eMedicine Specialties > Plastic Surgery > Facial Fractures

Facial Trauma, Frontal Sinus Fractures: Multimedia

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

Multimedia

CT scan showing frontal sinus fracture with commi...
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Media file 1: CT scan showing frontal sinus fracture with comminution injury to the anterior table and supraorbital rim. However, the posterior table appears to be intact.
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CT scan showing frontal sinus fracture with commi...

CT scan showing frontal sinus fracture with comminution injury to the anterior table and supraorbital rim. However, the posterior table appears to be intact.

More superior cut of CT scan showing frontal sinu...
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Media file 2: More superior cut of CT scan showing frontal sinus fracture with comminution injury to the anterior table and supraorbital rim. The degree of anterior table displacement was sufficient to cause significant aesthetic deformity. Although the fracture spares the base of the frontal sinus and the posterior wall, the sinuses were explored for nasofrontal duct injury. The ducts were found to be intact. The anterior table was repaired, and no obliteration was performed.
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More superior cut of CT scan showing frontal sinu...

More superior cut of CT scan showing frontal sinus fracture with comminution injury to the anterior table and supraorbital rim. The degree of anterior table displacement was sufficient to cause significant aesthetic deformity. Although the fracture spares the base of the frontal sinus and the posterior wall, the sinuses were explored for nasofrontal duct injury. The ducts were found to be intact. The anterior table was repaired, and no obliteration was performed.

Fracture of the frontal sinus involving the anter...
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Media file 3: Fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch.
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Fracture of the frontal sinus involving the anter...

Fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch.

Lower cut of CT scan in a patient with fracture o...
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Media file 4: Lower cut of CT scan in a patient with fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch. Note the fracture extension through the base of the frontal sinus and involvement of the anterior ethmoid complex. Even though the fracture spares the posterior table, damage to the nasofrontal ducts is highly likely.
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Lower cut of CT scan in a patient with fracture o...

Lower cut of CT scan in a patient with fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch. Note the fracture extension through the base of the frontal sinus and involvement of the anterior ethmoid complex. Even though the fracture spares the posterior table, damage to the nasofrontal ducts is highly likely.

Coronal views of a CT scan in a patient with frac...
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Media file 5: Coronal views of a CT scan in a patient with fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch. Note the injuries to the frontal recesses. Injury to the nasofrontal ducts is expected.
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Coronal views of a CT scan in a patient with frac...

Coronal views of a CT scan in a patient with fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch. Note the injuries to the frontal recesses. Injury to the nasofrontal ducts is expected.

More anterior view of a coronal CT scan in a pati...
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Media file 6: More anterior view of a coronal CT scan in a patient with fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch. Note associated orbital blowout fracture.
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More anterior view of a coronal CT scan in a pati...

More anterior view of a coronal CT scan in a patient with fracture of the frontal sinus involving the anterior table and both supraorbital rims, medial to the supraorbital notch. Note associated orbital blowout fracture.

A proposed algorithm for the management of anteri...
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Media file 7: A proposed algorithm for the management of anterior table fractures. Note that in the case of a displaced anterior table fracture with involvement of the nasolacrimal duct, some have also proposed recannulation of the duct.
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A proposed algorithm for the management of anteri...

A proposed algorithm for the management of anterior table fractures. Note that in the case of a displaced anterior table fracture with involvement of the nasolacrimal duct, some have also proposed recannulation of the duct.

A proposed algorithm for the management of fronta...
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Media file 8: A proposed algorithm for the management of frontal sinus posterior table fractures. In patients with cerebrospinal fluid leak and displacement, obliteration or cranialization is usually indicated. If no cerebrospinal fluid leak is present, the fracture can be reduced and the algorithm for anterior table fractures can be followed. See Image 7.
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A proposed algorithm for the management of fronta...

A proposed algorithm for the management of frontal sinus posterior table fractures. In patients with cerebrospinal fluid leak and displacement, obliteration or cranialization is usually indicated. If no cerebrospinal fluid leak is present, the fracture can be reduced and the algorithm for anterior table fractures can be followed. See Image 7.

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

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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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