Manolidis Spiros, Hollier Larry H
New York, N.Y.; and Houston, Texas From the Department of Otolaryngology-Head and Neck Surgery, Beth Israel Hospital, and Baylor College of Medicine and Department of Plastic Surgery, Ben Taub General Hospital.
Plast Reconstr Surg. 2007 Dec;120(7 Suppl 2):32S-48S. doi: 10.1097/01.prs.0000260732.58496.1b.
Frontal sinus fractures are relatively uncommon maxillofacial injuries, making up only 5 to 12 percent of all facial fractures. Associated intracranial, ophthalmologic, and other maxillofacial injuries are very common because of the force of injury required to fracture the frontal bone. High-resolution computed tomography of the frontal region in multiple planes is essential for predicting the degree of frontal injury, associated injuries, and the type of procedure indicated. Exploration of the frontal sinus with reduction alone is reserved for a small minority of very simple fractures. Most frontal sinus fractures will require the obliteration of the sinus. This is achieved in the majority of instances with preservation of the posterior wall. Those with more extensive injuries and the presence of a cerebrospinal fluid leak will require frontal sinus cranialization after repair of the dural injuries. In rare instances, primary bone grafts will be required. In both cranialization and obliteration procedures, the nasofrontal ducts must be managed appropriately to avoid complications. Newer techniques involving endoscopic image-guided surgery may offer an alternative for a small subset of patients with frontal sinus injury.
额窦骨折是相对少见的颌面损伤，仅占所有面部骨折的5%至12%。由于额骨骨折所需的损伤力量，相关的颅内、眼科及其他颌面损伤非常常见。多平面的额部高分辨率计算机断层扫描对于预测额部损伤程度、相关损伤及所需手术类型至关重要。仅行复位的额窦探查仅适用于极少数非常简单的骨折。大多数额窦骨折需要闭塞窦腔。在大多数情况下，这可通过保留后壁来实现。损伤更广泛且存在脑脊液漏的患者，在修复硬脑膜损伤后需要进行额窦颅骨化。在罕见情况下，需要一期植骨。在颅骨化和闭塞手术中，都必须妥善处理鼻额管以避免并发症。涉及内镜图像引导手术的新技术可能为一小部分额窦损伤患者提供另一种选择。
