Closed treatment of frontal sinus fracture with percutaneous screw reduction

Abstract

Fractures of the frontal sinus are a relatively common injury presenting to trauma units that deal with craniofacial injuries. Approximately one third of frontal sinus fractures affect the anterior wall alone, with two thirds involving the anterior wall, posterior wall, or frontonasal duct. Isolated posterior wall defects are exceedingly rare. Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. In the standard treatment modality of frontal sinus fractures, repair is best performed by way of a coronal approach, which offers excellent access. Most of the frontal sinus fractures deserve this attentive surgical manipulation to prevent late sequelae of infection or mucocele formation. In this article, we present a case of isolated depressed anterior wall fracture of the frontal sinus that was treated by closed reduction to avoid coronal incision. Anterior wall fracture of the right frontal sinus was diagnosed with preoperative evaluation of three-dimensional CT of a 34-year-old male patient with maxillofacial trauma. The anterior wall fracture was reduced by traction of two percutaneously applied screws to the depressed fragments. Accurate reduction was obtained, and neither recurrent displacement nor infection was observed during the follow-up period of 3 months. The screws were removed in the clinical setting without difficulty. Although percutaneous reduction of noncomminuted anterior wall frontal sinus fractures has limited indications, it has its own advantages over open techniques. This method is a less-invasive technique and can be performed without problem in selected cases. Our technique is not suitable for complex fractures of the frontal sinus.