scholarly journals Frontal Sinus Fractures: Management and Complications

2019 ◽  
Vol 12 (3) ◽  
pp. 241-247
Author(s):  
Xi Lin Jing ◽  
Edward Luce
Keyword(s):  
Frontal Sinus ◽  
Posterior Wall ◽  
Fracture Pattern ◽  
Csf Leak ◽  
High Resolution Computed Tomography ◽  
Posterior Wall Fracture ◽  
Long Term Follow Up ◽  
Frontal Sinus Fracture ◽  
Initial Injury

Frontal sinus fractures are relatively rare maxillofacial injuries (only 5–15% of all facial fractures). The appropriate management of frontal sinus fracture and associated pathology is controversial. Diagnosis and treatment of frontal sinus fractures has improved with the advances of high-resolution computed tomography technology. Treatment of frontal sinus fractures depends on several factors, including contour deformity of anterior table; the presence of CSF leak or air–fluid level in the sinus, likelihood of nasofrontal duct obstruction, and degree of displacement of posterior table. Nasofrontal duct patency should be checked if fracture pattern is highly suspicious of ductal injury. Cranialization is performed in cases of severely comminuted posterior wall fracture. Long-term complication of frontal sinus fracture can occur up to 10 years after initial injury or intervention; so, judicious long-term follow-up is warranted. This article presents the management and complications of frontal sinus fractures.

scholarly journals Complications of Frontal Sinus Fractures

2009 ◽  
Vol 2 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Stephen E. Metzinger ◽  
Rebecca C. Metzinger
Keyword(s):  
Frontal Sinus ◽  
Fracture Pattern ◽  
Medical Attention ◽  
Associated Injuries ◽  
Soft Tissue Envelope ◽  
Patient Gender ◽  
Maxillofacial Fractures ◽  
Long Term Follow Up ◽  
Frontal Sinus Fracture ◽  
The One

Frontal sinus fracture represents 5 to 12% of all maxillofacial fractures. Because of the anatomic position of the frontal sinus and the enormous amount of force required to create a fracture in this area, these injuries are often devastating and associated with other trauma. Associated injuries include skull base, intracranial, ophthalmologic, and maxillofacial. Complications should be categorized to address these four areas as well as the skin—soft tissue envelope, muscle, and bone. Other variables that should be examined are age of the patient, gender, mechanism of injury, fracture pattern, method of repair, and associated injuries. Management of frontal sinus fractures is so controversial that the indications, timing, method of repair, and surveillance remain disputable among several surgical specialties. The one universal truth that is agreed upon is that all patients undergoing reconstructive surgery of the frontal sinus have a lifelong risk for delayed complications. It is hoped that when patients do experience the first symptoms of a complication, they seek immediate medical attention and avoid potentially life-threatening situations and the need for crippling or disfiguring surgery. The best way to facilitate this is through long-term follow-up and routine surveillance.

Evaluation and Management of Frontal Sinus Fractures

Neurotrauma ◽  
2019 ◽  
pp. 143-154
Author(s):  
Geoffrey Peitz ◽  
Mark A. Miller ◽  
Gregory W. J. Hawryluk ◽  
Ramesh Grandhi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Frontal Sinus ◽  
Operative Management ◽  
Intracranial Extension ◽  
Long Term Follow Up ◽  
Initial Injury ◽  
Management Algorithms

Frontal sinus fractures are usually associated with traumatic brain injury and nasoorbitoethmoidal fractures. Much of the available evidence is retrospective, and management algorithms vary. In general, nondisplaced fractures without nasofrontal outflow tract (NFOT) obstruction may be managed with clinical and radiographic follow-up whereas fracture displacement, NFOT obstruction, and persistent CSF leaks are indications for operative management. The bicoronal incision and bifrontal craniotomy allow for proper access to the frontal sinus. If there is NFOT obstruction, the sinus should be cranialized or possibly obliterated if only the anterior table is fractured. The NFOT and sinus are packed with bone chips, fat, or muscle and then sealed with a pericardial graft, fascial graft, or synthetic dural substitute. Inadequate cranialization or obliteration can result in mucocele or mucopyocele, intracranial extension of which can lead to brain abscess or meningitis. Complications can occur years after the initial injury so long-term follow-up is necessary.

Repair of frontal sinus fractures: clinical and radiological long-term outcomes

2021 ◽  
pp. 1-4
Author(s):  
E E Alon ◽  
E Glikson ◽  
Y Shoshani ◽  
A Dobriyan ◽  
R Yahalom ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Surgical Repair ◽  
Trauma Centre ◽  
Inclusion Criteria ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
Frontal Sinus Fracture ◽  
Repair Techniques

Abstract Objective The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed. Methods A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included. Results Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6–132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration. Conclusion Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.

Extramedullary Plasmacytoma of The Frontal Sinus: A Case Report

FACE ◽  
2021 ◽  
pp. 273250162110536
Author(s):  
Joshua Harrison ◽  
Samantha Marley ◽  
Shawhin Shahriari ◽  
Christian Bowers ◽  
Anil Shetty
Keyword(s):  
Frontal Sinus ◽  
Surgical Excision ◽  
Extramedullary Plasmacytoma ◽  
High Rate ◽  
Solitary Plasmacytoma ◽  
Case Presentation ◽  
Long Term Follow Up ◽  
History Of

We report a rare case of an extramedullary plasmacytoma (EMP) in the frontal sinus with an indolent clinical presentation. Although a history of trauma was absent, the initial diagnosis was a mucocele, based on the radiological findings. Upon surgical excision, the patient was found to have an EMP. EMP, a form of solitary plasmacytoma, has a significantly high rate of conversion to multiple myeloma. This mandates long-term follow-up, even after successful radiotherapy and/or resection. While radiation therapy is generally considered a first line treatment for EMP, surgical intervention may provide optimal treatment in complicated cases. This case presentation highlights the prognosis of patients diagnosed with EMP.

Outcomes of 33 patients from the wars in Iraq and Afghanistan undergoing bilateral or bicompartmental craniectomy

2011 ◽  
Vol 115 (1) ◽  
pp. 124-129 ◽  
Author(s):  
Robert D. Ecker ◽  
Lisa P. Mulligan ◽  
Michael Dirks ◽  
Randy S. Bell ◽  
Meryl A. Severson ◽  
...  
Keyword(s):  
Medical Center ◽  
Systemic Infection ◽  
Categorical Variables ◽  
Cerebrovascular Injury ◽  
The Us ◽  
Long Term Follow Up ◽  
Initial Injury ◽  
Gcs Score

Object There are no published long-term data for patients with penetrating head injury treated with bilateral supratentorial craniectomy, or supra- and infratentorial craniectomy. The authors report their experience with 33 patients treated with bilateral or bicompartmental craniectomy from the ongoing conflicts in Iraq and Afghanistan. Methods An exploratory analysis of Glasgow Outcome Scale (GOS) scores at 6 months in 33 patients was performed. Follow-up lasting a median of more than 2 years was performed in 30 (91%) of these patients. The association of GOS score with categorical variables was explored using the Wilcoxon rank-sum test or Kruskal-Wallis analysis of variance. The Spearman correlation coefficient was used for ordinal/continuous data. To provide a clinically meaningful format to present GOS scores with categorical variables, patients with GOS scores of 1–3 were categorized as having a poor outcome and those with scores of 4 and 5 as having a good outcome. This analysis does not include the patients who died in theater or in Germany who underwent bilateral decompressive craniectomy because those figures have not been released due to security concerns. Results All patients were men with a median age of 24 years (range 19–46 years) and a median initial Glasgow Coma Scale (GCS) score of 5 (range 3–14). At 6 months, 9 characteristics were statistically significant: focus of the initial injury, systemic infection, initial GCS score, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, GCS score on dismissal from the medical center, Injury Severity Score, and patients with cerebrovascular injury. Six factors were significant at long-term follow-up: focus of initial injury, systemic infection, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, and GCS score on dismissal from the medical center. At long-term follow-up, 7 (23%) of 30 patients had died, 5 (17%) of 30 had a GOS score of 2 or 3, and 18 (60%) of 30 had a GOS score of 4 or 5. Conclusions In this selected group of patients who underwent bilateral or bicompartmental craniectomy, 60% are independent at long-term follow-up. Patients with bifrontal injury fared best. Systemic infection and cerebrovascular injury corresponded with a worse outcome.

Paraphimosis revisited: is chronic paraphimosis a predominantly third world condition?

2008 ◽  
Vol 38 (1) ◽  
pp. 40-42 ◽  
Author(s):  
M Rangarajan ◽  
S M Jayakar
Keyword(s):  
Chronic Condition ◽  
Third World ◽  
New Classification ◽  
The Third ◽  
Long Term Follow Up ◽  
Initial Injury ◽  
Acute Condition

Paraphimosis is an acute condition characterized by all the signs of inflammation. Here we describe a ‘chronic’ variant of paraphimosis where patients often present many days after the initial injury. The aim of this study is to identify and possibly classify this new variation of paraphimosis – the chronic condition. We studied 68 patients with this condition between 1997 and 2005. In all, the prepuce was fibrous and bunched up behind the glans penis and, in some cases, with ulcerations. All patients were treated by excision of the fibrous flap and circumcision, under local anaesthesia. Patients were discharged on the same dayon which the excision was done. Follow-up was on the third, seventh and ninetieth days. Long-term follow-up was possible in only 22 patients. This technique of modified circumcision was effective in treating this condition and we think a new classification of paraphimosis is warranted – acute and chronic.

Long-term follow up after bony mastoid and epitympanic obliteration: radiological findings

2009 ◽  
Vol 124 (1) ◽  
pp. 37-43 ◽  
Author(s):  
J-P Vercruysse ◽  
B De Foer ◽  
T Somers ◽  
J Casselman ◽  
E Offeciers
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Canal Wall ◽  
Resonance Imaging ◽  
High Resolution Computed Tomography ◽  
Long Term Follow Up ◽  
Echo Planar ◽  
Canal Wall Up

AbstractObjective:The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma.Patients:Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8–113.6 months).Intervention:All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging).Results:Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids.Conclusion:Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.

Injuries to the Neonatal Larynx from Long-Term Endotracheal Tube Intubation and Suggested Tube Modification for Prevention

1975 ◽  
Vol 84 (6) ◽  
pp. 764-770 ◽  
Author(s):  
Arthur S. Hengerer ◽  
Marshall Strome ◽  
Burton F. Jaffe
Keyword(s):  
Endotracheal Tube ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Long Term Effects ◽  
Posterior Commissure ◽  
Long Term Follow Up ◽  
Initial Injury ◽  
Cartilage Erosion

Since the early 1960's nasotracheal tubes have been used for neonates with primary respiratory diseases which necessitated positive pressure ventilation. This therapy may be required for extended periods of weeks to months meaning prolonged trauma to the neonatal larynx. The initial injury and long-term effects of the endotracheal tube in this age group have not been adequately investigated. The acute findings can be arytenoid and posterior commissure ulcerations and, in some cases, cartilage erosion. Long-term follow-up in these children to age 3.5 years showed a persistent arytenoid defect with chronic hoarseness. The consideration of a change in the structure of the endotracheal tube is suggested as a possible means of avoiding these injuries.

Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus

2020 ◽  
Author(s):  
David R. Peters ◽  
Caitlin Payne ◽  
Scott D. Wait
Keyword(s):  
Frontal Sinus ◽  
Analysis Data ◽  
Csf Leak ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
Patient Demographics ◽  
Eyebrow Incision ◽  
Csf Leaks

Abstract Background The eyebrow orbitozygomatic craniotomy is a minimally invasive approach that can access a wide variety of lesions. Unintentional breach of the frontal sinus frequently occurs and has been cited as a reason to avoid this approach. Lack of access to a large pericranial graft and the inability to completely cranialize the sinus requires alternate techniques of sinus repair. We describe a technique for repairing an opened frontal sinus and retrospectively reviewed complications related to this approach. Methods All patients, who underwent an orbitozygomatic craniotomy via an eyebrow incision by a single surgeon from August 1, 2012 to August 31, 2018, were included in this retrospective analysis. Data were collected on patient demographics, pathology treated, operative details, and perioperative morbidity. Follow-up ranged from 6 weeks to 6 years. Results Total 50 patients with a wide variety of pathologies underwent analysis. Frontal sinus breach occurred in 21 patients. All were repaired by the described technique. One patient (ruptured aneurysm) had a suspected cerebrospinal fluid (CSF) leak postoperatively that resolved without any additional intervention. One patient developed a pneumomeningocele 4 years postoperatively that required reoperation. No patient suffered any infection or delayed CSF leak. Conclusion Breach of the frontal sinus is common during eyebrow craniotomies. Despite reduced options for local repair, these patients have experienced no CSF leaks requiring intervention and no infections in our series. Long-term mucocele risk is not reliably determined with our length of follow-up. Breach of the frontal sinus is not a contraindication to the eyebrow approach.

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