Technology Improves Management of Frontal Sinus Fractures

It’s better to destroy the function [of the frontal sinus] and have a safe situation than to take the chance of preserving function and running into the mucocele problem down the road. – -David Kriet, MD

Frontal Sinus Fracture Reduction

Once a fracture has been identified, treatment can vary greatly depending on the location and extent of the fracture. Fractures of the frontal sinus can involve the anterior table, the posterior table, the frontal sinus ostia, or any combination of these areas. The treatment options will vary greatly depending upon which portion of the sinus is involved, and to what degree. Reduction and fixation may be easy or difficult depending on the degree of comminution and the degree of displacement, writes Dr. Rice.

Nondisplaced or minimally displaced isolated anterior table fractures can often be managed nonoperatively with local wound care and analgesics, as noted in the eMedicine article. Displaced fractures greater than 1 to 2 mm have an increased risk of aesthetic deformity and mucocele formation, and open reduction and internal fixation (ORIF) with frontal sinus obliteration is generally required.

E. Bradley Strong, MD, Associate Professor of Otolaryngology at the University of California-Davis, said in a phone interview that the improved quality of CT scanning and the option of endoscopic repair make it reasonable to consider delaying reduction of the fracture in some cases of isolated anterior table injuries. He stated, With a better diagnosis of the fracture and better potential treatment of any infections that may occur of the sinus, I felt we could take a less aggressive approach in treating the sinus fracture.

Dr. Strong has made tremendous progress in using a porous polyethylene sheeting to camouflage defects. The material can be custom designed based on CT images, or it can simply be layered into the contour defect and secured with a single screw. This procedure can be performed several weeks after the injury, allowing time for reduction of swelling and soft tissue healing.

Safe vs. Functional Sinus

One of the primary treatment goals in treatment of frontal sinus fractures is creating a safe sinus while avoiding long-term complications. A critical clinical question is whether there is injury to the frontal sinus outflow tract that may result in long-term complications if left untreated. These complications can include, but are not limited to, mucocele and meningitis. Additionally, mucosal lining, which can be trapped in the fracture line at the time of repair, can erode through the sinus walls over time, possibly into the cranial cavity or orbit.