Frontal sinus fractures: A surgical management paradigm.

Most frontal sinus fractures are the result of high-velocity injuries related to motor vehicle/industrial accidents, assaults, and sporting events. Patients often have associated injuries and the risk of long-term morbidity can be significant. The initial evaluation should focus on airway control and hemodynamic stability. A complete head and neck examination should then rule out injuries to brain, spine, orbits, and facial skeleton; including the frontal sinus. A thin-cut, multiplanar CT scan is critical for accurate diagnosis of frontal sinus fractures. Treatment often requires a team approach involving the otolaryngologist, neurosurgeon, and ophthalmologist. Treatment goals include avoidance of short- and long-term complications, reestablishment of an aesthetic facial contour, and the return of normal sinus function. The most appropriate treatment strategy can be determined by assessing the integrity of three anatomic regions: 1) anterior table, 2) frontal recess; and 3) posterior table. A comprehensive management plan and meticulous surgical techniques are critical to success. A treatment algorithm and surgical workflow for frontal sinus fractures are presented below.