Frontal sinus fracture: Difference between revisions
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==Background== | ==Background== | ||
*Requires high-energy | *Requires high-energy | ||
**Must rule-out TBI, additional fracture, and cervical spine injury | **Rarely occurs in isolation, often associated wth intracranial injuries <ref>Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779</ref> | ||
**Must rule-out [[TBI]], additional fracture, and [[cervical spine injury]] | |||
*Long term sequelae include chronic [[sinusitis]], mucocele, [[meningitis]], [[brain abscess]], frontal [[osteomyelitis]], and CSF leak <ref>Bell RB. A protocol for the management of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007</ref> | |||
== | ==Clinical Features== | ||
*Assess sinus involvement: | *Assess sinus involvement: | ||
**Crepitus | **Crepitus | ||
**Laceration over fracture site is typical | **Laceration over fracture site is typical | ||
==Differential Diagnosis== | |||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | |||
*Imaging | *Imaging | ||
**Head CT indicated if suspect fracture | **[[Head CT]] indicated if suspect fracture | ||
***Assess anterior and posterior tables | ***Assess anterior and posterior tables | ||
****Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection | ****Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection | ||
**If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured) | **If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured) | ||
==Management== | ==Management== | ||
*Sinus involvement? | *Sinus involvement? | ||
**If yes then give 1st | **If yes then give 1st generation [[cephalosporin]] or [[amoxicillin clavulanate]] | ||
*Isolated anterior table fracture? | *Isolated anterior table fracture? | ||
** | **Discharge with facial surgeon follow up | ||
* | *Depressed fracture? | ||
**Admit for IV | **Admit for IV [[antibiotics]] and operative repair | ||
*Consult neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
| Line 31: | Line 38: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Latest revision as of 20:56, 30 September 2019
Background
- Requires high-energy
- Rarely occurs in isolation, often associated wth intracranial injuries [1]
- Must rule-out TBI, additional fracture, and cervical spine injury
- Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomyelitis, and CSF leak [2]
Clinical Features
- Assess sinus involvement:
- Crepitus
- Laceration over fracture site is typical
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Imaging
- Head CT indicated if suspect fracture
- Assess anterior and posterior tables
- Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection
- Assess anterior and posterior tables
- If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)
- Head CT indicated if suspect fracture
Management
- Sinus involvement?
- If yes then give 1st generation cephalosporin or amoxicillin clavulanate
- Isolated anterior table fracture?
- Discharge with facial surgeon follow up
- Depressed fracture?
- Admit for IV antibiotics and operative repair
- Consult neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics