Endoscopic Management of Frontal Sinus Fractures

Objective Conventional treatment of frontal sinus posterior table fractures has included osteoplastic flap or cranialization procedures despite considerable advances in endoscopic technique and experience. The objective of the current study was to evaluate outcomes of frontal sinus fractures involving the posterior table managed using endoscopic approaches. Method Retrospective evaluation of patients with posterior table fractures was performed at the University of Alabama at Birmingham from January 2008 through December 2011. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of the skull base defect, complications, and clinical follow up Results Eleven patients (age 39 ± 5 years) with posterior table fractures were treated using endoscopic techniques from 2008‐2011. Mean follow‐up time was 44 ± 15 weeks (range 2‐164). Patients were primarily managed using Draf IIb frontal sinusotomies with 1 individual requiring a concomitant trephine. A Draf III procedure was performed in 1 patient. Average fracture defect (length vs width) was 13.5 3.6 mm and the average length involving the posterior table was 9.6 mm (1‐30 mm). Skull base defects were covered with a septal flap and/or Surgisus tissue grafts. One patient referred after failed cranialization was endoscopically obliterated. Although 1 individual required a revision frontal sinusotomy, all sinuses remain patent on last follow‐up. Conclusion Management of frontal sinus posterior table fractures using minimally invasive endoscopic techniques provides excellent outcomes in selected cases. Posterior table fractures of up to 30 mm in length were adequately managed in this series and indicate this approach should become an active part of the treatment algorithm.