FRACTURES OF THE FRONTAL SINUS CURRENT TREATMENT PROTOCOL mouth jaws face neck oral & maxillo facial surgery Adnan Aslam Assistant Professor & Consultant Department of Oral & Maxillofacial Surgery Margalla Institute of Health Sciences & affiliated hospitals Rawalpindi [email protected]
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FRACTURES OF THEFRONTAL SINUS
CURRENT TREATMENT PROTOCOL
mouthjawsfaceneck
oral &maxillofacial
surgery
Adnan AslamAssistant Professor & Consultant
Department of Oral & Maxillofacial SurgeryMargalla Institute of Health Sciences & affiliated hospitals
Embryology• Begin as an outgrowth from nasal chamber in utero• Absent at birth• Do not develop until 2nd year of life• Develop from ethmoidal infundibular air cells by invagination of
frontal bone through frontal recess or from superior meatus• Cannot be identified radiographically until about age of 8
years
mouthjawsfaceneck
oral &maxillofacial
surgery
mouthjawsfaceneck
oral &maxillofacial
surgery
ClassificationType 1: Anterior table fracture with minimum comminution
Type 2: Anterior Wall comminuted fracture with possible NOE or Orbital rim fracture
Type 3: Anterior & Posterior Wall fracture (Posterior wall fracture without significant displacement or ductal injury)
Type 4: Anterior & Posterior Wall fracture with dural injury & CSF leak
Type 5: Anterior & Posterior Wall fracture with dural injury, CSF leak, soft tissue or bone loss and/or severe disruption of anterior cranial fossa
Gerbino G, Roccia F, Benech A, et al. Analysis of 158 frontal sinus fractures: Current surgical management and complications. J Craniomaxillofac Surg 2000; 28:133
mouthjawsfaceneck
oral &maxillofacial
surgery
Clinical evaluationGeneralFacial pain
Forehead paraesthesia or anaesthesiaForehead laceration
Visible and/or palpable frontal bone depressionCSF rhinorrhoea
Neurological injuriesCerebral contusion
Subdural & epidural haematoma
Ophthalmic injuriesPupillary defect
Optic neuropathyHyphaemaDisc edema
Corneal defectLoss of globe integrity
Associated maxillofacial InjuriesNOE fracture
Orbital fractureZygomatic fracture
mouthjawsfaceneck
oral &maxillofacial
surgery
Radiographic evaluation
(Diagnostic Imaging)
Plain radiographsCaldwell viewLateral view
Evidence of air fluid levelClouding of frontal sinus
Pneumocephalus
High Resolution CT Scan
MRI
mouthjawsfaceneck
oral &maxillofacial
surgery
Objectives of management• To avoid immediate and short-term complications such as
CSF leak, meningitis, spreading infection.
• To avoid long-term complications such as frontal bone osteomyelitis, chronic frontal sinusitis, mucocele, mycopyocele, and brain abscess.
• To provide adequate exposure for anatomic reduction of naso-orbito-ethmoid (NOE) fractures.
• To restore proper aesthetic contour of the forehead
mouthjawsfaceneck
oral &maxillofacial
surgery
Management generally based onthree clinical factors:
• Fracture location and displacement• Dural and cerebral involvement