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Management of Frontal Sinus Fractures

Yavuzer, Reha M.D.; Sari, Alper M.D.; Kelly, Christopher P. M.D.; Tuncer, Serhan M.D.; Latifoglu, Osman M.D.; Celebi, M Cemalettin M.D.; Jackson, Ian T. M.D., D.Sc.(Hon.)

Plastic & Reconstructive Surgery: May 2005 - Volume 115 - Issue 6 - pp 79e-93e
doi: 10.1097/01.PRS.0000161988.06847.6A
CME: Pediatric/Craniofacial: Special Topic/CME

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the radiographic and clinical diagnosis of frontal sinus fractures. 2. Identify various management approaches to the frontal sinus fracture and the indications for each. 3. Understand the rationale behind the decision of sinus obliteration when needed. 4. Recognize the most common complications arising from frontal sinus fracture treatment and the methods of avoiding or managing these complications.

Summary: Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. There is no single algorithm for the choice of management, but appropriate treatment depends on an accurate diagnosis using physical examination, computed tomography data, and the findings of intraoperative exploration. The amount and location of fixation and the need for frontonasal duct and sinus obliteration or elimination of the entire sinus depend on the anatomy of the fracture in general and the extent of involvement of the anterior wall of the sinus, the frontonasal duct, and the posterior wall in particular. This article discusses an algorithm for frontal sinus fractures that was obtained from the literature and modified according to the authors’ experience. The decision-making process presented by the authors has withstood the test of time over a period of more than 20 years in their practice and has been proven to be safe and efficacious in treating frontal sinus fractures of all types.

Ankara, Turkey; and Southfield, Mich.

From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Gazi University Medical Faculty; and the Institute for Craniofacial and Reconstructive Surgery.

Received for publication January 27, 2004.

Presented in part at the 20th Annual Meeting of the European Society of Ophthalmic Plastic and Reconstructive Surgery, in Muenster, Germany, September 19 to 21, 2002, and at the 71st Annual Meeting of the American Society of Plastic Surgeons, Plastic Surgery Educational Foundation, and American Society of Maxillofacial Surgeons, in San Antonio, Texas, November 2 to 6, 2002.

Reha Yavuzer, M.D., Gazi University Medical Faculty, CranioMaxilloFacial Surgery Working Group, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gazi Hospital, 14th Floor, Besevler 06500, Ankara, Turkey, ryavuzer@hotmail.com

©2005American Society of Plastic Surgeons