Management of Aesthetic and Functional Deficits in Frontal Bone Trauma

Abstract

Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are immediate and long-term aesthetic and functional deficits resulting from such pathology. The immediate complications range from local infections in the frontal sinus to infections propagating inside the central nervous system, or the presence of cerebrospinal fluid leaks and vision impairment. We review current trends and available guidelines regarding the management of cases with frontal bone trauma. Treatment options taken into consideration are a conservative attitude towards minor lesions or aggressive surgical management of complex fractures involving the anterior and posterior frontal sinus walls. We illustrate and propose different approaches in the management of cases with long-term complications after frontal bone trauma. The team attending to these patients should unite otorhinolaryngologists, neurosurgeons, ophthalmologists, and maxillofacial surgeons. Take-home message: Only such complex interdisciplinary teams of trained specialists can provide a higher standard of care for complex trauma cases and limit the possible exposure to further legal actions or even malpractice.

Keywords: bone; complications; frontal; management; otorhinolaryngology; trauma.

Figure 1

Left frontal sinus fracture with displacement.

Figure 2

Osteosynthesis of a left frontal sinus fracture with displacement.

Figure 3

Human aggression using an axe resulting in right frontal sinus fracture with displacement—(A) clinical aspect; (B) 3D CT reconstruction.

Figure 4

Coronal approach with surgical reduction and osteosynthesis of a right frontal sinus fracture with multiple fragments displacement.

Figure 5

3D CT reconstruction of a right frontal fracture with displacement.

Figure 6

Surgical aspect of a right frontal sinus fracture with displacement benefiting from the use of a titanium mesh reconstruction.

Figure 7

Right frontal sinus mucocele developed after trauma with right orbital involvement—(A) clinical aspect; (B) CT scan; (C) 3D reconstruction.

Figure 8

Giant right frontal sinus mucocele—surgical ablation, cranialization of the right frontal sinus, and reconstruction with bone flap.

Figure 9

Recovery after surgical ablation of a post-traumatic mucocele, preservation of the esthetic aspect, and eye movements.