTT (p = 0.015) and CSF leak (p = 0.015). Frontobasal complexity was predictive of post-operative infection (p = 0.047). Neurosurgical operative involvement and cranialisation was predictive of post-operative infection, CSF leak, and RTT.

Understanding risk profiles in the management of FS fractures is vital in order to help clinicians mitigate these risks and also to better educate patients, including during the consent process. Further research could look at the medical and social risk factors that increase complication rates in this patient cohort.