Frontal sinus fracture surgery [Neurosurgery Wiki]

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====== Frontal sinus fracture surgery ======

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Dealing with [[frontal sinus]]

✖ Simple packing of the [[sinus]] (with [[bone wax]], [[Gelfoam]]®, [[muscle]], or [[fat]]) increases the possibility of [[infection]] or [[mucocele]] formation.

The rear wall of the sinus is removed (so-called [[cranialization]] of the [[frontal sinus]]). The sinus is then exenterated ([[mucosa]] is stripped from the sinus wall down to the [[nasofrontal duct]], the mucosa is inverted over itself in the region of the [[duct]] and is packed down into the duct, and [[temporalis muscle]] plugs are then packed into the [[frontonasal duct]]s)
((Robinson J, Donald PJ, Pitts LH, et al. Management of Associated Cranial Lesions. In: Craniospinal Trauma. New York: Thieme Medical Publishers, Inc.; 1990:59–87))
, and the bony wall of the sinus is drilled with a diamond burr to remove tiny remnants of mucosa found on the surface of bone that may proliferate and form a [[mucocele]]
((Donald PJ. The Tenacity of the Frontal Sinus Mucosa. Otolaryngol Head Neck Surg. 1979; 87: 557–566))

If there is any remnant of the sinus, it may then be packed with abdominal fat that fills all corners of the cavity. Post-op risks related to frontal sinus injury include infection, mucocele formation, and CSF leak.

If the posterior wall is fractured and there is [[cerebrospinal fluid leak]]age, treatment seeks to restore the integrity of the [[dura]] and isolate the [[intracranial]] contents through the obliteration of the [[nasofrontal duct]] and [[frontal sinus cranialization]]. 

==== Frontal sinus cranialization ====
see [[Frontal sinus cranialization]]

===== Conservative =====

Another group supports nonoperative management if no [[cerebrospinal fluid leak]]age is produced. The purpose is to avoid complications of [[meningitis]], fistula, and late sequelae. The difficulty lies in predicting which patients will develop complications
((Villafán-Quiroga R, Cienfuegos-Monroy R, Sierra-Martínez E. Fractures of the
posterior wall of the frontal sinus: non-surgical management and complications.
Cir Cir. 2010 Sep-Oct;78(5):387-92. English, Spanish. PubMed PMID: 21219808.)).

Management has become much more conservative due to the better understanding of [[frontal sinus]] fracture management and the advent and expertise developed in endoscopic sinus surgery
((Chen D J, Chen C T, Chen Y R, Feng G M. Endoscopically assisted repair of frontal sinus fracture. J Trauma. 2003;55:378–382.))
((Kanowitz S J, Batra P S, Citardi M J. Comprehensive management of failed frontal sinus obliteration. Am J Rhinol. 2008;22:263–270.))
((Strong E B. Endoscopic repair of anterior table frontal sinus fractures. Facial Plast Surg. 2009;25:43–48.))
((Strong E B, Buchalter G M, Moulthrop T H. Endoscopic repair of isolated anterior table frontal sinus fractures. Arch Facial Plast Surg. 2003;5:514–521.))
((Kim K S, Kim E S, Hwang J H, Lee S Y. Transcutaneous transfrontal approach through a small peri-eyebrow incision for the reduction of closed anterior table frontal sinus fractures. J Plast Reconstr Aesthet Surg. 2010;63:763–768.)).