Frontal sinus fractures: A treatment algorithm and assessment of outcomes based on 78 clinical cases

BACKGROUND: The purposes of this article were to retrospectively review frontal sinus fractures at the authors' center, to assess the final outcomes, and to establish a treatment algorithm. METHODS: A retrospective chart review was performed on 78 consecutive frontal sinus fractures treated by the same surgeon between January 1, 1994, and January 1, 2002. RESULTS: In this study, 57.7 percent of fractures occurred as a result of motorcycle accidents and 75.6 percent of those patients were not wearing helmets at the time of injury. The use of helmets did not significantly affect the fracture pattern. Frontal sinus fractures were commonly associated with orbital fractures (71 percent), intracranial injuries (39 percent), and severe ophthalmic injuries (26 percent). Associated injuries were more common when the fractures involved the posterior tables. The method of management comprised four groups: no surgical intervention (n = 6), open reduction and internal fixation of the anterior table with sinus preservation (n = 40), partial sinus obliteration (n = 18), and cranialization (n = 14). The complication rate was 16.7 percent (n = 13), including postoperative cerebrospinal fluid leaks (n = 6), wound infections (n = 4), meningitis (n = 1), sinusitis (n = 1), and pyomucocele (n = 1). CONCLUSIONS: Involvement of the nasofrontal duct and persistence of cerebrospinal fluid leaks are two key determinants of the treatment algorithm. The amount of displacement of the posterior table has not been found to be a key determinant of the need for surgical intervention. When the sinus is to be obliterated, partial obliteration can achieve a good result, with limited sinus complication and minimal donor-site morbidity.