Frontal sinus fractures might have serious consequences due to the proximity from the sinus to the intracranial cavity and also the potential for nasofrontal duct obstruction using its long-term sequelae. Delayed or improper management of frontal sinus fractures migh result in complications including meningitis, mucopyocele, pneumocephalus and brain abscess. Frontal sinus fractures comprise approximately 10% of facial fractures.
Males are injured more frequently than females (8:1). The incidence of fractures from the frontal sinus is greatest in the third decade of life. Automobile accidents would be the most typical cause. Other causes include physical altercations (including gunshot wounds), sports, industrial accidents and falls.
The paired frontal sinuses develop separately and therefore are frequently asymmetric. The frontal sinus starts to develop early in childhood and is rarely visible on radiographs earlier than the second year of life. The sinus invades the frontal bone by about 5 many years of age and slowly grows to achieve adult amount of 6-7 ml by late adolescence.
The sinus is roughly pyramid-shaped with its apex inferiorly and it is base superiorly. An intrasinus septum is generally present and also the distal borders from the sinus often spread to form an irregular pattern, making mucosal removal difficult during frontal sinus obliteration. The anterior wall is the strongest of the sinus walls and is twice as thick since the posterior wall. Each sinus wall has an anterior and posterior table.
The posterior wall separates the frontal sinus from the anterior cranial fossa. The floor from the frontal sinus may be the thinnest of the three walls and is therefore the easiest place for tapping an infected sinus (trephination). The ground of the sinus also functions as the supraorbital roof, and the drainage ostium is located in the posteromedial portion of the sinus floor. The frontal infundibulum is really a more narrow area inside the sinus that results in the ostium.
The blood supply from the frontal sinus is via the internal carotid system through the supraorbital branch of the ophthalmic artery as well as through some branches of the anterior ethmoidal artery. Venous drainage is thru two communicating routes.
External drainage is through the angular and anterior facial veins; the deep drainage is via transosseous venous channels through the posterior wall of the sinus known as the foramina of Breschet. The nerve supply is mainly from the supraorbital branch of the ophthalmic division from the trigeminal nerve.
The amount of force necessary to fracture the frontal sinus is 2 to 3 times more than that necessary to fracture other facial bones. The anterior wall is thicker than the posterior wall and can withstand between 800 to 2,200 pounds of force.
For this reason, damage to the posterior wall should be suspected in all case of anterior wall frontal sinus fracture. Moreover, patients with frontal sinus fractures have frequently sustained serious concomitant injuries, which should be appropriately addressed prior to management of the frontal sinus fracture.
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1. Clinical evaluation in humans
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