Facial Fracture Management and Outcome Differences Between Plastic and Reconstructive Surgery and Otolaryngology: A...

Facial injury consults often receive dual coverage by plastic and reconstructive surgery (PRS) and otolaryngology (ENT) services, with reported variations in management patterns between specialties. However, studies have not separated fracture patterns or reported variations in care specific to ENT or PRS. This single-institutional study evaluates differences in management and outcomes of frontal sinus fractures treated by PRS and ENT.

A retrospective chart review identified adult patients with frontal sinus fractures from 2010 to 2020. Wilcoxon rank sum and Fisher exact tests compared patient demographics, fracture characteristics, mechanism of injury, type of management, antibiotic usage and duration, and complications of patients managed either by PRS or ENT.

Of 111 patients, 60 were managed by ENT and 51 by PRS. Demographics and comorbidities did not differ significantly. ENT patients presented with more concomitant sphenoid fractures ( P =0.02) and were more likely to consult the ophthalmology service ( P =0.02). There were no differences in fracture involvement ( P =0.66), operative approach ( P =0.94), operative time ( P =0.93), or time to OR ( P =0.80). PRS utilized more antibiotics for both conservative and preoperative management, particularly Augmentin ( P =0.0008) and Unasyn ( P =0.0113). Hospital stay, ICU status, return to OR, complications, and 30-day mortality were comparable.

Minimal differences were observed between PRS and ENT in the management and outcomes of frontal sinus fractures, except for antibiotic use. To our knowledge, this is the first decade-long study of frontal sinus fractures and highlights opportunities to standardize facial trauma care across specialties.