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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