Frontal Sinus Fractures



10.1055/b-0034-97693

Frontal Sinus Fractures

Neil S. Sachanandani & Albert S. Woo
(a-c) A 37-year-old man presents following an assault to the forehead with a baseball bat.


Description




  • Large, oblique forehead laceration extending down to bone.



  • Displaced left frontal sinus fracture with involvement of the anterior and posterior tables.



Work-up



History




  • Mechanism of injury: Helpful in determining severity and type of injury.



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




    • Must rule out orbital injuries before considering operative intervention.



  • Numbness of forehead signifying injury to cranial nerve V1 distribution.



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



Physical examination




  • Identify any potentially life-threatening conditions.



  • Identify lacerations over the forehead, glabella, or supra-orbital ridge; may be used for direct access for repair in selected cases.



  • Evaluate for palpable step-offs and/or depressions in the frontal area.



  • Evaluate for sensibility changes in supraorbital/supratrochlear nerve distribution.



  • Examine for CSF rhinorrhea.




    • Ring test at the bedside.



    • May test for β-transferrin in nasal discharge, signifying CSF.



  • Test function of frontalis and corrugator muscles.



Pertinent imaging or diagnostic studies




  • High-resolution maxillofacial computed tomographic scan: Assessed in both axial and coronal planes.




    • Evaluate for involvement of anterior/posterior tables and determine degree of comminution/displacement.



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



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

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Frontal Sinus Fractures
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