Management of frontal air sinus fractures; Case series from a single institution and literature review

Document Type : Original Article

Authors

1 lecturer of neurosurgery beni-suef university faculty of medicine Beni-suef, Egypt

2 lecturer of neurosurgery beni-suef university faculty of medicine Beni-suef , Egypt

3 lecturer of neurosurgery fayoum university faculty of medicine Fayoum, Egypt

4 Assistant professor of neurosurgery beni-suef university faculty of medicine Cairo, Egypt

Abstract

Objective: Evaluation of different modalities used in management protocol of traumatic frontal air sinus fractures, and to make a simplified   algorithm for the treatment of FSF. Methods: This is a retrospective study done in the Department of Neurosurgery Beni-Suef university hospitals, between may 2018  and may 2023. We reviewed the data of 40 patients with documented traumatic frontal air sinus fracture (FASF) that were managed either non-surgically or surgically. The patients included in this review are from all the age groups with traumatic frontal sinus fracture diagnosed via CT brain with bone window thin cuts.  Results: Total of 40 patients were included in the study.  (80%) were males and (20%) were females with mean age of years 29.2, 80% of them in age group from 20 to 40 years old. Motor car accident was the top cause (50%) followed by trauma by blunt objects (35%) finally falling from height (15%). Isolated anterior table injury occurred in 16 cases (40%), and isolated posterior table injury occurred in 12 cases (30%), also12 cases (30%) had combined anterior and posterior walls fracture. Surgical management was done in patients with severe displaced or comminuted fractures, Naso-Frontal Outlet Tract injury or obstruction (NFOT) or cerebro spinal fluid (CSF) leak. Outcome: All the cases that were managed conservatively did not have complications. The cases managed surgically passed without complications except for one case that had wound infection and it was managed by wound debridement, and another case had CSF rhinorrhea that was managed conservatively and CSF leak stopped within 5days from surgery. Conclusion: frontal air sinus fracture is common neurosurgical issue. Management decision depends up on many factors as degree of fracture displacement, CSF leak, NFOT status, and other associated intra cranial injuries. The purpose of treatment should be: (1) surgical repair of the bonny defect and closure of the connection between both the intracranial and extracranial compartments  and  or (2) prevention  of any cerebrospinal fluid leakage . In this study we try to provide a simple plane for neurosurgical treatment of patients with traumatic frontal air sinus injuries.

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References

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Egyptian Journal of Medical Research
Volume 6, Issue 1
January 2025
Pages 27-34

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