eMedicine Specialties > Plastic Surgery > Facial Fractures

Facial Trauma, Frontal Sinus Fractures: Workup

Author: Arjun S Joshi, MD, Staff Physician, Division of Otolaryngology/Head and Neck Surgery, George Washington University Medical Center
Coauthor(s): Diego Preciado, MD, PhD, Assistant Professor, George Washington University School of Medicine, Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Medical Center; Patrick Byrne, MD, Assistant Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University; Adel R Tawfilis, DDS, Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center
Contributor Information and Disclosures

Updated: Sep 15, 2008

Workup

Imaging Studies

  • In the past, roentgenograms were the basis for diagnosing fractures to the frontal sinus.2 Admittedly, the sensitivity of conventional plain films was not considered to be very high.2 Plain films are especially poor in defining the severity of damage to the posterior table and the nasofrontal duct region.3
  • The use of high-resolution, 1.5-mm thin-cut CT scanning provides improved diagnostic power for assessing injuries to the frontal sinus and midface.4,5,3
    • Unfortunately, involvement of the nasofrontal duct is not clearly definable even with CT imaging; therefore, decisions regarding management of the duct and sinus are frequently made during surgical exploration.
    • Certain findings on a CT scan image strongly suggest injury to the nasofrontal duct. A CT image that demonstrates a fracture through the base of the frontal sinus and/or the anterior ethmoid complex strongly suggests trauma to the nasofrontal duct.3
  • Some authors have proposed obtaining a 6-foot Caldwell view plain film prior to surgical intervention. The goal is to obtain an image that depicts the exact dimensions of the patient's frontal sinuses.
    • This film is then sterilized and used as a template to mark the exact location of the frontal sinuses intraoperatively when the frontal bone is exposed.
    • The film assists in designing a precise osteoplastic flap. Take care to ensure that the dimensions of the skull correspond exactly to the patient.

More on Facial Trauma, Frontal Sinus Fractures

Overview: Facial Trauma, Frontal Sinus Fractures
Workup: Facial Trauma, Frontal Sinus Fractures
Treatment: Facial Trauma, Frontal Sinus Fractures
Follow-up: Facial Trauma, Frontal Sinus Fractures
Multimedia: Facial Trauma, Frontal Sinus Fractures
References
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References

  1. Metzinger SE, Guerra AB, Garcia RE. Frontal sinus fractures: management guidelines. Facial Plast Surg. Aug 2005;21(3):199-206. [Medline].

  2. May M, Ogura JH, Schramm V. Nasofrontal duct in frontal sinus fractures. Arch Otolaryngol. Dec 1970;92(6):534-8. [Medline].

  3. Harris L, Marano GD, McCorkle D. Nasofrontal duct: CT in frontal sinus trauma. Radiology. Oct 1987;165(1):195-8. [Medline].

  4. Johnson DH Jr. CT of maxillofacial trauma. Radiol Clin North Am. Mar 1984;22(1):131-44. [Medline].

  5. Schatz CJ, Becker TS. Normal CT anatomy of the paranasal sinuses. Radiol Clin North Am. Mar 1984;22(1):107-18. [Medline].

  6. Reidel. Schenk Inaug Dissertation. Jena. 1898.

  7. Killian G. Handbuch Der Haus, Nasen, Oren, Heilkunde, Dender Und Kahler. 1904;2:820.

  8. Lynch RC. The technique of a radical frontal sinus operation which has given me the best results. Laryngoscope. 1921;31.

  9. Bergara AR, Itoiz OA. Present status of the surgical treatment of chronic frontal sinusitis. Arch Otolaryngol. 1955;61:616-28.

  10. Goodale RL, Montgomery WW. Experiences with the osteoplastic wall approach to the frontal sinus. Arch Otolaryngol. 1958;68:271-83.

  11. Goodale RL, Montgomery WW. Anterior osteoplastic frontal sinus operation: five-year experience. Ann Otol Rhinol Laryngol. 1961;70:860-80.

  12. Goodale RL, Montgomery WW. Technical advances in osteoplastic frontal sinusectomy. Arch Otolaryngol. 1964;79:522-9.

  13. Levine SB, Rowe LD, Keane WM, Atkins JP Jr. Evaluation and treatment of frontal sinus fractures. Otolaryngol Head Neck Surg. Jul 1986;95(1):19-22. [Medline].

  14. Donald PJ, Bernstein L. Compound frontal sinus injuries with intracranial penetration. Laryngoscope. Feb 1978;88(2 Pt 1):225-32. [Medline].

  15. Bordley JE, Bosley WR. Mucoceles of the frontal sinus: causes and treatment. Ann Otol Rhinol Laryngol. Sep-Oct 1973;82(5):696-702. [Medline].

  16. McGraw-Wall B. Frontal sinus fractures. Facial Plast Surg. 1998;14(1):59-66. [Medline].

  17. Wright DL, Hoffman HT, Hoyt DB. Frontal sinus fractures in the pediatric population. Laryngoscope. Nov 1992;102(11):1215-9. [Medline].

  18. Shockley WW, Stucker FJ Jr, Gage-White L, Antony SO. Frontal sinus fractures: some problems and some solutions. Laryngoscope. Jan 1988;98(1):18-22. [Medline].

  19. Gerbino G, Roccia F, Benech A, Caldarelli C. Analysis of 158 frontal sinus fractures: current surgical management and complications. J Craniomaxillofac Surg. Jun 2000;28(3):133-9. [Medline].

  20. Yavuzer R, Sari A, Kelly CP, et al. Management of frontal sinus fractures. Plast Reconstr Surg. May 2005;115(6):79e-93e; discussion 94e-95e. [Medline].

  21. Rohrich RJ, Hollier LH. Management of frontal sinus fractures. Changing concepts. Clin Plast Surg. Jan 1992;19(1):219-32. [Medline].

  22. Nahum AM. The biomechanics of maxillofacial trauma. Clin Plast Surg. Jan 1975;2(1):59-64. [Medline].

  23. Gonty AA, Marciani RD, Adornato DC. Management of frontal sinus fractures: a review of 33 cases. J Oral Maxillofac Surg. Apr 1999;57(4):372-9; discussion 380-1. [Medline].

  24. Lee TT, Ratzker PA, Galarza M, Villanueva PA. Early combined management of frontal sinus and orbital and facial fractures. J Trauma. Apr 1998;44(4):665-9. [Medline].

  25. Sakas DE, Beale DJ, Ameen AA, et al. Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair. J Neurosurg. Mar 1998;88(3):471-7. [Medline].

  26. Ginsburg CM. Frontal sinus fractures. Pediatr Rev. Apr 1997;18(4):120-1. [Medline].

  27. Chen DJ, Chen CT, Chen YR, Feng GM. Endoscopically assisted repair of frontal sinus fracture. J Trauma. Aug 2003;55(2):378-82. [Medline].

  28. Strong EB, Buchalter GM, Moulthrop TH. Endoscopic repair of isolated anterior table frontal sinus fractures. Arch Facial Plast Surg. Nov-Dec 2003;5(6):514-21. [Medline].

  29. Luce EA. Frontal sinus fractures: guidelines to management. Plast Reconstr Surg. Oct 1987;80(4):500-10. [Medline].

  30. Heckler FR. Discussion of frontal sinus fractures. Guidelines to Management of Plastic Reconstructive Surgery. 1987;80:509-20.

  31. Stanley RB Jr. Fractures of the frontal sinus. Clin Plast Surg. Jan 1989;16(1):115-23. [Medline].

  32. Ioannides C, Freihofer HP, Vrieus J, Friens J. Fractures of the frontal sinus: a rationale of treatment. Br J Plast Surg. Apr 1993;46(3):208-14. [Medline].

  33. Thaller SR, Donald P. The use of pericranial flaps in frontal sinus fractures. Ann Plast Surg. Mar 1994;32(3):284-7. [Medline].

  34. Donald PJ. The tenacity of the frontal sinus mucosa. Otolaryngol Head Neck Surg. Sep-Oct 1979;87(5):557-66. [Medline].

  35. Hwang K, Song YB. Closed reduction of fractured anterior wall of the frontal bone. J Craniofac Surg. Jan 2005;16(1):120-2. [Medline].

  36. Swinson BD, Jerjes W, Thompson G. Current practice in the management of frontal sinus fractures. J Laryngol Otol. Dec 2004;118(12):927-32. [Medline].

  37. Tiwari P, Higuera S, Thornton J, Hollier LH. The management of frontal sinus fractures. J Oral Maxillofac Surg. Sep 2005;63(9):1354-60. [Medline].

  38. Wallis A, Donald PJ. Frontal sinus fractures: a review of 72 cases. Laryngoscope. Jun 1988;98(6 Pt 1):593-8. [Medline].

  39. Whatley WS, Allison DW, Chandra RK, Thompson JW, Boop FA. Frontal sinus fractures in children. Laryngoscope. Oct 2005;115(10):1741-5. [Medline].

  40. Wilson BC, Davidson B, Corey JP, Haydon RC 3rd. Comparison of complications following frontal sinus fractures managed with exploration with or without obliteration over 10 years. Laryngoscope. May 1988;98(5):516-20. [Medline].

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Further Reading

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Keywords

frontal sinus fractures, frontal sinus fracture, sinus fracture, facial trauma, anterior table fractures, posterior table fractures, frontal sinus trauma, nasofrontal duct trauma, facial fracture, face fracture, nasofrontal duct injury, intracranial trauma, maxillofacial trauma, maxillofacial fracture, blunt trauma, MVA, motor vehicle accident, car accident, low-velocity trauma, high-velocity trauma, penetrating trauma

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Contributor Information and Disclosures

Author

Arjun S Joshi, MD, Staff Physician, Division of Otolaryngology/Head and Neck Surgery, George Washington University Medical Center
Arjun S Joshi, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Diego Preciado, MD, PhD, Assistant Professor, George Washington University School of Medicine, Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Medical Center
Diego Preciado, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and Association for Research in Otolaryngology
Disclosure: Nothing to disclose.

Patrick Byrne, MD, Assistant Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University
Patrick Byrne, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Adel R Tawfilis, DDS, Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center
Adel R Tawfilis, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Society of Maxillofacial Surgeons
Disclosure: Nothing to disclose.

Medical Editor

James F Thornton, MD, Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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