Copyright @ 2010 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Experience in the Management of Frontal Sinus Fractures Massimiliano Tedaldi, MD, Valerio Ramieri, MD, Enrico Foresta, MD, Piero Cascone, MDS, PhD, and Giorgio Iannetti, MDS, PhD Abstract: International guidelines for frontal sinus fractures, dealing with the indication of surgical treatment, obliteration of the frontal sinus, drainage, and cranialization, may differ. In this work, we describe our experience with frontal traumas, analyzing indications, type of treatment, and outcomes by reviewing all data of 112 patients treated for frontal fractures at the Department of Maxillo-Facial Surgery, Universita ` degli studi di Roma Sapienza. We reviewed all clinical and surgical records of patients with traumatic frontal injury treated from 1997 to September 2008. Patients presenting displaced fractures of the anterior wall of the frontal sinus were treated through skin laceration, if existing, or through a coronal approach and fixed with rigid internal devices. Patients with fracture of the posterior wall of the frontal sinus un- derwent frontal sinus cranialization with galea pericranium pedicled flap to prevent eventful septic complications. Follow-up controls documented that 98 of 112 patients showed no neurologic impairment, no symptoms of cerebrospinal fluid leak, and no other complications after 6 months and 1 and 5 years when follow-up was possible. In the international literature, there is wide agreement about indications dealing with displaced fractures of the anterior wall, although there is a lively debate about posterior wall treatment. In our 10-year experience, the protocol we carried out showed satisfying outcomes, in particular, on the morphofunctional recovery and aesthetic results. Key Words: Frontal sinus, fractures, traumatology, sinus cranialization (J Craniofac Surg 2010;21: 208Y210) I njuries of the frontal area are relatively uncommon because of its position and to the existence of nasal prominence, thus protecting the naso-orbital region. Moreover, the particular shape and the anatomy of the frontal bones give a particular resistance to fractures. 1,2 One of the keys for a correct aesthetic harmony of the face is frontal sinus integrity; as a consequence, fractures of the anterior or the posterior wall or both may result in an alteration of facial eurythmy. Moreover, another possible complication may deal with its function, thus leading to eventual infections. In some cases, the meninges can be affected as well with very serious sequelae. 3,4 These 2 issues represent the main indications for surgical treatment of frontal sinus fractures. There is an active debate in the international literature on the best protocol for the treatment of these fractures; nevertheless, the final goal is represented by the restoration of the function and aesthetic issues. Guidelines may differ in dealing with the indication of surgical treatment, oblit- eration of the frontal sinus, drainage, and cranialization. Several classifications of fractures of the frontal cranial base have been reported in the literature. 1,3,5Y8 The common trait is represented by the presence of fractures of the anterior sinus wall, posterior sinus wall, and/or frontonasal duct, thus determining the treatment option. In this work, we describe our experience with frontal traumas, analyzing indications, type of treatment, and outcomes by reviewing all data of 102 patients in our department for frontal traumas. MATERIALS AND METHODS The authors reviewed all clinical and surgical records of patients with traumatic frontal injury treated from 1997 to September 2008. Frontobasal injuries were considered and were defined as fracture of the anterior portion of the anterior cranial fossa. A total of 112 patients were included. On the basis of radiologic findings, we divided the patients into 3 groups. Group 1 included patients with an isolated fracture of the anterior wall (Fig. 1). Group 2 included patients with only combined anterior and posterior wall fractures (Fig. 2). Group 3 included patients with combined anterior and posterior wall fractures in association with anterior cranial fossa involvement (orbital roof, ethmoid, sphenoid) (Fig. 3). All patients underwent surgery. Surgical approaches were divided as follows: 75 had coronal bitemporal incisions, 18 had an existing laceration, 10 had coronal incisions, 7 had eyebrow accesses, and 2 had temporal incisions. Titanium plates and screws were the criterion standard for stabilization of the fractures. Only 1 patient required the adoption of reabsorbable screws because the trauma occurred in growing age. Follow-up consisted of outpatient clinical controls at 1 week, 1 month, 6 months, and 1 year after surgery. All patients underwent preoperative and postoperative computed tomographic scan evaluation with three-dimensional reconstruction. RESULTS Patients were divided as follows: 94 were men and 18 were women. The mean age was of 31.8 years, with the youngest aged 14 years and the oldest aged 66 years. Group 1 consisted of 46 patients, group 2 consisted of 41 patients, and group 3 consisted of 35 patients. Patients of group 1 were treated for the restoration of anterior wall fracture (case 1). When possible, the surgical approach was performed through the existing skin laceration. However, coronal or emicoronal incisions were performed. Rigid internal fixation with titanium plates and screws was adopted. TECHNICAL EXPERIENCE 208 The Journal of Craniofacial Surgery & Volume 21, Number 1, January 2010 From the Universita ` di Roma BSapienza,[ Cattedra di Chirurgia Maxillo- Facciale, Rome, Italy. Received April 27, 2009. Accepted for publication May 30, 2009. Address correspondence and reprint requests to Valerio Ramieri, MD, Via Federico Cesi 21, 00193 Rome, Italy; E-mail: valerioramieri@gmail.com Copyright * 2010 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e3181cfe87a