Frontal Fracture Follow-up

  • Author: Thomas Widell, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Nov 17, 2011
 

Further Inpatient Care

  • Since these fractures require extreme force, admitting all except those few patients with isolated, nondisplaced anterior table fractures is appropriate.
  • Patients with depression of the inner table often require neurosurgical intervention to elevate the fragment.
  • Those with continued CSF leak may require a frontal sinus procedure involving ablation of the sinus and removal of the inner table to allow the frontal sinus to become part of cranium.
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Transfer

  • If appropriate specialists are not available, arrange transfer to a higher level hospital. Regulations of the Emergency Medical Treatment and Active Labor Act (EMTALA) must be followed.
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Deterrence/Prevention

  • Use of seat belts and airbags can reduce incidence of facial injuries in motor vehicle accidents. Use of helmets with facial guards can reduce injury in motorcycle accidents and in such sports as skiing, snowboarding, hockey, and football.
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Complications

  • CSF leaks may continue, though most cease by 2-3 weeks after the injury.
  • Observe patient closely for signs and symptoms of meningitis or abscess formation.
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Patient Education

  • For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article, Facial Fracture.
  • Patients should be made aware of the high incidence of posttraumatic stress disorder in facial injuries and have resources available should symptoms occur.[14]
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Contributor Information and Disclosures
Author

Thomas Widell, MD  Vice Chairman, Assistant Professor, Department of Emergency Medicine, Rosalind Franklin School of Medicine/The Chicago Medical School, North Chicago, Illinois; Associate Residency Director, University of Chicago Emergency Medicine Program, Chicago, Illinois; Program Director Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center, Chicago, Illinois

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Hendler BH, Rosen P. Maxillofacial trauma. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998:1093-1103.

  2. McGill J, Ling L, Taylor P. Facial trauma. Diagnostic Radiology in Emergency Medicine. Mosby-Year Book; 1992:51-76.

  3. Smith RG. Maxillofacial injuries. In: Harwood-Nuss A, ed. The Clinical Practice of Emergency Medicine. Lippincott Williams & Wilkins Publishers; 1991:337-43.

  4. Sullivan W. Trauma to the face. In: Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. Lippincott, Williams & Wilkins; 1996:242-69.

  5. Thomas SH, Shepherd SM. Maxillofacial injuries. In: Harwood-Nuss A, ed. The Clinical Practice of Emergency Medicine. Lippincott, Williams & Wilkins; 1996:408-18.

  6. Hasan N, Colucciello SA. Maxillofacial trauma. In: Tintinalli JE, Gabor KD, Stapczynski SJ, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill Co Inc; 2004:chap 257, p1583-1590.

  7. McKay MP. Facial trauma. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine, Concepts and Clinical Practice. Vol 1. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006:382-98/chap 39.

  8. Muminagic S, Masic T, Babajic E, Asotic M. Managment of frontal sinus fracture: obliteration sinus with cancellous bone graft. Med Arh. 2011;65(4):250-1. [Medline].

  9. Kummoona RK. Missile War Injuries of the Face. J Craniofac Surg. Nov 5 2011;[Medline].

  10. Kolodziej MA, Koblitz S, Nimsky C, Hellwig D. Mechanisms and consequences of head injuries in soccer: a study of 451 patients. Neurosurg Focus. Nov 2011;31(5):E1. [Medline].

  11. Guo L, Guo W, Li R, Sheng L, Yang B, Tang W, et al. Analysis of maxillofacial injuries caused by the 2010 Yushu earthquake in China. Emerg Med J. Oct 13 2011;[Medline].

  12. Spoor T, Ramocki JM, Kwito GM. Ocular trauma. In: Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. Lippincott, Williams & Wilkins; 1996:225-41.

  13. Snell RS, Smith MS. The face, scalp, and mouth. In: Clinical Anatomy for Emergency Medicine. Mosby-Year Book; 1993:206-241.

  14. Glynn SM, Asarnow JR, Asarnow R, et al. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. Jul 2003;61(7):785-92. [Medline].

 
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