Copyright @ 2007 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Closed Treatment of Frontal Sinus Fracture With Percutaneous Screw Reduction Mehmet Emin Mavili, MD, Halil Ibrahim Canter, MD Ankara, Turkey Fractures of the frontal sinus are a relatively common injury presenting to trauma units that deal with craniofacial injuries. Approximately one third of frontal sinus fractures affect the anterior wall alone, with two thirds involving the anterior wall, posterior wall, or frontonasal duct. Isolated posterior wall defects are exceedingly rare. Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. In the standard treatment modality of frontal sinus fractures, repair is best performed by way of a coronal approach, which offers excellent access. Most of the frontal sinus fractures deserve this attentive surgical manipulation to prevent late sequelae of infection or mucocele formation. In this article, we present a case of isolated depressed anterior wall fracture of the frontal sinus that was treated by closed reduction to avoid coronal incision. Anterior wall fracture of the right frontal sinus was diagnosed with preopera- tive evaluation of three-dimensional CT of a 34-year-old male patient with maxillofacial trauma. The anterior wall fracture was reduced by traction of two percutaneously applied screws to the depressed fragments. Accurate reduction was obtained, and neither recurrent displacement nor infection was observed during the follow-up period of 3 months. The screws were removed in the clinical setting without difficulty. Although percutaneous reduction of noncomminuted anterior wall frontal sinus fractures has limited indications, it has its own advantages over open techniques. This method is a less-invasive technique and can be performed without problem in selected cases. Our technique is not suitable for complex fractures of the frontal sinus. Key Words: Frontal sinus fracture, closed treatment, percutaneous screw reduction F ractures of the frontal sinus are a relatively common injury, constituting 5% to 15% of all maxillofacial fractures, with motor vehicle accidents being the most common and sports injuries the second most common cause of these injuries. 1Y5 Approximately one third of frontal sinus fractures affect the anterior wall alone, with two thirds involving the anterior wall, posterior wall, or frontonasal duct. Isolated posterior wall defects are exceedingly rare. 1 The clinical diagnosis of a frontal sinus fracture may be difficult because of the presence of overlying soft tissue edema. A high index of suspicion is therefore needed with this pattern of injury. Because of the nature of the injury, there is a high incidence of accompanying facial fractures; thus, careful exami- nation of the surrounding maxillofacial region should be carried out to rule out concomitant injury. 1 Clinical signs are usually depression of the area of the frontal sinus or bony fragments protruding through lacerations. Anesthesia or paresthesia of the supraorbital nerves, subconjunctival ecchymosis, cerebral spinal fluid (CSF) rhinorrhea, or air within the orbital cavity may also raise suspicion of this pattern of injury. 6 Patients presenting with rhinor- rhea or a suspected CSF leak should indicate to medical staff the possibility of disruption of the posterior wall with a dural laceration. However, it should be noted that a dural tear may present without CSF rhinorrhea if the outflow is blocked. 7 Although Caldwell and Waters’ projections provide good views of the vertical height of the frontal sinus, and lateral skull views display the anterior and posterior tables well, thin section axial and coronal computed tomographic (CT) scans are an essential part of the radiographic workup and allow an accurate preoperative surgical plan to be 415 From the Hacettepe University, Faculty of Medicine, Depart- ment of Plastic and Reconstructive Surgery, Ankara, Turkey. Address correspondence and reprint requests to Dr. Mehmet Emin Mavili, Hacettepe University, Faculty of Medicine, Depart- ment of Plastic and Reconstructive Surgery, Sihhiye Ankara 06100, Turkey; E-mail: emavili@hacettepe.edu.tr The authors have no financial interest in any product mentioned in the study.