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Goh EZ, Beech N, Johnson NR. Surgical management of frontal bone and naso-orbito-ethmoidal fractures: a 7-year multi-center retrospective review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:602-607. [PMID: 39127563 DOI: 10.1016/j.oooo.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Frontal and naso-orbito-ethmoidal (NOE) fractures are rare but important injuries due to their anatomical complexity and proximity to vital structures. This study aims to describe the patient factors, procedural factors, and postoperative outcomes in the surgical management of these fractures. STUDY DESIGN Retrospective review of patients aged 18 years or older who were surgically treated for these fractures at two Australian tertiary hospitals (2014-2020). Patient factors (demographics, mechanism of injury, fracture pattern, concomitant injuries); procedural factors (operation timing, surgical approach); and postoperative outcomes (complications, revision surgeries) were recorded. RESULTS 60 cases were included (41 frontal; 29 NOE; 10 combined). Mean age was 37 (frontal) and 39 years (NOE). Most cases were male (87.8%; 75.9%). The most common mechanism was traffic accidents (29.3%; 34.5%). The most common associated facial fractures were Le Fort fractures (46.3%; 89.7%). The most common associated systemic injuries were brain injuries (36.6%; 34.5%). Mean operation timing was 13 days (frontal) and 11 days (NOE). Coronal flap was most commonly used (68.3%; 82.8%). Postoperative complication rates were 39.0% (frontal) and 37.9% (NOE). Three cases required revision surgeries. CONCLUSION Further larger longitudinal studies are required to build knowledge and improve patient outcomes.
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Affiliation(s)
- Elizabeth Z Goh
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Nicholas Beech
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel R Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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Khojastepour L, Iravani S, Khaghaninejad M, Hasani M, Moayyedi S, Ahrari F. Frontal Sinus Fractures: An Evaluation of Patient Demographics, Mechanisms of Injury, Classification, and Management Strategies in Patients Referred to a Trauma Center, From 2014 to 2019. J Craniofac Surg 2023:00001665-990000000-01143. [PMID: 37902320 DOI: 10.1097/scs.0000000000009786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/10/2023] [Indexed: 10/31/2023] Open
Abstract
This retrospective study aimed to present demographic data, mechanisms of injury, anatomical locations, and management strategies in patients with frontal sinus fractures. The study included 91 patients with frontal sinus fractures attending the Rajaee Hospital of Shiraz between 2014 and 2019. The data recorded for each patient included age, sex, injury mechanism, fracture classification, associated craniofacial fractures, nasofrontal duct injury, cerebrospinal fluid leak, and treatment approach. The mean age of patients was 31.0±14.0 years, with male predominance (95.6%). Car crashes represented the most frequent mechanism of frontal sinus fracture, involving 31 subjects (34%). Isolated anterior and posterior table fractures were seen in 32 (35.2%) and 5 (5.5%) patients. Fifty-four patients (59.3%) presented both tables' involvement. Frontal sinus injuries occurred frequently (74.7%) with other facial fractures. Nasofrontal duct injury was found in 7 patients (7.7%), and 13 (14.3%) exhibited cerebrospinal fluid leakage. Fifty patients (55%) were treated with observation alone; 16 (17.5%) underwent sinus preservation, 12 (13.2%) experienced sinus obliteration, and 13 (14.3%) endured cranialization. Fisher's exact test revealed no significant association between the classification of fracture and the mechanism of injury (P=0.591). However, a significant association was observed between the fracture classification and the treatment applied (P=0.023). Frontal sinus fractures were most often caused by car crashes in young adults. Combined anterior and posterior table fractures were more commonly found than isolated anterior or posterior table involvement. Most frontal sinus fractures were treated conservatively without DDS surgical operation.
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Affiliation(s)
| | | | - Mohamadsaleh Khaghaninejad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz
| | | | | | - Farzaneh Ahrari
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Chen Y, Weber A, Chen C. Evidence-Based Medicine for Midface/Orbit/Upper Facial Fracture Repair. Facial Plast Surg 2023; 39:253-265. [PMID: 36929065 DOI: 10.1055/s-0043-1764290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
The face is one of the most common areas of traumatic injury, making up approximately 25% of all injuries in 2016. Assault, motor vehicle collision (MVC), fall, sports, occupational, and gunshot wounds (GSW) are all common causes of facial fractures, with MVC and GSW leading to significantly higher severity of injuries. Most facial fractures occur in the upper two-thirds of the face. Most facial fractures require timely assessment, diagnosis, and treatment for optimal restoration of facial structures and functions. Without proper initial management, significant complications including immediate complications such as airway compromise, massive bleeding, infection, intracranial hemorrhages, or even death, and long-term complications such as poor functional outcomes and aesthetic setbacks can occur. The goal of this review is to summarize the management of fractures of the upper face, orbit, and midface and provide an update about complications and their management.
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Affiliation(s)
- Yongzhen Chen
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alizabeth Weber
- Department of Otolaryngology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Collin Chen
- Department of Otolaryngology, Saint Louis University School of Medicine, Saint Louis, Missouri
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Singh DK, Shankar D, Yadav K, Kaif M, Singh RK. Frontal Sinus Trauma Presenting with Frontonasal Cutaneous Fistula: A Unique Case Report. INDIAN JOURNAL OF NEUROTRAUMA 2023. [DOI: 10.1055/s-0043-1760743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractFrontal sinus fractures account for 5 to 15% of craniofacial trauma. Road traffic accidents account for most of the cases. Combined injury of the anterior and posterior table with nasofrontal outflow tract contributes to 67% of craniofacial trauma. We here present an interesting case of a 33-year-old male patient with a traumatic left frontal sinus fracture with a unique presentation of a cutaneous–frontonasal fistula. Treatment algorithms for the management of frontal sinus fractures have been proposed in the past but they should be tailored to the need of the individual patient. Obliteration of the frontonasal outflow tract should be advocated in these cases as they minimize complications.
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Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Diwakar Shankar
- Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuldeep Yadav
- Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohammad Kaif
- Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar Singh
- Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Rothweiler R, Kuhn S, Stark T, Heinemann S, Hoess A, Fuessinger MA, Brandenburg LS, Roelz R, Metzger MC, Hubbe U. Development of a new critical size defect model in the paranasal sinus and first approach for defect reconstruction-An in vivo maxillary bone defect study in sheep. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:76. [PMID: 36264396 PMCID: PMC9584845 DOI: 10.1007/s10856-022-06698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Fractures of the paranasal sinuses often require surgical intervention. Persisting bone defects lead to permanent visible deformities of the facial contours. Bone substitutes for reconstruction of defects with simultaneous induction of new bone formation are not commercially available for the paranasal sinus. New materials are urgently needed and have to be tested in their future area of application. For this purpose critical size defect models for the paranasal sinus have to be developed. A ≥2.4 cm large bilateral circular defect was created in the anterior wall of the maxillary sinus in six sheep via an extraoral approach. The defect was filled with two types of an osteoconductive titanium scaffold (empty scaffold vs. scaffold filled with a calcium phosphate bone cement paste) or covered with a titanium mesh either. Sheep were euthanized after four months. All animals performed well, no postoperative complications occured. Meshes and scaffolds were safely covered with soft tissue at the end of the study. The initial defect size of ≥2.4 cm only shrunk minimally during the investigation period confirming a critical size defect. No ingrowth of bone into any of the scaffolds was observed. The anterior wall of the maxillary sinus is a region with low complication rate for performing critical size defect experiments in sheep. We recommend this region for experiments with future scaffold materials whose intended use is not only limited to the paranasal sinus, as the defect is challenging even for bone graft substitutes with proven osteoconductivity. Graphical abstract.
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Affiliation(s)
- R Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - S Kuhn
- Stryker Leibinger GmbH & Co. KG, Bötzinger Straße 41, 79111, Freiburg, Germany
| | - T Stark
- Stryker Leibinger GmbH & Co. KG, Bötzinger Straße 41, 79111, Freiburg, Germany
| | - S Heinemann
- INNOTERE GmbH, Meissner Str. 191, 01445, Radebeul, Germany
| | - A Hoess
- INNOTERE GmbH, Meissner Str. 191, 01445, Radebeul, Germany
| | - M A Fuessinger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - L S Brandenburg
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - R Roelz
- Department of Neurosurgery, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - M C Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - U Hubbe
- Department of Neurosurgery, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
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Frontal Sinus Fractures: Evidence and Clinical Reflections. Plast Reconstr Surg Glob Open 2022; 10:e4266. [PMID: 35450261 PMCID: PMC9015196 DOI: 10.1097/gox.0000000000004266] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
Background: Despite significant advances in the management of frontal sinus fractures, there is still a paucity of large-cohort data, and a comprehensive synthesis of the current literature is warranted. The purpose of this study was to present an evidence-based overview of frontal sinus fracture management and outcomes. Methods: A comprehensive literature search of PubMed and MEDLINE was conducted for studies published between 1992 and 2020 investigating frontal sinus fractures. Data on fracture type, intervention, and outcome measurements were reported. Results: In total, 456 articles were identified, of which 53 met our criteria and were included in our analysis. No statistically significant difference in mechanism of injury, fracture pattern, form of management, or total complication rate was identified. We found a statistically significant increase in complication rates in patients with nasofrontal outflow tract injury compared with those without. Conclusions: Frontal sinus fracture management is a challenging clinical situation, with no widely accepted algorithm to guide appropriate management. Thorough clinical assessment of the fracture pattern and associated injuries can facilitate clinical decision-making.
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Podolsky DJ, Moe KS. Frontal Sinus Fractures. Semin Plast Surg 2021; 35:274-283. [PMID: 34819810 DOI: 10.1055/s-0041-1736325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Management of frontal sinus fractures is controversial with no universally accepted treatment protocol. Goals of management are to correct aesthetic deformity, preserve sinus function when it is deemed salvageable, prevent sequela related to the injury, and minimize complications associated with intervention. Studies suggest that frontal sinus injuries, including disruption of the nasofrontal outflow tract (NFOT), can be managed nonoperatively in many cases. Advances in the utilization of endoscopic techniques have led to an evolution in management that reduces the need for open procedures, which have increased morbidity compared with endoscopic approaches. We employ a minimally disruptive protocol that treats the majority of fractures nonoperatively with serial clinical and radiographic examinations to assess for sinus aeration. Surgical intervention is reserved for the most severely displaced and comminuted posterior table fractures and unsalvageable NFOTs utilizing endoscopic approaches whenever possible.
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Affiliation(s)
- Dale J Podolsky
- Department of Plastic Surgery, University of Washington, Seattle, Washington
| | - Kris S Moe
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, Washington
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8
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Kim TG, Sin EG. A Case of Penetrating Brain Injury Followed by Delayed Cerebrospinal Fluid Leakage. Korean J Neurotrauma 2021; 17:168-173. [PMID: 34760829 PMCID: PMC8558028 DOI: 10.13004/kjnt.2021.17.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
Although penetrating brain injury is rare, it is associated with high morbidity and mortality. In several studies, even if very few patients arrive at the hospital alive, half of them eventually die, and the other half have significant neurological sequelae. Cerebrospinal fluid (CSF) leakage caused by traumatic brain injury is common. Therefore, we should be aware of the complications, prognosis, and follow-up strategies of penetrating brain injuries. A 55-year-old man was brought to our hospital with diffuse cerebral contusion and skull fracture. Three weeks after successful surgery, the patient returned with a large amount of pneumocephalus and pneumoventricle caused by delayed CSF leakage. Fortunately, the patient was discharged without neurological deficits after reoperation. In the urgent situation of penetrating brain injury, the treatment and prognosis vary depending on the initial actions and clinical factors. In addition, we should be aware that a variety of complications, as well as CSF leakage, can occur in patients with penetrating brain injuries.
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Affiliation(s)
- Tae Geon Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Eui Gyu Sin
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
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9
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Ghosh SK, Narayan RK. Fractures involving bony orbit: A comprehensive review of relevant clinical anatomy. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Frontal Sinus Fracture Management Meta-analysis: Endoscopic Versus Open Repair. J Craniofac Surg 2021; 32:1311-1315. [PMID: 33181610 DOI: 10.1097/scs.0000000000007181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Frontal sinus fracture management continues to be a point of controversy. Many systematic reviews have been done, but meta-analyses comparing various approaches to frontal sinus fractures are scarce. Our study focuses on open surgical repair versus endoscopic repair of frontal sinus fractures. MATERIALS AND METHODS A MEDLINE search was performed to identify prospective RCTs, non-RCTs, guidelines, case-control, and observational studies published in English before April 2019. Search terms included (1) frontal sinus, (2) skull fractures, (3) frontal bone, alone or in combination. An in-depth review was conducted to identify publications relevant to this analysis. Studies that included pediatric patients, case reports, and review articles without original data were excluded. Postoperative outcomes included were cosmesis, sinus function, mucocele, sinusitis, cerebrospinal fluid leak, meningitis, and brain abscess. Meta-analysis of proportions, Fisher exact test, and relative risks were calculated. RESULTS Seven studies were ultimately included in the meta-analysis. The assessment of heterogeneity indicated that the studies are comparable. The weighted outcome proportions of patients with postoperative cosmetic deformity and mucocele are found to be significantly higher in patients who underwent open repair compared to patients who received endoscopic treatment. No significant difference between the 2 intervention groups in regards to the other outcomes. CONCLUSION Based on this meta-analysis, no definitive conclusions regarding superiority of one approach over the other can be made. There are currently no universally accepted algorithms that aid in the decision to proceed with either approach. It is likely that these 2 techniques will come to serve different roles in treatment, as they can each be utilized to achieve different goals. At this time, the only recommendation is to proceed with whichever technique can be safely performed based upon surgeon experience and fracture pattern.
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Frontal Sinus Fractures: A Review on Etiology and Management Emphasizing Minimally Invasive and Endoscopic Techniques. J Craniofac Surg 2021; 32:1246-1250. [PMID: 33770048 DOI: 10.1097/scs.0000000000007623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In spite of a long and tortuous history of the acute management of frontal sinus fractures, current optimal management remains steeped in controversy. These fractures are frequently produced by excessive forces and are often accompanied with other injuries. However, disruption of the nasofrontal duct persists as essential to maintain proper sinus function and should guide current management. Although there has never been any distinct procedure defining optimal outcomes, proper treatment is contingent on precise diagnosis culled from a complete history, physical examination, and imaging studies. This is further augmented by the surgeon's intraoperative findings. Reconstruction will ultimately rest on the degree of disruption of the anterior and posterior sinus walls, as well as the status and function of the nasofrontal ducts. For these reasons, current management continues to be challenging and evolving. Thus, this review will discuss the etiology and clinical presentation of frontal sinus fractures, the current complications arising in the subject, and the evolution of treatment options towards a more conservative and endoscopic approach to care.
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Abstract
Frontal sinus fractures require a large amount of force and often occur in the context of a major trauma. Many patients with these fractures are assessed in an emergent setting where stabilization takes precedence. Delayed diagnosis and treatment of a sinus fracture can result in life-threatening conditions, such as a cerebrospinal fluid (CSF) leak. A number of different treatment algorithms have been proposed, highlighting the complexity of frontal sinus fracture management. The goal of this study is to determine how patients with frontal sinus fractures were treated at Texas Tech University Health Sciences Center and what complications arose as a result of the fracture and subsequent management strategy. Over 9 years, there were 69 reported cases. A total of 63 of these occurred in males (91.3%) versus 6 (8.7%) in females. The majority occurred after a motor vehicle collision (MVC) or a motorcycle collision (MCC). A total of 51 cases were unilateral fractures and 18 were bilateral fractures. Five patients (7.2%) had CSF leakage and 64 (92.8%) did not have CSF leakage. One patient with CSF leakage (20.0%) was managed operatively. Of the 64 patients without CSF leakage, 4 (6.3%) were managed operatively. All operative patients were managed by cranialization. Complications included vision changes, facial pressure, anosmia, facial paresthesia, pneumocephalus, and mucus retention cysts. Vision changes were the most common complication. There did not appear to be any significant difference in complications between the CSF leakage groups, indicating that non-operative management remains a viable option in the management of frontal sinus fractures.
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Douglas J, Gill K, Holmes S. Combining trauma severity indices to create a unified craniofacial disruption index: addition of the frontobasal unit to the ZS model. Br J Oral Maxillofac Surg 2020; 58:784-788. [DOI: 10.1016/j.bjoms.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
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Johnson NR, Roberts MJ. Frontal sinus fracture management: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2020; 50:75-82. [PMID: 32861554 DOI: 10.1016/j.ijom.2020.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/30/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Abstract
A systematic review of the frontal sinus fracture management literature was undertaken to document measurable outcomes, with emphasis on complications associated with the various treatment strategies. A comprehensive electronic search was undertaken in October 2018. Randomized controlled trials (RCT), controlled clinical trials, retrospective and prospective studies describing the management of frontal sinus fractures and complications were included. Twenty-four publications were included: one reporting a prospective RCT and 23 reporting consecutive case series studies (four prospective, 19 retrospective). These included 2388 patients (84.1% male, average age 23-43 years); 50.7% of cases were due to motor vehicle accidents and 61.8% had a concomitant intracranial injury. There were six categories for anterior table reconstruction, three endoscopic surgery categories, 11 for obliteration, and six for cranialization. Forest plots demonstrating complications based on the Clavien-Dindo classification of 1 ('low') and >3 ('high') were determined for total, early, and late complications, with heterogeneous effect sizes. Fractures with a nasofrontal outflow tract (NFOT) injury without obstruction can be treated with reconstruction if displaced, or managed conservatively if undisplaced. Obliteration and cranialization should be considered when there is obstruction of the NFOT. A computed tomography scan should be performed at 6 months to evaluate re-ventilation of the sinus. Endoscopic sinus surgery is a reasonable salvage re-ventilation procedure.
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Affiliation(s)
- N R Johnson
- Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia.
| | - M J Roberts
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
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Canzi G, De Ponti E, Novelli G, Mazzoleni F, Chiara O, Bozzetti A, Sozzi D. The CFI score: Validation of a new comprehensive severity scoring system for facial injuries. J Craniomaxillofac Surg 2019; 47:377-382. [DOI: 10.1016/j.jcms.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/19/2018] [Accepted: 01/04/2019] [Indexed: 12/01/2022] Open
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Abstract
Background: Timely, expeditious and appropriate management of Frontal bone fractures and associated Frontal Sinus (FS) injuries are both crucial as well as challenging. Treatment options vary considerably, depending upon the nature, extent and severity of these injuries as well as operator skill, expertise and experience. In cases of posterior table fractures of the Frontal Sinus, literature reports have in general, propounded direct visualization and exploration of the sinus via a bifrontal craniotomy, followed by sinus cranialization. Aims and Objectives: To review the standard protocols of management of Frontal bone fractures and Frontal Sinus injuries. To assess the efficacy of a more conservative approach in the management of outer and inner table fractures of the FS. Materials and Methods: Contemporary and evolving management protocols and changing treatment paradigms of different types and severities of frontal bone fractures and frontal sinus injuries, have been presented in this case series. A useful Treatment Algorithm has been proposed to efficiently and effectively manage these injuries. Results: In the present case series, effective and satisfactory results could be achieved in cases of significantly displaced inner and outer table fractures of the Frontal sinus by a more conservative protocol comprising of open reduction and internal fixation carried out via the existing scar of injury, without having to resort to the more radical intracranial approach and sinus cranialization. Nevertheless, presence of complicating factors such as cerebrospinal fluid rhinorrhea, evidence of meningitis or the development of encephalomeningocoeles necessitated the standard protocol of sinus exploration and its cranialization or obliteration. Conclusion: Management protocols of Frontal Sinus injuries vary, based on aspects such as the timing of presentation and intervention, degree of injury sustained, concomitant associated Craniomaxillofacial injuries present, presence of complicating factors or Secondary/Residual deformities & Functional debility, and need to be decided upon on a case to case basis.
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Affiliation(s)
- Priya Jeyaraj
- Commanding Officer Military Dental Centre (Gough Lines), Secunderabad, Telangana, India
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18
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Kim KS, Hwang JH. Aesthetic treatment of frontal sinus fractures and their complications. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.12.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
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Abstract
The frontal bone serves a protective role, representing the transition between the facial skeleton and the cranium. Within its enclosure, the frontal sinus lies adjacent to many important intracranial structures, and injury to this region has severe complications if not properly managed. Historically, the goals of frontal sinus fracture management have been to best prevent intracranial complications with invasive procedures, but a recent shift favoring conservative management now aims to preserve the form and function of the frontal sinus and its outflow tract. With the advancement of endoscopic techniques and the development of new technologies, many alternatives to aggressive surgical management are available.
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Affiliation(s)
- Kelly Schultz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tara L Braun
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tuan A Truong
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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20
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Kim YH, Kim BK. Approach to Frontal Sinus Outflow Tract Injury. Arch Craniofac Surg 2017; 18:1-4. [PMID: 28913294 PMCID: PMC5556736 DOI: 10.7181/acfs.2017.18.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 03/04/2017] [Accepted: 03/04/2017] [Indexed: 11/11/2022] Open
Abstract
Frontal sinus outflow tract (FSOT) injury may occur in cases of frontal sinus fractures and nasoethmoid orbital fractures. Since the FSOT is lined with mucosa that is responsible for the path from the frontal sinus to the nasal cavity, an untreated injury may lead to complications such as mucocele formation or chronic frontal sinusitis. Therefore, evaluation of FSOT is of clinical significance, with FSOT being diagnosed mostly by computed tomography or intraoperative dye. Several options are available to surgeons when treating FSOT injury, and they need to be familiar with these options to take the proper treatment measures in order to follow the treatment principle for FSOT, which is a safe sinus, and to reduce complications. This paper aimed to examine the surrounding anatomy, diagnosis, and treatment of FSOT.
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Affiliation(s)
- Yong Hyun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Baek-Kyu Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol 2016; 86:200-12. [PMID: 27260608 DOI: 10.1016/j.ijporl.2016.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/22/2022]
Abstract
CONTEXT Intracranial complications of rhinosinusitis are rare in the post-antibiotic era. However, due to potentially devastating outcomes, prompt recognition and management are essential. OBJECTIVE This study aims to perform the first systematic review of the intracranial complications of rhinosinusitis in order to better characterize their clinical presentation, diagnosis, and treatment, and report a case of frontal lobe empyema secondary to pediatric frontoethmoid sinusitis. DATA SOURCES Ovid MEDLINE, Cochrane Library, and Google Scholar. STUDY SELECTION Full-text, peer-reviewed journal publications from 1947 to January 1, 2015 in English; focus on intracranial complications of sinusitis; pediatric patients (<18 years of age); studies including data on diagnostic workup and treatment. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Sixteen studies involving 180 patients were included. An overwhelming majority of patients were young adolescent males (70%). The most common intracranial complications were subdural empyema (49%), epidural abscess (36%), cerebral abscess (21%), and meningitis (10%). Patients most often presented with nonspecific symptoms such as headache, fever, nausea and vomiting. Computed tomography with contrast or magnetic resonance imaging confirmed the diagnosis when intracranial complications were suspected. Typical treatment included surgical incision and drainage, often involving joint neurosurgical and otolaryngological procedures, combined with a long course of antibiotics. The morbidity rate was 27%, and the mortality rate was 3.3%. LIMITATIONS All studies were retrospective chart reviews, case series or case reports. CONCLUSIONS A review of the currently available literature shows that with a high degree of suspicion, multidisciplinary cooperation and aggressive treatment, favorable outcomes are attainable. The most effective surgical treatment for intracranial complications remains unclear and should be investigated further.
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Abstract
The paranasal sinuses are 4 paired airspaces that border the nasal cavity. Dental professionals are most familiar with the maxillary sinuses as viewed in 2-D imaging (eg, periapical, panoramic projections). With increasing implementation of 3-D imaging, specifically cone beam CT, there is a high probability that much or all of the paranasal sinuses and nasal cavity will be captured in a scan. It is incumbent on practitioners to be familiar with all the structures contained within a scanned area. The purpose of this article is to provide an overview of the anatomy of the nasal cavity as well as common anatomic variants and pathologic entities.
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Affiliation(s)
- Edwin T Parks
- Department of Oral Pathology Medicine and Radiology, Indiana University School of Dentistry, 1121 West Michigan Street, Room S110b, Indianapolis, IN 46202, USA.
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Garg RK, Afifi AM, Gassner J, Hartman MJ, Leverson G, King TW, Bentz ML, Gentry LR. A novel classification of frontal bone fractures: The prognostic significance of vertical fracture trajectory and skull base extension. J Plast Reconstr Aesthet Surg 2015; 68:645-53. [PMID: 25778872 DOI: 10.1016/j.bjps.2015.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The broad spectrum of frontal bone fractures, including those with orbital and skull base extension, is poorly understood. We propose a novel classification scheme for frontal bone fractures. METHODS Maxillofacial CT scans of trauma patients were reviewed over a five year period, and frontal bone fractures were classified: Type 1: Frontal sinus fracture without vertical extension. Type 2: Vertical fracture through the orbit without frontal sinus involvement. Type 3: Vertical fracture through the frontal sinus without orbit involvement. Type 4: Vertical fracture through the frontal sinus and ipsilateral orbit. Type 5: Vertical fracture through the frontal sinus and contralateral or bilateral orbits. We also identified the depth of skull base extension, and performed a chart review to identify associated complications. RESULTS 149 frontal bone fractures, including 51 non-vertical frontal sinus (Type 1, 34.2%) and 98 vertical (Types 2-5, 65.8%) fractures were identified. Vertical fractures penetrated the middle or posterior cranial fossa significantly more often than non-vertical fractures (62.2 v. 15.7%, p = 0.0001) and had a significantly higher mortality rate (18.4 v. 0%, p < 0.05). Vertical fractures with frontal sinus and orbital extension, and fractures that penetrated the middle or posterior cranial fossa had the strongest association with intracranial injuries, optic neuropathy, disability, and death (p < 0.05). CONCLUSIONS Vertical frontal bone fractures carry a worse prognosis than frontal bone fractures without a vertical pattern. In addition, vertical fractures with extension into the frontal sinus and orbit, or with extension into the middle or posterior cranial fossa have the highest complication rate and mortality.
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Affiliation(s)
- Ravi K Garg
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Ahmed M Afifi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA; Division of Plastic Surgery, Cairo University, Cairo, Egypt.
| | - Jennifer Gassner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Michael J Hartman
- Section of Head and Neck Imaging, Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Glen Leverson
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Timothy W King
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Michael L Bentz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Lindell R Gentry
- Section of Head and Neck Imaging, Department of Radiology, University of Wisconsin, Madison, WI, USA
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Connon FV, Austin SJB, Nastri AL. Orbital Roof Fractures: A Clinically Based Classification and Treatment Algorithm. Craniomaxillofac Trauma Reconstr 2014; 8:198-204. [PMID: 26269727 DOI: 10.1055/s-0034-1393728] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/03/2014] [Indexed: 10/24/2022] Open
Abstract
Orbital roof fractures are relatively uncommon in craniofacial surgery but present a management challenge due to their anatomy and potential associated injuries. Currently, neither a classification system nor treatment algorithm exists for orbital roof fractures, which this article aims to provide. This article provides a literature review and clinical experience of a tertiary trauma center in Australia. All cases admitted to the Royal Melbourne Hospital with orbital roof fractures between January 2011 and July 2013 were reviewed regarding patient characteristics, mechanism, imaging (computed tomography), and management. Forty-seven patients with orbital roof fractures were treated. Three of these were isolated cases. Forty were male and seven were female. Assault (14) and falls (13) were the most common causes of injury. Forty-two patients were treated conservatively and five had orbital roof repairs. On the basis of the literature and local experience, we propose a four-point system, with subcategories allowing for different fracture characteristics to impact management. Despite the infrequency of orbital roof fractures, their potential ophthalmological, neurological, and functional sequelae can carry a significant morbidity. As such, an algorithm for management of orbital roof fractures may help to ensure appropriate and successful management of these patients.
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Affiliation(s)
- Felicity Victoria Connon
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, Australia ; Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, Australia
| | - S J B Austin
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, Australia
| | - A L Nastri
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, Australia
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Abstract
This article reviews the importance of particular radiologic findings related to facial trauma and their implications for clinical and surgical management. An emphasis is placed on critical imaging signs that warrant immediate surgical attention.
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Affiliation(s)
- Alina Uzelac
- Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, 1X55, San Francisco, CA 94110, USA.
| | - Alisa D Gean
- Department of Radiology, Brain and Spinal Injury Center (BASIC), San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, 1X55, San Francisco, CA 94110, USA
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