Strong E Bradley
Department of Otolaryngology, University of California Davis School of Medicine, Sacramento, California 95817, USA.
Facial Plast Surg. 2009 Feb;25(1):43-8. doi: 10.1055/s-0028-1112231. Epub 2009 Feb 10.
Frontal sinus fractures account for 5 to 15% of all maxillofacial injuries. The majority of these fractures are the result of high-velocity injuries such as motor vehicle accidents, assaults, and sporting events. The treatment algorithm for complex frontal sinus fractures is controversial due to the associated risks of brain injury, meningitis, cerebrospinal fluid fistula, and mucocele formation. However, mild to moderately displaced anterior table fractures carry a relatively low risk of long-term morbidity and are generally treated as aesthetic deformities. Unfortunately, the coronal approach for repair of these injuries is associated with significant sequelae including a large scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. These sequelae may result in a greater cosmetic deformity than does the initial injury. Consequently, an endoscopic approach to these injuries has recently been described. The advantages of endoscopic surgery include limited incisions, reduced soft tissue dissection, reduced risk of alopecia, minimal risk of postoperative paresthesias, reduced hospital stay, and improved patient selection. Disadvantages include a moderate learning curve, narrow field of view, lack of depth perception, and the fact that the surgeon cannot operate bimanually without an assistant.
额窦骨折占所有颌面损伤的5%至15%。这些骨折大多是由高速损伤引起的，如机动车事故、袭击和体育赛事。由于存在脑损伤、脑膜炎、脑脊液瘘和黏液囊肿形成等相关风险，复杂额窦骨折的治疗方案存在争议。然而，轻度至中度移位的前壁骨折长期发病风险相对较低，一般作为美容畸形进行治疗。不幸的是，修复这些损伤的冠状切口入路会带来明显的后遗症，包括大的瘢痕、脱发、感觉异常，以及罕见的面神经损伤。这些后遗症可能导致比初始损伤更严重的美容畸形。因此，最近有人描述了一种针对这些损伤的内镜入路。内镜手术的优点包括切口有限、软组织剥离减少、脱发风险降低、术后感觉异常风险极小、住院时间缩短以及患者选择改善。缺点包括学习曲线较陡、视野狭窄、缺乏深度感知，以及外科医生在没有助手的情况下无法双手操作。
