Executive Editor: Daniel Buchbinder General Editor: Daniel Buchbinder

Authors: S Fusetti, B Hammer, R Kellman, C Matula, EB Strong, Co-author: A Di Ieva

Skull base & Cranial vault - Frontal sinus, anterior table

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Glossary

General considerations

Treatment of frontal sinus fractures should be made based on the assessment of the following parameters:

  • An anterior table fracture (A)
  • A posterior table fracture (B)
  • A nasofrontal recess fracture (C)
  • A dural tear (CSF leak) (D)
  • Fracture comminution

Treatment options include:

  • Observation
  • Open reduction internal fixation (ORIF)
  • Obliteration
  • Cranialization
  • Ablation
Observation
Main indication Skill Equipment
Minimally displaced anterior table fractures (< 1-2 mm) not involving the nasofrontal recess injury. Basic surgical experience, no specialized skills Basic equipment only
Open reduction internal fixation
Main indication Skill Equipment
Fractures with greater displacement (> 2 mm) NOT INVOLVING the nasofrontal recess. Some specialized surgical experience Simple surgical and imaging resources

Further indication

  • Anterior table fractures resulting in cosmetic deformity of the forehead
Obliteration
Main indication Skill Equipment
Anterior table fractures which include the sinus floor resulting in nasofrontal recess injury. Some specialized surgical experience Simple surgical and imaging resources

Further indications

  • Severely comminuted fractures of the anterior table (with or without involvement of nasofrontal recess injury)
  • Significant mucosal disruption that can result in a non-functioning sinus postoperatively
Delayed endoscopic repair
Main indication Skill Equipment
Isolated fractures of the anterior table with residual cosmetic deformity, without demonstrable obstructive sinus pathology. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Advantages

  • Limited incisions (minimally invasive approach)
  • Treated with an onlay implant to camouflage the defect

Disadvantages

  • Requires specialized equipment
  • Technically challenging
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2011-05-14