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Frontal Sinus Fractures
Published in Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez, Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Mark D. Walsh, Jeffrey R. Marcus
Drainage of the frontal sinuses occurs through the nasofrontal ducts, or recesses. The term duct implies a narrow passage, whereas recess is more accurate, reflecting the wider, funnel-shaped configuration of this space. The recesses open interiorly and medially and drain near the middle meatus (Fig. 12-2). The frontal sinuses are lined with mucosa. The mucosal surface incorporates invaginations in the inner table, called the pits of Breschet. Mucus secreted by the mucosal surfaces undergoes intrinsic recirculation through the frontal sinus with subsequent drainage through the nasofrontal recess (Fig. 12-3). Fractures of the frontal sinus or the nasoorbital ethmoid complex can lead to obstruction of this drainage. Obstruction results in sinus congestion, and prolonged obstruction can lead to formation of a mucocele (see Fig. 12-3).
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The frontal sinus drains via the nasofrontal duct to the middle meatus. It is absent unilaterally in 10%, bilaterally in 4%. The anterior table is thick and severe force is needed for the frontal region to be fractured. There is a CSF leak in up to 20%. There may be a palpable deformity and paraesthesia of the forehead. X-ray may demonstrate a fluid level, but CT (axial and coronal) is usually needed to delineate the fracture clearly. Late complications include sinusitis, mucocoeles and meningitis; thus prophylactic antibiotics are often given.
Frontal osteoplastic flap without frontal sinus obliteration for orbital roof decompression
Published in Orbit, 2021
Matthew Kim, Marc Otten, Michael Kazim, David A. Gudis
Draf III frontal sinusotomy has gained popularity as a technique to address refractory frontal sinusitis and to provide adequate access for resection of frontal sinus tumors.23–27 This procedure involves removal of the frontal sinus floor from orbit to orbit and reduction of the nasofrontal beak to widen the anteroposterior dimension of the nasofrontal duct, along with an anterosuperior septectomy and resection of the intersinus septum to create a single frontal sinus cavity. When combined with an osteoplastic flap, the Draf III sinusotomy obviates the need for obliteration by restoring normal frontal sinus function, while also providing the additional benefit of allowing endoscopic surveillance.28 Our case demonstrates the combined external and endoscopic management of a frontal BFOL, comparable in extent to a Grade IV osteoma. In addition to facilitating complete resection of the lesion anteriorly and laterally, the osteoplastic flap approach allowed direct access for decompression of the orbital roof bilaterally, which was vital to address the patient’s right orbital asymmetry. Draf III frontal sinusotomy was performed to avoid the need to obliterate the frontal sinus and to allow endoscopic surveillance postoperatively.