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Frontal Sinus Fractures

The frontal bone is the strongest bone of the face; a direct isolated high-energy impact is usually needed to fracture this bone. The frontal sinuses are absent in 4% of individuals, rudimentarily developed in 5%, and unilateral in 10% of individuals.

Anatomy

The anatomy of the frontal sinuses is comprised of (Fig. 10–1)

•   Two paired irregular cavities

•   Anterior wall = anterior table

•   Posterior wall = posterior table

Physical Examination

•   Forehead contusion

•   Forehead laceration

•   Forehead or orbital hematomas

•   Epistaxis

•   Otorrhea or rhinorrhea from dural tears – test with halo sign on paper towel; send fluid for glucose and β transfer

•   Palpable step deformity secondary to underlying fracture; may be obscured by overlying swelling in the acute setting

•   Paresthesias in the supraorbital nerve distribution

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