Frontal sinus fracture
Background
- Requires high-energy
- Rarely occurs in isolation, often associated wth intracranial injuries [1]
- Must rule-out TBI, additional fracture, and cervical spine injury
- Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomyelitis, and CSF leak [2]
Clinical Features
- Assess sinus involvement:
- Crepitus
- Laceration over fracture site is typical
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Imaging
- Head CT indicated if suspect fracture
- Assess anterior and posterior tables
- Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection
- Assess anterior and posterior tables
- If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)
- Head CT indicated if suspect fracture
Management
- Sinus involvement?
- If yes then give 1st generation cephalosporin or amoxicillin clavulanate
- Isolated anterior table fracture?
- Discharge with facial surgeon follow up
- Depressed fracture?
- Admit for IV antibiotics and operative repair
- Consult neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics
Disposition
See Also
- Maxillofacial Trauma
References
- Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779
- Bell RB. A protocol for the management of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007
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