Frontal sinus obliteration with iliac crest bone grafts. Review of 8 cases

Management of frontal sinus trauma: a retrospective study of surgical interventions and complications

BACKGROUND

Frontal sinus injuries are relatively rare among facial bone traumas. Without proper treatment, they can lead to fatal intracranial complications, including meningitis or brain abscesses, as well as aesthetic and functional sequelae. The management of frontal sinus injuries remains controversial, with various treatment methods and outcomes being reported. This article describes the clinical characteristics, surgical methods, and outcomes among 17 patients who underwent surgery for frontal sinus injury and related complications.

CASE PRESENTATION

We retrospectively included 17 patients who underwent surgery for frontal sinus injury and its related complications at the Kangwon National University Hospital between July 2010 and September 2021. Among them, six underwent simple open reduction and fixation of the anterior wall, eight underwent sinus obliteration, and three underwent cranialization. Two patients who underwent sinus obliteration died due to infection-related complications. The patient who underwent cranialization reported experiencing chronic headache and expressed dissatisfaction regarding the esthetic outcomes of the forehead. Except for these three patients, the other patients achieved satisfactory esthetic and functional recovery.

CONCLUSION

Active surgical management of frontal sinus injuries is often required owing to the various complications caused by these injuries; however, several factors, including the fracture type, clinical presentation, related craniomaxillofacial injury, and medical history, should be considered while formulating the treatment plan. Surgical treatment through the opening of the frontal sinus should be actively considered in patients with severely damaged posterior wall fractures and those at risk of developing infection.

Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches

Frontal sinus fractures are an uncommon injury of the maxillofacial skeleton, and account for 5-15% of all maxillofacial fractures. As the force of impact increases, fractures may extend beyond the anterior table to involve adjacent skull, posterior table and frontal sinus outflow tract (FSOT). Fractures at these subsites should be evaluated independently to assess the need for and type of operative intervention. Historically, these fractures were managed aggressively with open techniques resulting in obliteration or cranialization. With significant injuries, these approaches are still indispensable. However, the treatment of frontal sinus fractures has changed dramatically over the past half-century, and recent case series have demonstrated favorable outcomes with conservative management. Concurrently, there has been an increasing role of minimally invasive endoscopic techniques, both for primary and expectant management, with a focus on sinus preservation. Here, we review the diagnosis and management of frontal sinus fractures, with an emphasis on subsite evaluation. Following a detailed assessment, an appropriate treatment strategy is selected from a variety of open and minimally invasive approaches available in the surgeon's armamentarium.

Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures

PURPOSE OF REVIEW

The purpose of this manuscript is to review the current literature regarding the management of frontal sinus fractures and offer the authors opinion on the current management of these traumatic injuries. We evaluate recently proposed management algorithms as well as novel surgical approaches reported within the last few years.

RECENT FINDINGS

Patient selection for sinus sparing treatment modalities is balanced between fracture severity, involved structures, and reliable patient surveillance. Minimally invasive, aesthetically favorable approaches grow in diversity for anterior table fractures. For fractures of the posterior sinus wall and nasofrontal outflow tract, the literature focuses on sinus sparing surgery, as well as better defining the patients in which obliteration and/or cranialization is appropriate.

SUMMARY

Lack of large patient cohorts and follow-up limits generalizability of frontal sinus fracture research, and the ability to develop national guidelines of management. Evidence-based literature shows growing support for conservative management and sinus preservation. Improvements in frontal sinus fracture classification schemes, surgical technique, and patient selection direct this treatment paradigm shift.

First results of frontal sinus obliteration with a synthetic, resorbable and osteoconductive bone graft of ß-tricalcium phosphate

BACKGROUND

Despite advances in endoscopic sinus surgery, frontal sinus obliteration is still indicated in some cases. Current options for obliteration include autologous and synthetic materials. The use of ß-tricalcium phosphate as a resorbable bone graft substitute is a good alternative for frontal sinus obliteration. This study aimed to report our experience with this material.

METHODS

A retrospective chart review of patients who underwent frontal sinus obliteration at our clinic between 2008 and 2013 was performed. Demographic data, indications, previous surgery, and immediate and late complications were examined. Information on persisting symptoms and patient outcomes was collected using a telephone questionnaire in February 2016.

RESULTS

None of the patients underwent further surgery for frontal sinus disease. All of them reported a good cosmetic result and symptom improvement.

CONCLUSION

ß-tricalcium phosphate is a good, safe and cost-effective material for frontal sinus obliteration.