Frontal sinus fractures

Abstract

The frontal bone is an anatomically robust transverse facial buttress, lending strength and rigidity to the upper craniofacial skeleton. Despite this structural integrity, a pair of mucosa-lined, air-filled cavities are housed within the frontal bone, protecting the brain from blunt and penetrating trauma through the absorption of transmitted forces. In addition, the frontal sinuses afford a multitude of other functions ranging from immunological defense to the maturation of vocal resonance. Due to the close proximity of the anterior cranial fossa, any connection between the brain and upper aerodigestive tract secondary to trauma could result in life-threatening infectious complications. Traumatic disruption or obstruction of the frontonasal ductal system can lead to mucocele development and other morbidity associated with poor sinus drainage. The frontal bone also serves as the fundamental component of the forehead aesthetic unit. Accordingly, the reconstructive aim for such bony injury is the restoration of normal anatomical boundaries. Treatment algorithms should directly correlate with the anatomy of the fracture pattern, focusing on (1) returning brow and forehead aesthetics to their premorbid condition, (2) evaluation of frontonasal duct patency, (3) reestablishing a hermetic barrier between the sinus and intracranial contents, and (4) restoring the structurally sound, protective bony skeleton in order to adequately shield the brain from subsequent trauma. A thorough knowledge of local anatomy is the sine qua non for frontal sinus reconstruction. While the management of these injuries remains varied and controversial, this chapter presents a cogent, anatomically based approach to frontal sinus fracture repair.