Incidence, patterns, and management of frontal sinus fractures: A 10-year retrospective study at a tertiary medical center, Saudi Arabia.

OBJECTIVES: To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications. METHODS: A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test. RESULTS: A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories. CONCLUSION: Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.

Frontal sinus fractures: a treatment algorithm and assessment of outcomes based on 78 clinical cases.

BACKGROUND: The purposes of this article were to retrospectively review frontal sinus fractures at the authors' center, to assess the final outcomes, and to establish a treatment algorithm. METHODS: A retrospective chart review was performed on 78 consecutive frontal sinus fractures treated by the same surgeon between January 1, 1994, and January 1, 2002. RESULTS: In this study, 57.7 percent of fractures occurred as a result of motorcycle accidents and 75.6 percent of those patients were not wearing helmets at the time of injury. The use of helmets did not significantly affect the fracture pattern. Frontal sinus fractures were commonly associated with orbital fractures (71 percent), intracranial injuries (39 percent), and severe ophthalmic injuries (26 percent). Associated injuries were more common when the fractures involved the posterior tables. The method of management comprised four groups: no surgical intervention (n = 6), open reduction and internal fixation of the anterior table with sinus preservation (n = 40), partial sinus obliteration (n = 18), and cranialization (n = 14). The complication rate was 16.7 percent (n = 13), including postoperative cerebrospinal fluid leaks (n = 6), wound infections (n = 4), meningitis (n = 1), sinusitis (n = 1), and pyomucocele (n = 1). CONCLUSIONS: Involvement of the nasofrontal duct and persistence of cerebrospinal fluid leaks are two key determinants of the treatment algorithm. The amount of displacement of the posterior table has not been found to be a key determinant of the need for surgical intervention. When the sinus is to be obliterated, partial obliteration can achieve a good result, with limited sinus complication and minimal donor-site morbidity.

Comparison of 2 preferred methods used for frontal sinus obliteration.

PURPOSE: This study was undertaken to compare total operating room cost, total operating time, and potential complications in frontal sinus obliteration using 2 different techniques. PATIENTS AND METHODS: Hospital records of all patients with frontal sinus fractures treated by the Division of Maxillofacial Surgery at the University of Florida, Jacksonville between October 1998 and December 2003 were reviewed. Twelve patients required frontal sinus obliteration based on the severity and location of injury. All cases were caused by traumatic etiology. Patients were divided into group A or B. Six patients (group A) were treated using autogenous abdominal fat for obliteration purposes, while the other 6 patients (group B) underwent frontal sinus obliteration using a hydroxyapatite cement. Total operating cost, total operating time, and any complications were recorded and analyzed for each group and then statistically evaluated using a t test. RESULTS: Follow-up ranged from 2 weeks to 6 months. Patients in group A had a lower total operating cost compared with group B. This cost difference was statistically significant. Total operating time was slightly greater in group A versus group B, although this was not statistically significant. CONCLUSION: Frontal sinus obliteration using autogenous abdominal fat appears to be more cost effective compared with hydroxyapatite cement. The slight difference in total operating time was not statistically significant and this factor alone should not be a deterrent from performing this surgical procedure.