eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Frontal Sinus Fractures: Follow-up

Author: Travis T Tollefson, MD, FACS, Assistant Professor, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center
Coauthor(s): E Bradley Strong, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of California at Davis
Contributor Information and Disclosures

Updated: Jul 13, 2009

Outcome and Prognosis

Patients with mildly displaced anterior table fractures do extremely well after surgical repair, and significant long-term sequelae are uncommon.

Displaced FS fractures generally result from more extreme forces. Consequently, most patients who undergo surgical treatment of these injuries have some long-term sequelae. The most common sequelae are mild and include frontal headache (20%), sinus infections (12%), sinus fullness (11%), sinus drainage (10%), and forehead depression (10%). Less common but more severe long-term sequelae include diplopia (4%), seizures (4%), mucocele formation (exact incidence uncertain [0-10%]), and brain abscess (1%).

For excellent patient education resources, see eMedicine's Headache Center and Breaks, Fractures, and Dislocations Center. Also, visit eMedicine's patient education articles, Sinus Infection and Facial Fracture.

Future and Controversies

The most common controversies associated with FS trauma are the aggressiveness of surgical repair for a given fracture type and the optimum material used for FS obliteration. Unfortunately, long-term follow-up in patients with FS fractures is extremely difficult. Definitive studies on the most efficacious management do not exist.

The author(s) has proposed a conservative treatment algorithm (see Image 3) to guide the surgical repair of given fracture types. When obliteration is indicated, the author prefers autologous fat. Other materials that have been used include muscle, bone, fascia, osteoneogenesis (auto-obliteration), hydroxyapatite cement, and bioactive glass. Although autologous fat does have donor site morbidity, it is readily available, easy to handle, and cost-effective. Most importantly, it has long-term proven efficacy.

A similar algorithm that advocates observation of nondisplaced anterior table fractures that do not demonstrate radiographic evidence of nasofrontal recess obstruction has recently been suggested after reviewing 857 patients.1

 


More on Frontal Sinus Fractures

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

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Further Reading

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Keywords

frontal sinus fractures, FS, FS fractures, nasoorbitoethmoid fractures, NOE fractures, frontal sinus trauma, FS trauma, facial bone fracture, broken bone, face, fractured face, sinus, facial trauma, facial fractures, anterior table, posterior table

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Contributor Information and Disclosures

Author

Travis T Tollefson, MD, FACS, Assistant Professor, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center
Travis T Tollefson, MD, FACS is a member of the following medical societies: American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Coauthor(s)

E Bradley Strong, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of California at Davis
E Bradley Strong, MD is a member of the following medical societies: Alpha Omega Alpha and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Hassan H Ramadan, MD, MSc, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University
Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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