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2015 ; 6
(ä): 141
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Surgical management of traumatic frontal sinus fractures: Case series from a
single institution and literature review
#MMPMID26392917
Ravindra VM
; Neil JA
; Shah LM
; Schmidt RH
; Bisson EF
Surg Neurol Int
2015[]; 6
(ä): 141
PMID26392917
show ga
BACKGROUND: Neurosurgeons are frequently involved in the management of patients
with traumatic frontal sinus injury; however, management options and operative
techniques can vary significantly. In this study, the authors review the current
literature and retrospectively review the clinical series at a single tertiary
referral center. METHODS: After Institutional Review Board approval, the medical
records and computed tomographic (CT) imaging of patients whose traumatic frontal
sinus fractures were treated surgically at the University of Utah were
retrospectively reviewed. Demographic information, mechanism of injury,
associated injuries, operative technique, and pattern of injury on CT were
analyzed. RESULTS: Between 2000 and 2012, 33 patients underwent successful
cranialization of the frontal sinus following traumatic injury. The material used
to obliterate the sinus varied. No patients required immediate or delayed
reoperation. Nasofrontal outflow tract obstruction, the importance of which has
been emphasized in the plastic surgery literature, was apparent on either initial
or retrospective review of the available CT imaging in 96%. CONCLUSIONS: In this
series, we successfully surgically treated 33 patients with frontal sinus
fractures. The presence of cerebrospinal fluid leak, nasofrontal outflow tract
injury, associated depressed skull fractures, and subsequent formation of
communicating pathways and infection must be considered when constructing a
treatment plan. The goals of treatment should be: (i) surgical repair of the
defect and elimination of the conduit from the intracranial space to the outside
and (ii) elimination of any cerebrospinal fluid pressure gradient that may
develop across the surgical repair. We present a treatment algorithm focusing on
the presence of nasofrontal outflow tract injury/obstruction, cosmetic deformity,
and cerebrospinal fluid leak.