Frontal sinus fracture surgery

• Management of Traumatic Anterior Skull Base Fractures and Cerebrospinal Fluid Fistulas
• Indications and Complications in Conservative Versus Surgical Management of Frontal Sinus Fractures
• Contemporary Management of Frontal Sinus Fractures
• New Surgical Devices for Closed Reduction of Frontal Sinus Bone Fracture
• Augmented Reality Navigation in Craniomaxillofacial/Head and Neck Surgery
• Biomechanical evaluation of zygomatic-orbital-maxillary complex fractures following internal fixation
• Frontal Sinocutaneous Fistula with Frontal Osteomyelitis as a Delayed Complication of Bone Wax Obliteration of Frontal Sinus Fracture
• Possible complications of frontal sinus fractures after conservative or surgical treatment: retrospective study

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 ducts) ¹⁾ , 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 ²⁾

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 leakage, 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.

see Frontal sinus cranialization

Another group supports nonoperative management if no cerebrospinal fluid leakage is produced. The purpose is to avoid complications of meningitis, fistula, and late sequelae. The difficulty lies in predicting which patients will develop complications ³⁾.

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 ^{4) 5) 6) 7) 8)}.