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INTRODUCTION

ESSENTIALS OF DIAGNOSIS

  • History of head trauma.

  • Visible open fracture.

  • Fracture on computed tomography (CT) scan or plain x-ray.

General Considerations

The frontal sinus begins as an outgrowth of the nasal chamber in utero but does not begin to aerate the vertical portion of the frontal bone until the fourth year of life. The sinus attains adult configuration at age 15 years and typically reaches adult size by age 20 years. A variable structure, the frontal sinuses are typically asymmetric and may be unilateral (10%) or absent altogether (5%).

The anterior wall of the fully developed frontal sinus is a thick bony arch that can withstand between 800 and 2200 pounds of force. The force required to fracture this robust structure often leads to multiple injuries; therefore, a full trauma workup of all patients with frontal sinus fractures is paramount. As with all trauma patients, the airway, circulatory system, and other organ systems must be evaluated upon arrival. Ophthalmologic and neurologic examinations as well as radiographic and clinical examination of the cervical spine are critical components of the initial patient evaluation. Intracranial injury (40%–50%) and other facial fractures (75%–95%) are among the most commonly associated injuries in patients with frontal sinus fractures.

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Delaney  SW. Treatment strategies for frontal sinus anterior table fractures and contour deformities. J Plast Reconstr Aesthetic Surg. 2016;69(8):1037–1045.
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Wright  DL, Hoffman  HT, Hoyt  DB. Frontal sinus fractures in the pediatric population. Laryngoscope. 1992;102(11):1215–1219.  [PubMed: 1405980]
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Rodriguez  ED, Stanwix  MG, Nam  AJ,  et al. Twenty-six-year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques. Plast Reconstr Surg. 2008;122(6):1850–1866.  [PubMed: 19050539]
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Gossman  DG, Archer  SM, Arosarena  O. Management of frontal sinus fractures: a review of 96 cases. Laryngoscope. 2006;116(8):1357–1362.  [PubMed: 16885735]

Pathogenesis

CLINICAL PEARLS

  • Use of airbags and seatbelts has significantly decreased the incidence of frontal sinus fractures.

  • Trauma severe enough to fracture the frontal sinus frequently results in intracranial injuries.

Motor vehicle accidents are the most common mechanism of injury for patients with frontal sinus fractures, accounting for 60% to 70% of all frontal sinus fractures. Assault typically requires the use of a blunt object to fracture the frontal sinus; fists alone rarely generate sufficient force. Other mechanisms of injury include industrial accidents, recreational accidents, and gunshot wounds. Young men in their third decade of life are most at risk for frontal sinus fracture. In one study, 30% of patients with frontal sinus fractures had blood alcohol levels over the legal limit or positive urine toxicology screens.

The anterior wall of the frontal sinus is significantly thicker than the posterior wall. Injuries that provide enough force to fracture the anterior wall of the frontal sinus often have enough force to fracture ...

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