Document Detail


A protocol for the management of frontal sinus fractures emphasizing sinus preservation.
MedLine Citation:
PMID:  17448829     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The purpose of this retrospective study is to review the incidence and etiology of frontal sinus fractures at an urban trauma center and validate a treatment protocol by assessing the outcome of a consecutive series of patients treated over a 10-year period. PATIENTS AND METHODS: All patients with frontal sinus fractures admitted to our trauma service from 1995 to 2005 were managed by the same surgeons using similar treatment philosophies based on the amount of displacement or comminution of the anterior and/or posterior table, the integrity of the nasofrontal duct, and the neurologic status of the patient as determined by clinical and radiographic examination. Using information obtained from the Trauma Registry and from individual physician chart notes, a database was created for the purpose of assessing outcome, defined as complications, length of hospital stay, and death. Demographics, injury severity score, fracture pattern, mechanism of injury, length of hospital stay, the number of operations, concomitant maxillofacial injuries, treatment, follow-up, and complications were statistically described. Outcome measures were evaluated by Student's t test using continuous variables. RESULTS: One thousand two hundred seventy-five patients with facial fractures were identified during the study period, of which 144 patients (11.3%) carried the diagnosis of frontal sinus fracture; 28 patients had inadequate records, leaving a study group of 116 patients. The majority of patients were male, had a mean age of 33.7 years, and presented with significant injuries demonstrated by a mean injury severity score of 23.7 and mean length of hospital stay of 8.9 days. The most common mechanisms of injury were blunt trauma resulting from a motor vehicle collision, fall, assault, or other accidents. Sixty-six patients presented with nondisplaced frontal sinus fractures that were managed nonoperatively; 50 patients had frontal sinus injuries that required surgical repair consisting of: 1) open reduction and internal fixation of the anterior table alone, with preservation of the sinus membrane (n = 29); 2) removal of all sinus mucosa, obliteration of the frontal sinus with autogenous abdominal fat, and reconstruction of the anterior table (n = 5); and 3) removal of all sinus mucosa, cranialization of the frontal sinus, and lining of the nasofrontal recess with a pericranial flap (n = 16). Six patients died of concomitant injuries. With follow-up ranging between 0 and 90 weeks, there were no known complications in the patients treated nonoperatively; 82% of the patients maintained normal sinus function and anatomy and the overall complication rate was 6.9%. Complications occurred in 16% of those patients treated surgically: including brain abscess, contour deformity, osteomyelitis, hematoma, meningitis, and mucocele. There was no statistically significant association between complications and other patient variables (P > .05), other than the test for injury severity score, which was different between survivors and nonsurvivors (P < .01). CONCLUSION: Application of the management protocol described in this report results in functional sinus preservation for the majority of patients, with relatively few significant perioperative complications.
Authors:
R Bryan Bell; Eric J Dierks; Pardeep Brar; Jason K Potter; Bryce E Potter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons     Volume:  65     ISSN:  0278-2391     ISO Abbreviation:  J. Oral Maxillofac. Surg.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-23     Completed Date:  2007-05-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8206428     Medline TA:  J Oral Maxillofac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  825-39     Citation Subset:  AIM; D; IM    
Affiliation:
Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital and Health Center, Department of Oral and Maxillofacial Surgery, Oregon Health & Science University, Portland, OR, USA. bellb@hnsa1.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Clinical Protocols
Female
Fracture Fixation / methods*,  statistics & numerical data
Fracture Fixation, Internal / methods,  statistics & numerical data
Frontal Sinus / injuries*,  surgery
Humans
Incidence
Injury Severity Score
Length of Stay
Male
Middle Aged
Oregon / epidemiology
Patient Care Planning
Reconstructive Surgical Procedures / methods*
Retrospective Studies
Skull Fractures / epidemiology,  mortality,  surgery*
Statistics, Nonparametric
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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