Management of frontal sinus fractures: A review of 33 cases

Purpose: The purpose of this article is to provide an overview of fracture patterns, patient characteristics, and surgical approaches associated with frontal sinus fractures. The short- and long-term complications of frontal sinus fractures treated over a 20-year period are presented. Patients and Methods: The records of patients admitted to the University of Kentucky Medical Center from 1975 through 1994 with a diagnosis of frontal sinus fracture were reviewed. Fracture patterns were categorized and information collected related to demographics, circumstance of injury, perioperative management, surgical procedures, and complications. Long-term complications were studied by asking patients to return for clinical and radiographic follow-up. Results: The average age of patients with frontal sinus fractures was 32 years. Thirty-one of the 33 victims were male. Motor vehicle accidents were the most common cause. Twenty-one patients had anterior table fractures (type I), 11 had combined anterior/posterior table fractures (type II = 9, type IV = 2), and one patient had an isolated posterior table fracture (type III). Short-term postoperative and perioperative complications were minimal. Long-term complications included acute frontal sinusitis (one patient), cosmetic forehead defects (two patients), and encephalitis (one patient). Conclusions: The critical elements to successful frontal sinus fracture repair are precise diagnosis of the craniofacial fracture pattern, appropriate management of the frontonasal duct(s). and prevention of serious brain sequelae. Long-term follow-up of patients with frontal sinus injuries is recommended.