Patel Sapna A, Berens Angelique M, Devarajan Karthik, Whipple Mark E, Moe Kris S
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
Department of General Surgery, University of Washington, Seattle.
JAMA Facial Plast Surg. 2017 May 1;19(3):225-231. doi: 10.1001/jamafacial.2016.1769.
Despite common goals of frontal sinus fracture treatment (restoring forehead contour and creating a safe sinus), there remains significant variability in evaluation and treatment.
To describe our experience with a minimally disruptive treatment protocol for the treatment of frontal sinus fractures.
DESIGN, SETTING, AND PARTICIPANTS: Analysis of prospectively collected data from 2010 through 2015 at a level 1 trauma center. All patients with frontal sinus fractures treated with our protocol from January 2010 to December 2015. Patients with poor follow-up and/or incomplete medical records were excluded from analysis.
Presence of an aerated frontal sinus and aesthetically acceptable forehead contour. Secondary outcome measures were complications related to frontal sinus fractures.
A total of 39 patients were treated under our minimally disruptive protocol, and 25 patients were included in the study; 18 (72%) were male and 7 (28%) were female. Their ages ranged from 6 to 62 years. After review, 22 patients had both clinical and radiographic follow-up. No patients underwent immediate frontal sinus repair. Five of 22 patients underwent surgery for indications other than their frontal sinus fracture: 1 of 5 patients underwent immediate surgical repair due to bilateral LeFort fractures, and 4 of 5 underwent delayed surgery due to nasal polyps (1 patient), scar revision (1 patient), and concomitant LeFort fractures (2 patients). Two of 22 patients (9%) underwent frontal sinus repair after outpatient surveillance due to persistent cerebrospinal fluid leak (1 patient) and orbital roof fracture (1 patient). The remaining 20 patients were treated nonoperatively, and 19 of 20 (95%) had spontaneous improvement in opacification and/or contour deformity. Twelve of 20 patients (60%) had improvement or resolution in both. One patient had ongoing partial opacification and deformity at the 3-month follow-up but was asymptomatic and had bony contour that was aesthetically acceptable to the patient. There were no complications. The median of all follow-up was 3 months.
Frontal sinus fractures treated nonoperatively had a high rate of spontaneous ventilation and bony autoreduction with aesthetically acceptable frontal bone remodeling. There were no complications in the nonoperative group. The initial results of this study support further study of the safety and efficacy of a minimally disruptive protocol for frontal sinus fractures.
尽管额窦骨折治疗有共同目标（恢复前额轮廓并建立安全的鼻窦），但在评估和治疗方面仍存在显著差异。
描述我们采用微创治疗方案治疗额窦骨折的经验。
设计、地点和参与者：对2010年至2015年在一级创伤中心前瞻性收集的数据进行分析。纳入2010年1月至2015年12月期间采用我们的方案治疗的所有额窦骨折患者。随访不佳和/或病历不完整的患者被排除在分析之外。
存在通气的额窦以及美学上可接受的前额轮廓。次要结局指标是与额窦骨折相关的并发症。
共有39例患者按照我们的微创方案接受治疗，25例患者纳入研究；18例（72%）为男性，7例（28%）为女性。年龄范围为6至62岁。经审查，22例患者有临床和影像学随访。无患者接受即刻额窦修复。22例患者中有5例因额窦骨折以外的指征接受手术：5例患者中有1例因双侧勒福骨折接受即刻手术修复，5例中有4例因鼻息肉（1例）、瘢痕修复（1例）和合并勒福骨折（2例）接受延迟手术。22例患者中有2例（9%）在门诊观察后因持续性脑脊液漏（1例）和眶顶骨折（1例）接受额窦修复。其余20例患者接受非手术治疗，20例中有19例（95%）的混浊和/或轮廓畸形自发改善。20例患者中有12例（60%）在这两方面均有改善或恢复。1例患者在3个月随访时仍有部分混浊和畸形，但无症状，且骨轮廓在美学上患者可接受。无并发症发生。所有随访的中位数为3个月。
非手术治疗的额窦骨折自发通气率和骨质自动复位率高，前额骨重塑在美学上可接受。非手术组无并发症。本研究的初步结果支持进一步研究额窦骨折微创方案的安全性和有效性。
4级。
