Frontal Sinus Fracture

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.

Facts: Frontal Sinus Fracture

• 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.

Classification

• 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

Imaging

• 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).

Reference:

Thaller SR, McDonald WS. Facial trauma. Informa Health Care; 2004.

Joshi AS. Frontal sinus fracture. Emedicine, September 15, 2008.