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Difference between revisions of "Frontal sinus fracture"
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**Rarely occurs in isolation, often associated wth intracranial injuries <ref>Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779</ref> | **Rarely occurs in isolation, often associated wth intracranial injuries <ref>Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779</ref> | ||
**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> | ||
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+ | ==Clinical Features== | ||
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+ | ==Differential Diagnosis== | ||
+ | {{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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==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
Contents
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
- Le Fort fractures
- Skull fracture (peds)
- Auricular hematoma
- Nasal fracture
- 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
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
- Assess anterior and posterior tables
- If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)
- Head CT indicated if suspect fracture
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
Disposition
See Also
References
- ↑ Strong EB. Frontal sinus fractures: a 28-year retrospective review. Otolaryngol Head Neck Surg. 2006;135(5):774-779
- ↑ Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007
Authors
Ross Donaldson, Lisa Yee, Neil Young, Michael Holtz, Claire, Daniel Ostermayer