Fox Paige M, Garza Rebecca, Dusch Marie, Hwang Peter H, Girod Sabine
From the *Division of Plastic and Reconstructive Surgery, and †Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
J Craniofac Surg. 2014 Nov;25(6):2038-42. doi: 10.1097/SCS.0000000000001105.
The optimal management of frontal sinus fractures remains controversial, and previously accepted indications for surgical intervention are being challenged. The goals of this study were to determine how frontal sinus fracture management has changed at a single institution across multiple disciplines and to evaluate the long-term outcomes of operative and nonoperative treatment modalities.Patients treated for a frontal sinus fracture at Stanford Hospital and Clinics between June 1998 and June 2009 were included in the study. Inpatient records, clinic notes, operative reports, and radiographic studies were reviewed. The patients were invited for a follow-up clinic visit, physical examination, and focused sinus computed tomography. For a period of 11 years, 124 patients were treated for a frontal sinus fracture by physicians from 3 surgical subspecialties: otolaryngology, plastic surgery, and neurosurgery. A low short-term complication rate was observed (5.6%), and there was a trend toward nonsurgical management within the study population. Ten patients returned for a long-term follow-up. Of these, the 2 patients who underwent cranialization experienced as many or more long-term complications compared with the patients treated by other modalities. These complications included abnormal frontal bone contour with bony discontinuity and altered sensation in the distribution of the trigeminal nerve.The demonstrated trend toward nonsurgical management of frontal sinus fractures seems to be safe. In the limited group of patients who returned for follow-up, more long-term complications were observed in the patients who underwent cranialization. However, a larger long-term follow-up cohort will be necessary to elucidate the relationship between treatment modality and long-term outcomes and complications.
额窦骨折的最佳治疗方法仍存在争议，先前公认的手术干预指征也受到了挑战。本研究的目的是确定在一家单一机构中多个学科对额窦骨折的治疗方式是如何变化的，并评估手术和非手术治疗方式的长期疗效。1998年6月至2009年6月期间在斯坦福医院及诊所接受额窦骨折治疗的患者被纳入本研究。对住院记录、门诊病历、手术报告和影像学研究进行了回顾。邀请患者进行随访门诊、体格检查和鼻窦计算机断层扫描重点检查。在11年的时间里，124例额窦骨折患者由3个外科亚专业的医生进行治疗：耳鼻喉科、整形外科和神经外科。观察到短期并发症发生率较低（5.6%），并且在研究人群中有非手术治疗的趋势。10例患者进行了长期随访。其中，与接受其他治疗方式的患者相比，接受颅骨化手术的2例患者出现了同样多或更多的长期并发症。这些并发症包括额骨轮廓异常伴骨质连续性中断以及三叉神经分布区域感觉改变。额窦骨折非手术治疗所显示出的趋势似乎是安全的。在有限的随访患者组中，接受颅骨化手术的患者观察到更多长期并发症。然而，需要更大规模的长期随访队列来阐明治疗方式与长期疗效及并发症之间的关系。
