Chapter 33: Frontal Sinus Fractures Flashcards
What is the normal developmental pattern of the frontal sinus?
It is absent at birth, but begins in development at birth pneumatization can be seen radiographically around age 6-7 and completion of development occurs by age 15-20
Where does the frontal sinus drain?
Via nasofrontal duct or nasofrontal outflow tract to the middle meatus
What is the tissue type that lines the frontal sinus?
Like any sinus, it is respiratory epithelium. Pseudostratified, ciliated columnar epithelium with goblet cells.
What percentage of the population has a true nasofrontal duct? What percentage of the population has a nasofrontal outflow tract?
15%
85%
What can occur is the nasofrontal outflow tract becomes obstructed?
Mucocele formation 2/2 obstruction. Anaerobic environment can cause sinusitis and risk intracranial infection.
What is the epidemiology of frontal sinus fractures?
High velocity impacts (MVC, assault, sports, falls)
What is the most common frontal sinus fracture pattern?
Anterior and posterior table fractures followed by anterior table fractures. Isolated posterior table fractures are rare.
How is the risk of frontal sinus fracture in children different than adults?
Frontal sinus development begins at birth and does not begin to pneumatize until age 6-7. Development isn’t complete until 15-20. Due to the development timeline, the frontal sinus is non-existent or small in children/adolescents and therefore less likely to be involved in facial injury
What are the possible EARLY complications associated with frontal sinus fracture? (early within the first 6 months s/p injury)
- Epistaxis
- CSF leakage and fistula
- Frontal sinusitis
- Meningitis
- Intracranial hematoma or abscess
- Damage to supratrochlear or supraorbital nerve
- Cavernous sinus thrombosis
What are possible LATE complications associated with frontal sinus fracture? (occur 6 months or later s/p injury)
- Mucocele/mucopyocele formation
- Late frontal sinusitis leading to orbital abscesses
- Brain abscess 2/2 to frontal sinus infection
- Frontal contour defects
- Osteomyelitis of the frontal bone
What is obliteration with respect to the frontal sinus?
Obliteration occurs when the fracture involved the nasofrontal outflow tract. The procedures involves removal of all sinus mucosa then packing the sinus duct and entire sinus with material that encourages scarring or ossification of the sinus and tract.
What are autologous options for frontal sinus obliteration?
bone, muscle (temporalis), fat (temporal or abdominal), fascia, and periosteal flaps
What are alloplastic options for frontal sinus obliteration?
Gelfoam, synthetic bone
What is cranialization with respect to the frontal sinus?
Cranialization occurs with severely displaced or comminuted posterior table which could have caused a dural tear or parenchymal brain injury or pose the risk of those injuries. With CSF leak/dural tear, NSGY repairs the dura and the posterior table is removed, the inner cortices are debrided of respiratory epithelium and the outflow tract is obstructed.
