A 10-year review of frontal sinus fractures

Clinical outcomes of conservative management of posterior table fractures

Matthew Choi, Yiping Li, Scott Shapiro, Robert J. Havlik, Roberto L. Flores

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Frontal sinus cranialization is commonly indicated for posterior table fractures with significant comminution, displacement, or cerebrospinal fluid leaks. This study assessed the clinical outcomes of conservative management. Methods: A 10-year retrospective review of all frontal sinus fractures treated at a level 1 trauma center was performed using medical records and radiographic images. Results: A total of 875 patients with frontal sinus fractures were identified, and 68 had posterior table involvement. Nine died within the first 48 hours from other injuries. The remaining 59 patients constituted the study population. Average follow-up approached 1 year (342 days). The more common mechanisms of injury were blunt interpersonal violence (29 percent) and motor vehicle accidents (27 percent). Concurrent central nervous system injury was common (73 percent), and the average Glasgow Coma Scale score was 12.7. Posterior wall fracture pattern was nondisplaced and noncomminuted in 33 patients (54 percent) and comminuted and/or displaced in 27 (46 percent). Cerebrospinal fluid leak was recorded in 11 patients (19 percent). Conservative management was the more common strategy (78 percent), followed by open reduction and internal fixation with sinus preservation (12 percent), obliteration (8 percent), and cranialization (2 percent). Of the 27 patients with comminuted and/or displaced fractures, 16 (59 percent) underwent conservative management, and 11 (41 percent) underwent surgical management, but only one patient (2 percent) underwent cranialization. There was no incidence of intracranial infection, except for one patient who died from encephalitis secondary to a gunshot wound to the head. Conclusion: The vast majority of frontal sinus fractures involving the posterior table, including those with comminution, displacement, or cerebrospinal fluid leaks, can be safely managed without cranialization. Clinical Question/Level of Evidence: Therapeutic, IV.

Original languageEnglish
Pages (from-to)399-406
Number of pages8
JournalPlastic and Reconstructive Surgery
Volume130
Issue number2
DOIs
StatePublished - Aug 2012

Fingerprint

Frontal Sinus
Nervous System Trauma
Gunshot Wounds
Nonpenetrating Wounds
Glasgow Coma Scale
Trauma Centers
antineoplaston A10
Motor Vehicles
Encephalitis
Conservative Treatment
Violence
Accidents
Medical Records
Central Nervous System
Head
Incidence
Wounds and Injuries
Infection
Population

ASJC Scopus subject areas

  • Surgery

Cite this

A 10-year review of frontal sinus fractures : Clinical outcomes of conservative management of posterior table fractures. / Choi, Matthew; Li, Yiping; Shapiro, Scott; Havlik, Robert J.; Flores, Roberto L.

In: Plastic and Reconstructive Surgery, Vol. 130, No. 2, 08.2012, p. 399-406.

Research output: Contribution to journalArticle

Choi, Matthew ; Li, Yiping ; Shapiro, Scott ; Havlik, Robert J. ; Flores, Roberto L. / A 10-year review of frontal sinus fractures : Clinical outcomes of conservative management of posterior table fractures. In: Plastic and Reconstructive Surgery. 2012 ; Vol. 130, No. 2. pp. 399-406.
@article{6aa9dfb705d643fb92fa4696570b212d,
title = "A 10-year review of frontal sinus fractures: Clinical outcomes of conservative management of posterior table fractures",
abstract = "Background: Frontal sinus cranialization is commonly indicated for posterior table fractures with significant comminution, displacement, or cerebrospinal fluid leaks. This study assessed the clinical outcomes of conservative management. Methods: A 10-year retrospective review of all frontal sinus fractures treated at a level 1 trauma center was performed using medical records and radiographic images. Results: A total of 875 patients with frontal sinus fractures were identified, and 68 had posterior table involvement. Nine died within the first 48 hours from other injuries. The remaining 59 patients constituted the study population. Average follow-up approached 1 year (342 days). The more common mechanisms of injury were blunt interpersonal violence (29 percent) and motor vehicle accidents (27 percent). Concurrent central nervous system injury was common (73 percent), and the average Glasgow Coma Scale score was 12.7. Posterior wall fracture pattern was nondisplaced and noncomminuted in 33 patients (54 percent) and comminuted and/or displaced in 27 (46 percent). Cerebrospinal fluid leak was recorded in 11 patients (19 percent). Conservative management was the more common strategy (78 percent), followed by open reduction and internal fixation with sinus preservation (12 percent), obliteration (8 percent), and cranialization (2 percent). Of the 27 patients with comminuted and/or displaced fractures, 16 (59 percent) underwent conservative management, and 11 (41 percent) underwent surgical management, but only one patient (2 percent) underwent cranialization. There was no incidence of intracranial infection, except for one patient who died from encephalitis secondary to a gunshot wound to the head. Conclusion: The vast majority of frontal sinus fractures involving the posterior table, including those with comminution, displacement, or cerebrospinal fluid leaks, can be safely managed without cranialization. Clinical Question/Level of Evidence: Therapeutic, IV.",
author = "Matthew Choi and Yiping Li and Scott Shapiro and Havlik, {Robert J.} and Flores, {Roberto L.}",
year = "2012",
month = "8",
doi = "10.1097/PRS.0b013e3182589d91",
language = "English",
volume = "130",
pages = "399--406",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - A 10-year review of frontal sinus fractures

T2 - Clinical outcomes of conservative management of posterior table fractures

AU - Choi, Matthew

AU - Li, Yiping

AU - Shapiro, Scott

AU - Havlik, Robert J.

AU - Flores, Roberto L.

PY - 2012/8

Y1 - 2012/8

N2 - Background: Frontal sinus cranialization is commonly indicated for posterior table fractures with significant comminution, displacement, or cerebrospinal fluid leaks. This study assessed the clinical outcomes of conservative management. Methods: A 10-year retrospective review of all frontal sinus fractures treated at a level 1 trauma center was performed using medical records and radiographic images. Results: A total of 875 patients with frontal sinus fractures were identified, and 68 had posterior table involvement. Nine died within the first 48 hours from other injuries. The remaining 59 patients constituted the study population. Average follow-up approached 1 year (342 days). The more common mechanisms of injury were blunt interpersonal violence (29 percent) and motor vehicle accidents (27 percent). Concurrent central nervous system injury was common (73 percent), and the average Glasgow Coma Scale score was 12.7. Posterior wall fracture pattern was nondisplaced and noncomminuted in 33 patients (54 percent) and comminuted and/or displaced in 27 (46 percent). Cerebrospinal fluid leak was recorded in 11 patients (19 percent). Conservative management was the more common strategy (78 percent), followed by open reduction and internal fixation with sinus preservation (12 percent), obliteration (8 percent), and cranialization (2 percent). Of the 27 patients with comminuted and/or displaced fractures, 16 (59 percent) underwent conservative management, and 11 (41 percent) underwent surgical management, but only one patient (2 percent) underwent cranialization. There was no incidence of intracranial infection, except for one patient who died from encephalitis secondary to a gunshot wound to the head. Conclusion: The vast majority of frontal sinus fractures involving the posterior table, including those with comminution, displacement, or cerebrospinal fluid leaks, can be safely managed without cranialization. Clinical Question/Level of Evidence: Therapeutic, IV.

AB - Background: Frontal sinus cranialization is commonly indicated for posterior table fractures with significant comminution, displacement, or cerebrospinal fluid leaks. This study assessed the clinical outcomes of conservative management. Methods: A 10-year retrospective review of all frontal sinus fractures treated at a level 1 trauma center was performed using medical records and radiographic images. Results: A total of 875 patients with frontal sinus fractures were identified, and 68 had posterior table involvement. Nine died within the first 48 hours from other injuries. The remaining 59 patients constituted the study population. Average follow-up approached 1 year (342 days). The more common mechanisms of injury were blunt interpersonal violence (29 percent) and motor vehicle accidents (27 percent). Concurrent central nervous system injury was common (73 percent), and the average Glasgow Coma Scale score was 12.7. Posterior wall fracture pattern was nondisplaced and noncomminuted in 33 patients (54 percent) and comminuted and/or displaced in 27 (46 percent). Cerebrospinal fluid leak was recorded in 11 patients (19 percent). Conservative management was the more common strategy (78 percent), followed by open reduction and internal fixation with sinus preservation (12 percent), obliteration (8 percent), and cranialization (2 percent). Of the 27 patients with comminuted and/or displaced fractures, 16 (59 percent) underwent conservative management, and 11 (41 percent) underwent surgical management, but only one patient (2 percent) underwent cranialization. There was no incidence of intracranial infection, except for one patient who died from encephalitis secondary to a gunshot wound to the head. Conclusion: The vast majority of frontal sinus fractures involving the posterior table, including those with comminution, displacement, or cerebrospinal fluid leaks, can be safely managed without cranialization. Clinical Question/Level of Evidence: Therapeutic, IV.

UR - http://www.scopus.com/inward/record.url?scp=84864995594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864995594&partnerID=8YFLogxK

U2 - 10.1097/PRS.0b013e3182589d91

DO - 10.1097/PRS.0b013e3182589d91

M3 - Article

VL - 130

SP - 399

EP - 406

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 2

ER -