Definition
Whereas in traumas caused by little force, soft tissue injuries are prominent, isolated force onto the frontal bone can lead to impression fractures and sometimes open frontal sinus fractures. Publications show a high incidence of associated injuries in severe midfacial fractures.
 
Therapy Goals
Restoration of the facial form
Restoration of the physiological function of the frontal sinus
Removal and prevention of a drainage disorder in the area of the frontal sinus
Removal and prevention of a sensory and nerve dysfunction
Restoring the eye function
Restoring the drainage of the frontal sinus
Prevention of a neurological impairment
Infection prophylaxis
Pain intervention
 
Therapy Indications
Clinical and/ or radiological evidence of a fracture in the area of the frontal sinus
Clinical or radiological proof of associated fractures (nose, orbit, naso-ethmoidal complex, frontobasal fracture)
Dysfunction of the supra-orbital nervus
Ptosis and/ or enophthalmus
Injury of the covering soft tissue
Continuity disorder/ defect
Liquorrhoea
Periorbital haematoma
Xenolith
Infection prophylaxis

Examinations
Inspection
Palpation
X-rays
Computer tomography
Magnetic resonance tomography
Neurological tests
Chemical laboratory tests (e.g. glucose test of the nasal secretion in the case of suspected liquorrhoea)
Arterial digital subtraction technique (in case of frontobasal involvement and cerebral vascular injuries)
Sinuscopy

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Therapy
Conservative Therapy
Surveillance
Antibiotic therapy
Ordering the patient not to blow his/ her nose
Decongesting measuresSurgical Therapy
Reconstruction and osteosynthesis (mini-, micro-plates)
Drainage insertion for secretion discharge and prevention of secretion retention
If indicated, duraplasty
Obliteration of the frontal sinus on both sides in injuries of the nasofrontal duct that cannot be reconstructed
Minor fracture and/ or dislocation in the area of the posterior wall of the frontal sinus with doubtful drainage frontal sinus
Associated neurological/ neurosurgical injuries
In cases with severe dislocation of the dorsal wall of the frontal sinus in case of:
-neurological and/ or neurosurgical injuries which require a decompression
-injuries, where a reconstruction of the dorsal wall of the frontal sinus is not possible
-increased risk of sinusitis
 
Additional Measures
Analgesic therapy
If indicated, antibiotic therapy
Ordering the patient not to blow his/ her nose
 
Recommendation
For the surgical fracture treatment a neurosurgeon should be consulted, if necessary.

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