Frontal Fracture Follow-up

Updated: Apr 02, 2016
  • Author: Thomas Widell, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
  • Print
Follow-up

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. 

A CSF leak in patients with facial fracture can result in meningitis and other central nervous system complications. In a retrospective cross-sectional study of 1,287 patients admitted to a medical center with head and face injuries over a 7-year period (2004-2010), 17 had CSF leaks. Of the patients with CSF leak, 8 (47%) were treated spontaneously, 2 (11.8%) were treated using lumbar drain placement, and 7 (41.2%) were treated by surgical intervention. [5]

Pediatric frontal sinus fractures are rare. A retrospective review of 39 patients aged 0 to 18 yr showed that fractures of the anterior and posterior table with displacement greater than one table width were significantly associated with higher hospital costs, higher velocity mechanism of injuries, lower Glasgow Coma Scale scores, nasofrontal outflow tract (NFOT) involvement, and CSF leak. According to the authors, pediatric patients without NFOT involvement can be managed with observation only, but those with NFOT involvement or persistent CSF leak should be treated with obliteration or cranialization, respectively, to reduce the risk of severe complications. [6]

Next:

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.

Previous
Next:

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.

Previous
Next:

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.

A delay in operative management of frontal sinus fractures in patients requiring operative intervention was shown to be associated with an increased risk for serious infections. A retrospective chart review was performed of 242 consecutive patients with surgically managed frontal sinus fractures. Serious infections included meningitis, encephalitis, brain abscess, frontal sinus abscess, and osteomyelitis. Delayed operative interventions were defined as procedures performed more than 48 hours after admission. Operative delay beyond 48 hours was independently associated with a 4.03-fold increased risk for serious infection; external cerebrospinal fluid drainage catheter use and local soft-tissue infection conferred a 4.09-fold and 5.10-fold increased risk, respectively. [21]

In retrospective review of pediatric facial fractures (285 patients 18 yr or younger), the most common fractures were those of the mandible (29.0%), orbit (26.5%), nasal bone (14.4%), zygoma (7.7%), and frontal bone/frontal sinus (7.5%). Intracranial hemorrhage was present in 70 patients (24.6%), a skull fracture in 50 (17.5%), a cervical spine fracture in 10 (3.5%), and a lumbar spine fracture in 11 (3.9%). Midface fractures and a depressed Glasgow Coma Scale (GCS) showed a strong correlation with intracranial hemorrhage and cervical spine fracture. The mean GCS for patients with and without intracranial hemorrhages was 11.0 and 14.6, respectively (P < 0.05). The mean GCS for patients with and without cervical spine fractures was 11.2 and 13.8, respectively (P < 0.05). The authors recommended that patients with midface fractures be evaluated for intracranial hemorrhage and spine fracture if the GCS isabnormal. [4]

Previous
Next:

Patient Education

For patient education resources, see the Breaks, Fractures, and Dislocations Center, as well as 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. [20]

Previous