Frontal Fracture Workup

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

Laboratory Studies

Lab studies include direct lab studies toward a workup of a trauma patient. If fracture is an isolated injury, obtain preoperative labs if surgery is planned.

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Imaging Studies

Obtain routine facial views, including Waters, Caldwell, and lateral projections.

Caldwell projection provides the best view of the anterior table; however, the posterior table is difficult to assess in any of the standard plain film views.

Frontal sinus fractures usually require CT scan, examining bone windows to evaluate the posterior table of the frontal sinus.

Look for associated orbital rim and nasoethmoidal fractures on CT scan.

Consider brain CT scan to exclude brain injuries or intracranial bleeds.

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Other Tests

Test clear rhinorrhea for glucose to help determine if it is CSF, as nasal secretions are normally low in glucose.

If blood is present, this test is unreliable.

Blood-tinged fluid can be placed on filter paper to look for a double ring sign of CSF around blood; however, this is not reliable.

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Procedures

When dural leak causing CSF rhinorrhea is suspected yet cannot be proven, the following procedure, which is generally not performed in the emergency department, may be done. Inject fluorescein dye into the lumbar subarachnoid space. Examine the discharged nasal fluid 30 minutes later with a Wood lamp for fluorescence; fluorescence confirms CSF rhinorrhea.

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