Frontal sinus fractures are uncommon (associated with around 5-15% of facial fractures). The authors divide frontal sinus fractures into isolated anterior table fractures, fractures involving the frontal sinus outflow tract and posterior table fractures, discuss some of the recent relevant literature and suggest a treatment algorithm for each of these presentations. These algorithms are designed to address or mitigate the effects of associated complications, such as cosmetic deformity, sequelae from sinus outflow disruption and CSF leak/intracranial complications. For isolated frontal sinus fractures, the authors advocate observational management for displacement less than 4mm, with discussion of the primary repair options for more displaced or comminuted fractures. With frontal sinus outflow obstruction, they advocate observation of a narrowed but patent frontal recess with subsequent interval repeat CT scan, with intervention suggested for a fully obstructed frontal recess (endonasal sinusotomy or obliteration). Posterior table fractures are classified and managed with regards to the degree of displacement and/or comminution, the presence/absence of CSF leak, and evidence of ongoing frontal sinus outflow obstruction; another algorithm is presented to outline this decision-making. Whilst the rare nature of this issue does limit the quality and volume of the associated literature, it is not clear from the article if the literature was reviewed systematically. The algorithms are largely focused on the broader decision-making of active intervention versus monitoring and appear to be derived to some degree from the senior authors’ own experience, without discussion of the authors’ own patient outcomes from use of these pathways. However, for those who have had a limited exposure to such pathology, the management algorithms provide a useful foundation from which one can manage these patients

Contemporary management of frontal sinus fractures.
Dedhia RD, Morisada MV, Tollefson TT, Strong EB.
2019; 27(4):253-60.
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Matthew Coates

Freeman Hospital, Newcastle-Upon-Tyne, UK.

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