Difference between revisions of "Frontal sinus fracture"

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(→‎Background)
 
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**Must rule-out [[TBI]], additional fracture, and [[cervical spine injury]]
 
**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 <ref>Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007</ref>
 
*Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomy- elitis, and CSF leak <ref>Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007</ref>
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==Clinical Features==
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==Differential Diagnosis==
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{{Maxillofacial trauma DDX}}
  
 
==Evaluation==
 
==Evaluation==
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****Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection
 
****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)
 
**If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)
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==Differential Diagnosis==
 
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{{Maxillofacial trauma DDX}}
 
  
 
==Management==
 
==Management==
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*Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics
 
*Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics
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==Disposition==
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==See Also==
 
==See Also==
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==References==
 
==References==
 
<references/>
 
<references/>
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[[Category:ENT]]
 
[[Category:ENT]]
 
[[Category:Orthopedics]]
 
[[Category:Orthopedics]]
 
[[Category:Trauma]]
 
[[Category:Trauma]]

Latest revision as of 22:49, 9 May 2017

Background

  • Requires high-energy
    • Rarely occurs in isolation, often associated wth intracranial injuries [1]
    • 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 [2]

Clinical Features

Differential Diagnosis

Maxillofacial Trauma

Orbital trauma

Acute

Subacute/Delayed

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?
  • 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

Disposition

See Also

References

  1. ↑ Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779
  2. ↑ Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007
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