Technology Improves Management of Frontal Sinus Fractures

In the Laryngoscope study, fourteen patients who had sustained acute traumatic frontal sinus fractures were evaluated. Seven patients fulfilled the criteria set forth by the authors and elected to follow the modified treatment algorithm. Of the seven patients treated in accordance with the algorithm, only two needed follow-up surgical intervention, which was performed successfully using endoscopic procedures in both cases.

Not every patient will be a candidate for these less invasive procedures. However, many patients may now realize a potential benefit from alternative, less invasive treatment options.

Improvements through Technology

Dr. Kriet cited the increased use of endoscopy as a huge advance in caring for fractures of the sinus. He called it an example of taking procedures that were being used initially for dealing with chronic sinusitis and applying that technique to the trauma patient. Dr. Kriet said, This is an example of using techniques from within our specialty or other subspecialties.

Dr. Strong added, When I started thinking about endoscopic approaches, I thought, can we do it better, and if we can do it less invasively, is it safe? He noted the reasons doctors can consider a different approach than they did 15 years ago are the availability of improved CT scans and better potential for delayed treatment endoscopically.

By utilizing less invasive endoscopic techniques to treat some frontal sinus fractures, a cosmetic and reconstructive advantage can be recognized by the reduction in scarring. Many potential long-term complications can be avoided, and a high percentage of patients are left with a functioning sinus. Not every patient will be a candidate for these less invasive procedures. However, many patients may now realize a potential benefit from alternative, less invasive treatment options.

Treatment Algorithm for Managing Anterior Table Fractures

1. Preoperative assessment of the frontal outflow tract by high-resolution, thin-section CT with sagittal reconstructions;
2. Accurate restoration of the displaced bony fragments with internal rigid fixation;
3. Adjunctive postoperative broad-spectrum antibiotics for four weeks to treat potentially contaminated sinuses;
4. Serial postoperative CT scans to check for ventilation and restoration of mucociliary clearance of the frontal sinus; and
5. Endoscopic frontal sinus surgery for persistent frontal outflow tract obstruction.

Source: Laryngoscope. 2002;112:784-790.

©2006 The Triological Society