Frontal sinus fractures with suspected outflow tract obstruction: A new approach for sinus preservation

• Published in: Journal of cranio-maxillo-facial surgery Vol. 43; no. 1; pp. 1 - 6
• Main Authors: Emara, Tarek Abdelzaher, Elnashar, Ismail Seddik, Omara, Tharwat Abdelzaher, Basha, Waleed Mohamed, Anany, Ahmad Mohamad
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.01.2015
• Subjects: Adolescent; Adult; Debridement - methods; Endoscopic clearance of frontal recess; Endoscopy - methods; Ethmoid Sinus - injuries; Ethmoid Sinus - surgery; Follow-Up Studies; Fracture Fixation, Internal - methods; Frontal outflow obstruction; Frontal Sinus - injuries; Frontal Sinus - surgery; Frontal sinus fractures; Frontal Sinusitis - etiology; Frontal Sinusitis - prevention & control; Humans; Image Processing, Computer-Assisted - methods; Intraoperative Care; Male; Mucociliary Clearance - physiology; Nasal Bone - injuries; Nasal Bone - surgery; Nasal Mucosa - surgery; Orbital Fractures - surgery; Preservation of sinus function; Prospective Studies; Skull Fractures - complications; Skull Fractures - surgery; Surgery; Tomography, X-Ray Computed - methods; Young Adult; Frontal sinus fractures; Frontal outflow obstruction; Preservation of sinus function; Endoscopic clearance of frontal recess
• ISSN: 1010-5182; 1878-4119; 1878-4119
• DOI: 10.1016/j.jcms.2014.09.013

The description of a new approach for the management of patients with frontal sinus fractures and associated obstruction of the frontal outflow tract to, restore sinus function and avoiding sinus obliteration. In a prospective study, 21 patients with anterior wall frontal sinus fractures associated with potential obstruction of the frontal outflow tract, underwent rigid internal fixation and intraoperative guarded nasal endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. Patients were followed up clinically and radiologically by CT to assess the status of the frontal sinus and to detect any manifestations of frontal sinusitis or any other complications. Seventeen patients completed the postoperative follow-up while four patients were excluded from the study. Postoperative follow-up ranged from 6 to 34 months with a mean of 20 months. All patients had associated craniofacial fractures. Follow-up CT scans showed complete restoration of frontal sinus ventilation and mucociliary clearance for 13 patients. Four patients showed frontal sinus mild mucosal thickening without signs of chronic sinusitis. Patients with anterior wall frontal sinus fractures associated with frontal sinus outflow tract obstruction could be successfully managed with rigid internal fixation and intraoperative guarded endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. This type of management could increase the chance of frontal sinus preservation and decrease the need for frontal sinus obliteration for similar patients.