Treatment of frontal sinus fractures

Frontal sinus fractures are relatively uncommon and usually seen as a part of severe cranio-facial injuries, and their management involves many difficulties. Fifty-four cases with frontal sinus fractures have been treated at the Department of Plastic and Reconstructive Surgery of Fujita-Gakuen Health University Hospital between December, 1978 and December 1989: the experiences we have encountered and a discussion of our management of these cases are represented. Our concept of fundamental treatment is based on not obliterating the sinus, but rather removing the devitalized mucosa and establishing permanent drainage to the nose. Wide drainage through the nasofrontal duct is first made possible and the silicon tube to accomplish this is left in place for 2 to 3 weeks. Cranialization is considered for cases in which the posterior wall is lost, along with corresponding damage to the mucosa and nasofrontal duct. It seems more desirable to use an outer table skull graft when rebuilding a frontal contour in cases of severe comminution and bone loss of the walls. Up to now we have experienced no significant complications and have achieved uniformly good results, both functionally and aesthetically.