Frontal Sinus Fractures: Current Strategy of Diagnostics and Treatment

Introduction. Frontal sinus fracture, despite rather low frequency of their occurrence, is one of the most complex problems of modern cranio-maxillofacial surgery, and strategies for their treatment are controversial. The complex anatomical structure of the sinus, the proximity of vital organs (brain, eyeball, nasal cavity), the need to attract the special diagnostic equipment, high risk of intra- and postoperative complications – only some factors that emphasize the severity of damage, determine its prognosis and require the multidisciplinary approach to the diagnostic and treatment process of the specified category of the patients. Frontal sinus fractures occur in 5.0-15.0 % of all cranio-maxillofacial injuries and may vary from isolated anterior table fractures to complex fractures involving the sinus, orbits, skull base and intracranial content. The aim of this work was to generalize the literature data and personal experience of the surgical treatment of patients with traumatic fractures of the frontal sinus. Materials and methods. The professional literary analysis reports and case histories of 18 patients (17 men and 1 woman aged 18-45 years) with the fractures of the frontal sinus that were treated in the department of maxillofacial surgery, neurosurgery and otorhinolaryngology of Lviv Regional Clinical Hospital and Lviv City Emergency Hospital during 2005-2011. Results. Among the most common complications of fractures of the anterior wall of the frontal sinus are aesthetic defects, paresthesia of the lobar region, chronic sinusitis. Fractures of the deeper structures, which are accompanied by the aggressive surgical tactics, can lead to persistent diplopia or loss of vision, threatening inflammatory complications in the form of meningitis and brain abscess. Computer tomography with three-dimensional reconstruction today is the standard in the diagnosis of fracture of the frontal sinus. Axial projections provide the information on the state of the anterior and posterior sinus walls, the coronal – allows the visualization of its bottom and the vaults of the ocular fossa, and the sagital – the nose-frontal cavity and the natural sinus duct visualization. Regardless of a severity of the trauma all fractures require a thorough diagnostics, including a multiplanar computed tomography and endoscopic revision of the sinus cavity, allowing to choose the most appropriate treatment strategy and to minimize the patient's morbidity. Conclusions. Proposed by the World Association of cranio-maxillofacial osteosynthesis the science-based and clinically proven algorithms for the diagnosis and treatment of fractures of the frontal sinus allow to provide the quality medical care to patients under the conditions of any location and combination of traumatic injury.