The frontal sinus: a culprit or a victim? A review of 40 cases.

PURPOSE: Frontal sinus fractures represent 2-12% of facial trauma. The purpose of this article is to discuss proper management of these fractures and to evaluate the indications for treatment, the complications and the morphologic results of surgery. MATERIAL AND METHODS: The records of 40 patients admitted to this department with a frontal sinus fracture were reviewed. Sex, age, the circumstances of injury, the imaging techniques, fracture patterns, associated injuries, length of hospital stay, surgical approaches and the complications were analysed. The operations included 3 main options: cranialization, obliteration or reconstruction of the frontal sinus. RESULTS: There were 32 men and 8 women (average 34 years). The most common cause of injury was motor vehicle accidents. Conventional radiography of the face was complemented by computed tomography and 3D reconstructions. Isolated anterior table fractures were found in 72.5% and combined anterior/posterior table fractures in 27.5% of the cases. The treatment was surgical for 70% of the patients; the average length of hospitalization was 1 week. Postoperative complications were: 1 brain abscess, 2 cases of frontal sinusitis and 2 cases of chronic headache. CONCLUSION: Long-term complications in frontal sinus fractures are intracranial infection, sinusitis and forehead defects. To avoid these it was decided to treat all displaced fractures surgically in displaced anterior table fractures the sinus was obliterated with cancellous bone and in displaced posterior table fractures the sinus was cranialized.