Weitman Efi, Shilo Dekel, Emodi Omri, Rachmiel Adi
*Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus †Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
J Craniofac Surg. 2017 Oct;28(7):1812-1815. doi: 10.1097/SCS.0000000000003832.
Frontal sinus fractures account for 2% to 15% of maxillofacial injuries. Up to 66% to 87% of the patients with frontal sinus fractures experience associated facial fractures. The majority of classifications used today categorize frontal sinus fractures depending on the integrity of the anterior table, posterior table, and the nasofrontal outflow. A retrospective study was performed, which included 24 patients diagnosed with frontal sinus fractures. Treatment in all patients consisted of open reduction and bone fixation. We analyzed population variables, injury etiology, fracture site, associated craniofacial injuries, surgical technique employed, handling of the nasofrontal duct, and postoperative complications. The most frequent etiology was falling accidents. Fifty-eight percent of the fractures involved both the anterior and posterior tables. Sixty-six percent experienced associated facial fractures. Fifty percent of frontal sinus fractures were treated by open reduction internal fixation as the only treatment, 33.3% underwent sinus obliteration, and 16.6% were treated with cranialization. Frontal sinus fractures resulting from high-energy impact exhibited additional facial bone fractures in 100% of the cases, whereas fractures following low-energy impact showed involvement of additional facial fractures in only 27% of the cases. In this report, we suggest a modification to the anteroposterior classification of frontal sinus fractures. In addition to the involvement of the anterior and posterior walls and the degree of dislocation, high and low energy impact can direct us to the involvement of additional facial fractures and influence the surgical strategy.
额窦骨折占颌面损伤的2%至15%。高达66%至87%的额窦骨折患者伴有面部骨折。如今使用的大多数分类方法是根据前壁、后壁和鼻额管的完整性对额窦骨折进行分类。进行了一项回顾性研究，纳入了24例诊断为额窦骨折的患者。所有患者均接受切开复位和骨固定治疗。我们分析了人口统计学变量、损伤病因、骨折部位、相关的颅面损伤、采用的手术技术、鼻额管的处理以及术后并发症。最常见的病因是坠落事故。58%的骨折累及前壁和后壁。66%的患者伴有面部骨折。50%的额窦骨折仅通过切开复位内固定进行治疗，33.3%的患者进行了鼻窦闭塞术，16.6%的患者采用了颅骨化治疗。高能冲击导致的额窦骨折在100%的病例中伴有其他面部骨折，而低能冲击导致的骨折仅在27%的病例中伴有其他面部骨折。在本报告中，我们建议对额窦骨折的前后分类进行修改。除了前壁和后壁的累及情况以及脱位程度外，高能和低能冲击可指导我们判断是否伴有其他面部骨折，并影响手术策略。
