Frontal sinus fractures with suspected outflow tract obstruction: a new approach for sinus preservation.

OBJECTIVE: The description of a new approach for the management of patients with frontal sinus fractures and associated obstruction of the frontal outflow tract to, restore sinus function and avoiding sinus obliteration. SUBJECTS AND METHODS: In a prospective study, 21 patients with anterior wall frontal sinus fractures associated with potential obstruction of the frontal outflow tract, underwent rigid internal fixation and intraoperative guarded nasal endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. Patients were followed up clinically and radiologically by CT to assess the status of the frontal sinus and to detect any manifestations of frontal sinusitis or any other complications. RESULTS: Seventeen patients completed the postoperative follow-up while four patients were excluded from the study. Postoperative follow-up ranged from 6 to 34 months with a mean of 20 months. All patients had associated craniofacial fractures. Follow-up CT scans showed complete restoration of frontal sinus ventilation and mucociliary clearance for 13 patients. Four patients showed frontal sinus mild mucosal thickening without signs of chronic sinusitis. CONCLUSION: Patients with anterior wall frontal sinus fractures associated with frontal sinus outflow tract obstruction could be successfully managed with rigid internal fixation and intraoperative guarded endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. This type of management could increase the chance of frontal sinus preservation and decrease the need for frontal sinus obliteration for similar patients.

[Effectiveness of the treatment of frontal sinus inflammation and its prevention]. / Povyshenie éffektivnosti lecheniia bol'nykh s vospalitel'nymi zabolevaniiami lobnykh pazukh i ikh profilaktika.

The analysis of intraoperative data obtained at correction of ethmoid bone structure in 130 patients with frontal sinusitis including the removed tissue histology shows that the severity of ostiomeatal complex deformation correlates with actual advance of the destructive alterations in the ethmoid labyrinth by the frontal sinus. Removal of necrobiotic tissues adjacent to the frontal sinus is pathogenetically valid and the most effective treatment of frontal sinusitis which has reduced the number of recurrences to 3.5%.