Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.
J Craniofac Surg. 2021 Jun 1;32(4):1376-1380. doi: 10.1097/SCS.0000000000007426.
Frontal sinus fractures account for 5% to 15% of all facial fractures, and have traditionally been associated with high kinetic energy blunt injury. Surgical management is largely focused on minimizing potentially serious sequelae including frontal sinus dysfunction, CSF leak, and significant cosmetic deformity. An institutional database of 1944 patients presenting with maxillofacial fractures over a 10-year period was queried. Demographics, mechanism of injury, yearly trends, surgical approaches, and follow-up data were examined. A total of 160 (8.3%) patients presented with at least 1 fracture of the frontal sinus anterior table, posterior table, or frontal sinus outflow tract during the study period. The average annual number of cases was 15.9 ± 5.7 per year with a peak of 21.5 ± 4.0 cases during the 2014 to 2015 period and a decline to 8.5 ± 1.5 cases/year from 2016 to 2017. Among those patients with falls, 61.5% (n = 40) were a result of tripping or fainting at a height of <6 ft. 55.6% of fracture types were isolated to the anterior table, but fracture location was not significantly associated with operative intervention. Cases of operative fracture type had a higher rate of both displacement and comminution compared to nonoperative fractures (P < 0.00001). Of all patients presenting with frontal sinus fractures, 75% of cases were managed nonoperatively. However, many patients presented with falls and other seemingly low energy injuries which are not traditionally associated with frontal sinus trauma. These results highlight the need for continued follow-up even in otherwise low-risk urban populations in order to avoid long term sinus dysfunction.
额窦骨折占所有面部骨折的 5%至 15%，传统上与高动能钝性损伤有关。手术治疗主要集中在最大限度地减少潜在的严重后遗症，包括额窦功能障碍、CSF 漏和明显的美容畸形。对 10 年来 1944 例颌面部骨折患者的机构数据库进行了查询。检查了人口统计学、损伤机制、逐年趋势、手术入路和随访数据。在研究期间，共有 160 名（8.3%）患者至少有 1 处额窦前壁、后壁或额窦流出道骨折。平均每年病例数为 15.9±5.7 例，高峰期为 2014 年至 2015 年期间的 21.5±4.0 例，从 2016 年至 2017 年降至 8.5±1.5 例/年。在那些因跌倒而受伤的患者中，61.5%（n=40）是由于在<6 英尺高的地方绊倒或晕倒造成的。55.6%的骨折类型仅限于前壁，但骨折位置与手术干预无显著相关性。手术骨折类型的移位和粉碎发生率均高于非手术骨折（P<0.00001）。所有额窦骨折患者中，75%的病例采用非手术治疗。然而，许多患者因跌倒和其他看似低能量损伤而就诊，这些损伤传统上与额窦外伤无关。这些结果强调了即使在其他低风险的城市人群中，也需要持续随访，以避免长期窦功能障碍。
