Case 4 Frontal Sinus Fractures



Dardan Beqiri, Lauren O. Roussel, and Albert S. Woo

Case 4 Frontal Sinus Fractures

Case 4 (a, b) A 21-year-old male unrestrained passenger presents to the emergency department following a motor vehicle crash against a tree.



4.1 Description




  • Large avulsion of the forehead involving the brow



  • Computed tomography (CT) demonstrates depression of the anterior table of the frontal sinus



  • Status of the posterior table of the frontal sinus and nasofrontal outflow tract is unknown and must be elucidated



4.2 Work-Up



4.2.1 History




  • Mechanism of injury




    • Blunt versus sharp



    • High energy of impact raises concern for additional injuries



  • Change in vision, loss of vision, or double vision




    • Must rule out orbital injuries prior to considering operative intervention



  • Numbness of forehead: Injury to V1 distribution



  • Rhinorrhea: Concern for dural injury and cerebrospinal fluid (CSF) leak



4.2.2 Physical Examination




  • ABCs and primary survey: Identify any potentially life-threatening conditions




    • Greater suspicion depending on mechanism and greater force of injury



  • Identify lacerations over the forehead, glabella, or supraorbital ridge




    • May be utilized for direct access in repair



  • Palpate for step-offs and/or depressions in the frontal area




    • Edema often masks contour deformities



  • Evaluate for sensory changes in supraorbital/supratrochlear nerves



  • Test function of frontalis and corrugator muscles of forehead



  • Examine for nasal drainage: Must rule out CSF rhinorrhea




    • Ring test at the bedside: CSF will separate on filter paper and create a double ring or halo sign



    • Beta-2 transferrin is the definitive test for CSF, but it may take several days to obtain the results



4.2.3 Pertinent Imaging or Diagnostic Studies




  • High resolution maxillofacial CT scan of both axial and coronal planes




    • Evaluate for injury to anterior and posterior tables; determine degree of comminution/displacement



    • Evaluate nasofrontal outflow tract for ability to drain the frontal sinus



    • Identify intracranial injuries (e.g., pneumocephalus, etc.) and other facial fractures

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 4 Frontal Sinus Fractures
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