Endoscopic‑assisted rigid internal fixation of anterior wall frontal sinus fractures

Tarek A. Emaraa, Ashraf E. OdaBashaa, Tharwat A. Omarab, Mohamad S. Abdelazema, Ahmed M. Ananya

aDepartment of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Zagazig University, bDepartment of Oral and Maxillofacial Surgery, Al‑Ahrar General Hospital, Zagazig, Egypt

Objectives: Isolated anterior wall frontal sinus fractures are usually managed through a coronal approach, with its potential complications such as big scar, alopecia, and paresthesia. This study evaluates the endoscopic repair of isolated anterior wall frontal sinus fractures with rigid internal fixation.
Study design This was a prospective clinical trial.

Setting: This study was conducted at a tertiary care academic medical center.

Patients and methods: A total of 24 patients with isolated anterior wall frontal sinus fractures, documented with computed tomographic (CT) scans, were treated from 2010 to 2013. All were men with a mean age of 31 years (range, 21–43 years). Via a 10‑mm skin incision placed in a skin crease, an endoscopic reduction by microplate fixation of the displaced bony segments was achieved.

Results: Three patients were excluded from the study owing to incomplete follow‑up. Follow‑up ranged from 13 to 29 months, with an average of 17 months. Contour deformities were perfectly restored, and cosmetic results were acceptable in all patients. Postoperative CT scans showed an excellent anatomic restoration of the frontal sinus contour in 17 patients. In four patients who had the anterior frontal sinus fractures affecting the superior orbital rime, the postoperative CT scans showed a suboptimal reduction of the bony fragments; however, they were satisfying with the forehead aesthetic contour. None of the patients complained of sinusitis or other related complications.

Conclusion: Isolated anterior wall frontal sinus fractures can be successfully treated endoscopically by microplate fixation. This method is a safe procedure that can be done with ease and minimal morbidity to avoid the comorbidities associated with the coronal approach. 

Level of evidence: The level of evidence is IIb.

Keywords: Anterior wall frontal sinus fractures, endoscopic repair, frontal sinus outflow tract, rigid internal fixation.

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