Authors of section


S Fusetti, B Hammer, R Kellman, C Matula, EB Strong, A Di Ieva

General Editor

Daniel Buchbinder

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Indications for surgery


Treatment of frontal sinus fractures is complex and sometimes controversial. Appropriate treatment decisions can be made by assessing 5 anatomic parameters, these include the presence of:

  • An anterior table fracture (A)
  • A posterior table fracture (B)
  • A nasofrontal recess fracture (C)
  • A dural tear (CSF leak) (D)
  • Fracture comminution

Treatment options would include:

  • Observation
  • Open reduction internal fixation (ORIF)
  • Obliteration
  • Cranialization
  • Ablation
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Minimally displaced anterior table fractures (< 1-2 mm) not involving the nasofrontal recess injury can be observed with little risk of long term morbidity.

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Open reduction internal fixation (ORIF)

Fractures with greater displacement (> 2 mm) not involving the nasofrontal recess injury present little risk to sinus function. However, the risk of an esthetic deformity increases corresponding to the fracture size/displacement.

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CT scan demonstrates mild comminution and moderate depression of a patient without nasofrontal recess injury (not shown).

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Severe comminution of the anterior table (with or without involvement of nasofrontal recess injury) may make open reduction with the existing bone fragments very challenging. Mucosal disruption can result in a non-functioning sinus postoperatively. In this unusual situation sinus obliteration may be required.

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further reading
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