Frontal sinus fracture

Background

• Requires high-energy
  • Rarely occurs in isolation, often associated wth intracranial injuries
  • 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

Clinical Features

• Assess sinus involvement:
  • Crepitus
  • Laceration over fracture site is typical

Differential Diagnosis

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

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
  • If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)

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

See Also

• Maxillofacial Trauma