Plastic Surgery for Frontal Sinus Fractures Workup

Updated: Mar 27, 2023
  • Author: Arjun S Joshi, MD; Chief Editor: Jorge I de la Torre, MD, FACS  more...
  • Print

Imaging Studies

In the past, roentgenograms were the basis for diagnosing fractures to the frontal sinus. [3] Admittedly, the sensitivity of conventional plain films was not considered to be very high. [3] Plain films are especially poor in defining the severity of damage to the posterior table and the nasofrontal duct region. [4]

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. [5, 6, 4, 36, 37, 38, 39] 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. [4]

A study by Gala et al indicated that maxillofacial CT scanning can more effectively reveal anterior table frontal sinus fractures than head CT scanning can. Out of 47 of these fractures, head CT scanning identified 32, compared with all 47 for maxillofacial CT scanning. With regard to posterior table frontal sinus fractures, the success rate for head CT scanning did not significantly differ from that for maxillofacial scanning. [40]

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.