Management of frontal sinus fractures: A review of 96 cases

Objectives: The optimal treatment algorithm for frontal sinus fracture management remains ill-defined. The purpose of the study was to classify fracture types, review management methods, document associated injuries, and identify complications associated with various treatment options. Study Design: The authors conducted a retrospective chart review evaluating a 13-year experience with frontal sinus fracture management. Methods: Complete medical records of 96 frontal sinus fracture patients treated by the University of Kentucky Otolaryngology Service from 1990 to 2003 were reviewed. Results: The average patient age was 39 years. Fifty percent of the fractures involved the anterior table of the frontal sinus alone, and 50% involved both anterior and posterior tables. Forty-seven percent of the injuries were managed with observation, whereas 50% of patients underwent surgical repair. In the surgical group, 60% underwent open reduction and internal fixation (ORIF), 23% had a cranialization procedure, and 17% underwent sinus obliteration. The average length of follow up was 9 months. Complications occurred in 17% of the patients (5% in the nonsurgical group and 12% in the surgical group). Conclusion: Our results support conservative management of nondisplaced or minimally displaced fractures based on the low complication rate seen in this series. Significant bone displacement can frequently be managed with simple ORIF. Complex fractures affecting the orbit or intracranial contents require cranialization. or possibly obliteration. A subset of patients with suspected frontal sinus outflow obstruction can be considered for observation or simple ORIF with close follow up and endoscopic repair if outflow complications manifest.