In the setting of traumatic frontal sinus fracture, how effective is a minimally disruptive protocol of primary expectant treatment and a transorbital endoscopic approach when repair is indicated?
In this case series analysis, 23 of 25 patients with frontal sinus fractures were treated nonoperatively, had improvement in opacification and/or contour deformity, and experienced no complications. The 2 remaining patients underwent repair without complication through a transorbital endoscopic approach.
After evaluating prognostic factors and operative indications, frontal sinus fractures can be safely and effectively treated using a minimally disruptive strategy that favors functional sinus preservation.
Despite common goals of frontal sinus fracture treatment (restoring forehead contour and creating a safe sinus), there remains significant variability in evaluation and treatment.
To describe our experience with a minimally disruptive treatment protocol for the treatment of frontal sinus fractures.
Design, Setting, and Participants
Analysis of prospectively collected data from 2010 through 2015 at a level 1 trauma center. All patients with frontal sinus fractures treated with our protocol from January 2010 to December 2015. Patients with poor follow-up and/or incomplete medical records were excluded from analysis.
Main Outcomes and Measures
Presence of an aerated frontal sinus and aesthetically acceptable forehead contour. Secondary outcome measures were complications related to frontal sinus fractures.
A total of 39 patients were treated under our minimally disruptive protocol, and 25 patients were included in the study; 18 (72%) were male and 7 (28%) were female. Their ages ranged from 6 to 62 years. After review, 22 patients had both clinical and radiographic follow-up. No patients underwent immediate frontal sinus repair. Five of 22 patients underwent surgery for indications other than their frontal sinus fracture: 1 of 5 patients underwent immediate surgical repair due to bilateral LeFort fractures, and 4 of 5 underwent delayed surgery due to nasal polyps (1 patient), scar revision (1 patient), and concomitant LeFort fractures (2 patients). Two of 22 patients (9%) underwent frontal sinus repair after outpatient surveillance due to persistent cerebrospinal fluid leak (1 patient) and orbital roof fracture (1 patient). The remaining 20 patients were treated nonoperatively, and 19 of 20 (95%) had spontaneous improvement in opacification and/or contour deformity. Twelve of 20 patients (60%) had improvement or resolution in both. One patient had ongoing partial opacification and deformity at the 3-month follow-up but was asymptomatic and had bony contour that was aesthetically acceptable to the patient. There were no complications. The median of all follow-up was 3 months.
Conclusions and Relevance
Frontal sinus fractures treated nonoperatively had a high rate of spontaneous ventilation and bony autoreduction with aesthetically acceptable frontal bone remodeling. There were no complications in the nonoperative group. The initial results of this study support further study of the safety and efficacy of a minimally disruptive protocol for frontal sinus fractures.
Patel SA, Berens AM, Devarajan K, Whipple ME, Moe KS. Evaluation of a Minimally Disruptive Treatment Protocol for Frontal Sinus Fractures. JAMA Facial Plast Surg. Published online February 02, 2017. doi:10.1001/jamafacial.2016.1769