Frontal Sinus Fractures: Evidence and Clinical Reflections

Abstract

Background: Despite significant advances in the management of frontal sinus fractures, there is still a paucity of large-cohort data, and a comprehensive synthesis of the current literature is warranted. The purpose of this study was to present an evidence-based overview of frontal sinus fracture management and outcomes.

Methods: A comprehensive literature search of PubMed and MEDLINE was conducted for studies published between 1992 and 2020 investigating frontal sinus fractures. Data on fracture type, intervention, and outcome measurements were reported.

Results: In total, 456 articles were identified, of which 53 met our criteria and were included in our analysis. No statistically significant difference in mechanism of injury, fracture pattern, form of management, or total complication rate was identified. We found a statistically significant increase in complication rates in patients with nasofrontal outflow tract injury compared with those without.

Conclusions: Frontal sinus fracture management is a challenging clinical situation, with no widely accepted algorithm to guide appropriate management. Thorough clinical assessment of the fracture pattern and associated injuries can facilitate clinical decision-making.

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart of included studies.

Fig. 2.

Complication rate based on the presence of NFOT injury.

Fig. 3.

Relationship of complications and follow-up length.

Fig. 4.

Intraoperative view of pericranial flap for NFOT obliteration. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.

Fig. 5.

Intraoperative cranialization. *Denotes the frontal sinus cavity. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.

Fig. 6.

CT scan following cranialization with calvarial bone graft seal. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.

Fig. 7.

CT image of severe comminuted anterior table and posterior table fracture. A, Sagittal view. B, Axial view. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.

Fig. 8.

CT scan showing mucocele. A (sagittal view) and B (axial view) demonstrate mucocele communication with the remnant frontal sinus (red arrow). C (coronal view) demonstrates mucocele (red arrow) causing displacement of left eye prosthesis. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.

Fig. 9.

Intraoperative mucocele. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.

Fig. 10.

CT scan free fibula for persistent frontal sinus infection management. Published with permission from and copyrights retained by Eduardo D. Rodriguez, MD, DDS.