The sinuses are relatively delicate parts of the facial bones. They hold air and mucus and are designed to make the head feel lighter. There are the maxillary sinuses in the cheek bones, ethmoid sinuses in the space between the nose and the eyes, the sphenoid sinuses at the base of the skull and the frontal sinuses, in the forehead. All have relatively thin walls that can break easily.
A study was done of individuals who suffered from a severe frontal sinus fracture following a motor vehicle accident. Some had such severe fractures that they had damage to the anterior and posterior walls of the sinus or fractures through the sinus floor. There were twenty six patients in the study who were in the process of being treated for severe frontal sinus fractures. The idea was to see what kinds of complications the patients had during the course of their treatment.
The researchers looked at what kinds of fractures the patient had, their causes, and whether or not they had other facial fractures alongside their frontal sinus fractures. They noted whether or not the patient had skin grafts or implants and the type of fixation used during surgery. They noted whether or not the patient had nasofrontal duct repair, antibiotic use or any complications. Late complications were studied by giving the person an x-ray of their sinuses after they had recovered to the maximum.
Patients averaged 29 years of age. Ninety two percent of all subjects were male. They were followed for a total of 3.6 years. By far and away, the injuries happened as a result of motor vehicle accidents although some happened as a result of physical aggression. The fractures were severe with all being comminuted with dislocation of the anterior walls. Thirty five percent had posterior wall fractures and forty six percent had sinus floor fractures.
A total of seven patients or 27 percent of patients suffered from some kind of complication of their fracture or of the repair of the fracture. Some had a pneumoencephalus, which is air in the brain cavity. Others had a frontal cutaneous fistula or a permanent connection between the frontal sinuses and the outside world. Still others had sinusitis or a frontal bone irregularity once the sinus was supposedly repaired. This represents a fairly high rate of complication of these sinus fractures.
The researchers concluded that doing a frontal sinus reconstruction was a good idea to immediately repair the fracture, especially if there is not too much comminution, severe dislocation or instability of the posterior aspect of the frontal sinuses. Doctors also want to see that the frontonasal duct area is not damaged or can easily be repaired. This duct is important for the proper drainage of the frontal sinuses into the nose. Doctors also discovered that many complications happened when the frontal sinus was reconstructed when it really didn’t need to be done.