Frontal sinus fracture

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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 osteomy- elitis, and CSF leak [2]

Clinical Features

Differential Diagnosis

Maxillofacial Trauma

Evaluation

  • Assess sinus involvement:
    • Crepitus
    • Laceration over fracture site is typical
  • 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?
  • Isolated anterior table fracture?
    • Discharge with facial surgeon follow up
  • Depressed fracture?
    • Admit for IV antibiotics and operative repair
  • Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics

Disposition

See Also

References

  1. Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779
  2. Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007