Endoscopic Repair of Anterior Table Frontal Sinus Fractures

ABSTRACT

Frontal sinus fractures account for 5 to 15% of all maxillofacial injuries.[1] The majority of these fractures are the result of high-velocity injuries such as motor vehicle accidents, assaults, and sporting events. The treatment algorithm for complex frontal sinus fractures is controversial due to the associated risks of brain injury, meningitis, cerebrospinal fluid fistula, and mucocele formation.[2] However, mild to moderately displaced anterior table fractures carry a relatively low risk of long-term morbidity and are generally treated as aesthetic deformities. Unfortunately, the coronal approach for repair of these injuries is associated with significant sequelae including a large scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. These sequelae may result in a greater cosmetic deformity than does the initial injury. Consequently, an endoscopic approach to these injuries has recently been described. The advantages of endoscopic surgery include limited incisions, reduced soft tissue dissection, reduced risk of alopecia, minimal risk of postoperative paresthesias, reduced hospital stay, and improved patient selection. Disadvantages include a moderate learning curve, narrow field of view, lack of depth perception, and the fact that the surgeon cannot operate bimanually without an assistant.

Frontal sinus - frontal sinus fracture - endoscopic - facial fracture

REFERENCES

• 1 Strong E B, Sykes J M. Frontal sinus and nasoorbitoethmoid complex fractures. In: Papel ID Facial Plastic and Reconstructive Surgery. 2nd ed. New York, NY; Thieme Medical Publishers 2002: 747-758
• 2 McGraw-Wall B. Frontal sinus fractures.  Facial Plast Surg. 1998;  14 59-66
• 3 Strong E B, Kellman R M. Endoscopic repair of anterior table: frontal sinus fractures.  Facial Plast Surg Clin North Am. 2006;  14 25-29
• 4 Kim K K, Mueller R, Huang F et al.. Endoscopic repair of anterior table: frontal sinus fractures with a Medpor implant.  Otolaryngol Head Neck Surg. 2007;  136 568-572
• 5 Strong E B, Buchalter G M, Moultrop T H. Endoscopic repair of isolated anterior table frontal sinus fractures.  Arch Facial Plast Surg. 2003;  5 514-521
• 6 Forrest C R. Application of endoscopic-assisted minimal-access techniques in orbitozygomatic complex, orbital floor, and frontal sinus fractures.  J Craniomaxillofac Trauma. 1999;  5 7-12
• 7 Graham III H D, Spring P. Endoscopic repair of frontal sinus fracture: case report.  J Craniomaxillofac Trauma. 1996;  2 52-55
• 8 Lappert P W, Lee J W. Treatment of an isolated outer table frontal sinus fracture using endoscopic reduction and fixation.  Plast Reconstr Surg. 1998;  102 1642-1645