Management of frontal sinus trauma: a retrospective study of surgical interventions and complications

Abstract

Background: Frontal sinus injuries are relatively rare among facial bone traumas. Without proper treatment, they can lead to fatal intracranial complications, including meningitis or brain abscesses, as well as aesthetic and functional sequelae. The management of frontal sinus injuries remains controversial, with various treatment methods and outcomes being reported. This article describes the clinical characteristics, surgical methods, and outcomes among 17 patients who underwent surgery for frontal sinus injury and related complications.

Case presentation: We retrospectively included 17 patients who underwent surgery for frontal sinus injury and its related complications at the Kangwon National University Hospital between July 2010 and September 2021. Among them, six underwent simple open reduction and fixation of the anterior wall, eight underwent sinus obliteration, and three underwent cranialization. Two patients who underwent sinus obliteration died due to infection-related complications. The patient who underwent cranialization reported experiencing chronic headache and expressed dissatisfaction regarding the esthetic outcomes of the forehead. Except for these three patients, the other patients achieved satisfactory esthetic and functional recovery.

Conclusion: Active surgical management of frontal sinus injuries is often required owing to the various complications caused by these injuries; however, several factors, including the fracture type, clinical presentation, related craniomaxillofacial injury, and medical history, should be considered while formulating the treatment plan. Surgical treatment through the opening of the frontal sinus should be actively considered in patients with severely damaged posterior wall fractures and those at risk of developing infection.

Keywords: Complications; Cranialization; Frontal sinus fracture; Infection; Obliteration.

Fig. 1

a, c, e, and g Computed tomographic imaging at the time of injury. b, d, f, and g Post-injury images at 9 years and 9 months, 6 years and 7 months, 1 year and 8 months, and 4 years and 11 months, respectively

Fig. 2

An absorbable mesh was used as the repair material. a and b Approach via the forehead laceration. c and d Bicoronal approach

Fig. 3

a and b Combined anterior and posterior wall fracture of the frontal sinus. c and d Osteotomized and elevated anterior wall of the frontal sinus and exposed posterior wall. The mucous membrane of the invaded sinus was removed. e Sinus obliteration performed using hydroxyapatite cement and anterior wall repositioning

Fig. 4

a and b Osteotomized and elevated anterior wall of the frontal sinus. Removed posterior wall and exposed dura. c Repositioned anterior wall

Fig. 5

a and b Through-and-through fracture caused by a hammer impact. Pneumocephalus can be observed on the image. c and d CT image acquired at 1 year postoperatively shows anterior expansion of the frontal lobe (red circle). CT, computed tomography

Fig. 6

a and b Combined fracture of the anterior and posterior wall of the frontal sinus. Pneumocephalus can be observed on the image. c The supraorbital bone fragment was elevated, and the dura was exposed. d A subdural abscess had developed in the left hemisphere at 1 postoperative year

Fig. 7

a–c CT image acquired at the first visit. Medical history of craniotomy, extensive pneumocephalus, defects in the posterior wall and floor of the frontal sinus, and channel formation between the brain and paranasal sinus. The patient refused surgery at this time and was discharged. d and e CT scan acquired during the second visit. Intracranial abscess formation and pneumocephalus can be observed. f The osteotomized anterior wall of the frontal sinus is elevated, and the eroded posterior wall can be observed. Meticulous debridement of the mucosal membrane was performed. The formed channel was identified through the eroded posterior wall. g and h CT scan image acquired during the third visit (four postoperative weeks) shows increased pneumocephalus. i Craniotomy and dural repair were performed. CT, computed tomography