![]() Each category was further subdivided based on presence or absence of fracture displacement. Injuries were classified into three broad categories: isolated anterior table fracture, anterior and posterior wall fractures, and isolated posterior wall fracture. 3 Particular attention was paid to fracture location, degree of displacement, comminution, and FSOT injury. The largest of these is a 6-year, single-institution experience of 857 patients. The literature regarding frontal sinus fractures is largely limited to retrospective reviews. 2 With the advent and success of endoscopic techniques to maintain frontal recess patency, treatment options have evolved, and there continues to be controversy regarding the need for obliteration for fractures involving the FSOT. 3, 4 For fractures that involve the FSOT, frontal sinus obliteration at the time of the fracture repair has traditionally been recommended. 3 For fractures with significant posterior table comminution, displacement, or persistent cerebrospinal fluid (CSF) leak, cranialization or obliteration have historically been recommended. The latter two options have largely been relegated to history as they are associated with increased complication rates and, in the case of ablation/exenteration, significant cosmetic deformation. 3 Potential treatment of these fractures has traditionally included observation, open reduction, and internal fixation, obliteration, cranialization, ablation/exenteration (removal of anterior wall, mucosa, supraorbital rims, and proximal nasal bones to allow skin retraction to posterior wall or dura), or osteoneogenesis (mucosal stripping, frontal outflow tract sealing, and preservation of sinus cavity with delayed healing as scar tissue and bone fill the cavity). The treatment goals of frontal sinus fracture repair include maintenance of normal sinus function, avoidance of short- and long-term complications, and preservation of an aesthetic facial contour. 2, 4 Complications of FSOT obstruction include mucocele formation and chronic frontal sinusitis as a result of anatomic obstruction. 1, 2 Indications of FSOT obstruction include fracture of the floor of the frontal sinus, fracture of the medial aspect of the anterior table, and gross obstruction. 3 Patients with frontal sinus outflow tract (FSOT) injuries have three times more concomitant facial fractures than those without. The remaining fractures involve both the anterior and posterior table, and isolated fractures of the posterior table are very rare. 1, 2 Approximately half of frontal sinus fractures are limited to the anterior table. 1, 2 These fractures are often associated with intracranial injury and other facial fractures. Frontal sinus fractures account for 5% to 15% of all facial fractures and are most commonly due to high velocity, blunt force injuries such as motor vehicle accidents and blunt interpersonal violence.
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