anterior wall of frontal sinus. Open reduction and internal
Balasubramanian M.S. D.L.O.
Introduction: Fractures involving
the frontal sinus is one of the rare fractures involving the
facial bones. Its close proximity to the frontal lobe of the
brain and orbit makes it a difficult one to manage if the posterior
table of the frontal bone is also involved in the fracture
This 39 year old male patient was admitted
with h/o road traffic accident sustained 15 days back.
O/E there was an irregular sutured wound seen over the
anterior wall of left frontal sinus. There was also a
depression seen over the anterior wall of left frontal sinus.
Crepitus was also elicitable over that area.
sinus fractures if they involve the frontal sinus mucosa can lead to
the formation of troublesome mucoceles / mucopyoceles. All
these cases must be surgically explored to rule out frontal
sinus mucosal entrapment.
The advantages of open
1. The fracture can be reduced under
2. Any mucosal entrapment can be easily identified and
3. Frontal sinus can be explored and bony
fragments if any inside the sinus can be removed. Fluid
accumulation inside the sinus can also be sucked out.
reduction and internal fixation:
Under general anesthesia the
fracture site is exposed via a curvilinear incision just under
the left eyebrow. The incision is usually depened up
to the level of periosteum. The periosteum is stripped
from the anterior table with the help of a periosteal
elevator. Perfect hemostasis is a must during the whole of
this procedure. Repeated cauterisation of the bleeding points
helps a lot in obtaining a dry field.
fragment is first disimpacted and elevated using an
elvator. Suction is applied to the frontal sinus.
If damage to the naso frontal duct is suspected then the intersinus
septum must also be divided at this stage. It is always better
to remove the intersinus septum as damage to the naso frontal duct
could not be easily identified in a CT scan. Using a small
burr a small hole is drilled into the fractured fragment.
While drilling the fractured fragment should be continuously
supported by an elevator inserted under the fragment.
Stainless steel plates and screws can be used to fix the
fractured fragments to the adjacent bone. In this case you can
see 2 - 0 proline being used to anchor the fractured
site contents © Copyright drtbalu 2006, All rights