Frontal sinus fracture

Background

• Requires high-energy
  • Rarely occurs in isolation, often associated wth intracranial injuries
  • Must rule-out TBI, additional fracture, and cervical spine injury
• Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomy- elitis, and CSF leak

Differential Diagnosis

Maxillofacial Trauma

• Le Fort fractures
• Skull fracture (peds)
• Auricular hematoma
• Nasal fracture
  • Nasal septal hematoma
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Dental trauma
• Mandible fracture

Orbital trauma

Acute

• Ruptured Globe^
• Corneal Abrasion
• Ocular foreign body
• Conjunctival laceration
• Caustic Keratoconjunctivitis^^
• Subconjunctival hemorrhage
• Traumatic iritis
• Traumatic hyphema
• Retinal detachment
• Retrobulbar hemorrhage/hematoma
• Traumatic mydriasis
• Orbital fracture
  • Frontal sinus fracture
  • Naso-ethmoid fracture
  • Inferior orbial wall fracture
  • Medial orbital wall fracture

Subacute/Delayed

• Endophthalmitis^
• Corneal Ulcer^

Evaluation

• Assess sinus involvement:
  • Crepitus
  • Laceration over fracture site is typical
• Imaging
  • Head CT indicated if suspect fracture
    • Assess anterior and posterior tables
      • Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection
  • If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)

Management

• Sinus involvement?
  • If yes then give 1st gen cephalosporin or amoxicillin clavulanate
• Isolated anterior table fracture?
  • Discharge with facial surgeon follow up
• Depressed fracture?
  • Admit for IV antibiotics and operative repair

• Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics

See Also

• Maxillofacial Trauma

References

Authors

Ross Donaldson