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Frontal sinus fractures are currently managed by various medical specialists, including otolaryngologists/head and neck surgeons, maxillofacial surgeons, plastic surgeons, and neurosurgeons. As a result, consensus does not exist regarding the timing, indications, and treatment modality of these injuries.
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FRONTAL SINUS
FRACTURESFrederick Mars Untalan MD
OBJECTIVES
• Surgical Anatomy
• Approaches
• Special considerations influencing ORIF
• Treatment
• Complications
ANATOMY
MUST KNOW…
•Olfactory bulb & cribriform plate
MUST KNOW…
NASOFRONTAL RECESS
MUST KNOW…
FRONTOBASILAR FRACTURE
MUST KNOW…
FRONTOBASILAR FRACTURE
PRINCIPLES
SAFE SINUS
RESTORE FACIAL
CONTOUR
AVOID SHORT &
LONG TERM
COMPLICATIONS
IMAGING
IMAGING
IMAGING
TREATMENT
APPROACHES
APPROACH
APPROACH
Special considerations influencing ORIF
Aesthetics
Internal Derangemen
t of the Sinus
Intracranial Injuries
Other maxillofacial
injuries
Special considerations influencing ORIF
Aesthetics : Loss of forehead contour
Physical Examination may be inconsistent w/ the severity of the fractures
Early open surgery is preferable.
A depressed anterior table may not lead to a noticeable forehead flattening.
Special considerations influencing ORIF
Internal derangement of the frontal sinus
Special considerations influencing ORIF
Internal derangement of the frontal sinus
Special considerations influencing ORIF
Intracranial injuries
Special considerations influencing ORIF
Associated Maxillofacial Injuries
DECISION MAKING & TREATMENT
DECISION MAKING
Depressed Anterior
table
Anterior wall fractures with Supraorbital Rim
or NOE fractures w/ Nasofrontal recess injury
NO ISSUE SINUS OBLITERATION
DECISION MAKING
Anterior & Posterior table (nondisplaced)
Anterior & Posterior table (severely
fragmented)
SINUS OBLITERATION
CRANIALIZATION
DECISION MAKING
OBLITERATION CRANIALIZATION
BRAIN
NOSE
FS BRAIN
NOSE
FS
TREATMENT
•PERIOPERATIVE•Lumbar drain
•CSF Rhinorrhea
•Broad spectrum IV Antibiotics
•Contaminated Wound
ANTIBIOTIC Therapy
• Frontal Sinus Fractures are CONTAMINATED
The use of additional antibiotics outside the perioperative timeframe does not reduce the rate of postoperative infections; however, such antibiotic use may be warranted in cases of severe facial trauma with multiple open fracture wounds
Lauder A, Jalisi S, Spiegel J, Stram J, Devaiah AAntibiotic prophylaxis in the management of complex midface and frontal sinus trauma. Laryngoscope. 2010 Oct.
ANTIBIOTIC Therapy
N: 242 pxs (1996-2011)
Relative risk estimates were obtained using multivariable regression.
Antibiotic use beyond 48 hours postoperatively was not associated with fewer infections.
Delay in operative management of frontal sinus fractures in patients requiring operative intervention is associated with an increased risk for serious infections.
Continued antibiotic prophylaxis beyond the perioperative period provides little benefit in preventing serious infections.
Bellamy JL, eta l. Severe infectious complications following frontal sinus fracture: the impact of operative delay and perioperative antibiotic use. Plast Reconstr Surg. 2013 Jul;132(1):154-62.
COMPLICATIONS
SUMMARY
• Surgical Anatomy
• Approaches
• Special considerations influencing ORIF
• Treatment
• Complications
FRONTAL SINUS
FRACTURESFrederick Mars Untalan MD
