Frontal Fracture Treatment & Management

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

Prehospital Care

ABCs are first priority. Hold airway open by chin lift, jaw thrust, or airway adjuncts, including endotracheal intubation. [8]

Because of concerns over intracranial placement of endotracheal tubes, avoid using the nasotracheal route for intubation if the patient has extensive facial damage or midface fracture is suspected.

Place the patient on a backboard with a collar if cervical spine injury is a possibility.

Treat hypoventilation with intubation and bag ventilation.

Control actively bleeding wounds by applying a bandage with direct pressure.

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Emergency Department Care

ABCs take priority; reassess airway frequently.

Do not focus solely on the obvious deformity, thereby failing to perform a complete primary survey.

Rapidly diagnose other life threats and undertake appropriate resuscitation. Follow with a complete secondary survey.

Diagnosis of frontal bone fracture in the ED is part of secondary survey.

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Consultations

If a frontal fracture is diagnosed, refer patient to a neurosurgeon, as these injuries often are associated with intracranial injury.

Provide care for a patient with multiple injuries in conjunction with a surgeon experienced in trauma care.

The incidence of posttraumatic stress disorder is high in patients with facial injuries, and a consultation with a psychiatrist should be considered. [20]

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Medical 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]

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