Axial CT image shows a depressed, comminuted fracture of the anterior wall of the frontal sinus. There is small hemosinus. The posterior wall is intact.
3D CT image beautifully demonstrates depression of the frontal sinus.
- Because of density, thickness and arched configuration of the anterior wall of frontal sinus, a fracture requires considerable force
- Isolated frontal sinus fracture uncommon. Most fractures occur with other midface or intracranial injuries
- Most common cause is blunt trauma
- Late complications include aesthetic deformity, infection (sinus, intracranial), CSF leakage.
- Anterior wall fracture
- Posterior wall fracture
- Combined anterior and posterior wall fracture
- Decision for surgical exploration based on presence of displacement, depression, posterior wall involvement, CSF leakage, nasofrontal duct involvement
- CT is the current gold standard for diagnosis
- Look for fracture comminution, depression, involvement of posterior wall, degree of displacement and nasofrontal duct injury
- Fracture extending to the base of frontal sinus and anterior ethmoid complex has a high likelihood of nasofrontal duct obstruction
- Some surgeons advocate surgical management if a posterior wall fracture displaces more than one both width (higher likelihood of dural tear, CSF leak).