Frontal Sinus - External Approach for Fracture Repair without Obliteration

Considerations

• • Approach

    • Bi-coronal

      • Type of incision

        • curvilinear

        • trichophytic

• 2006: Frontal sinus fractures: a 28-year retrospective review

Preparation

• • Plan the incision

    • Although many possible incision types exist, plan the incision that best suites the patient in terms of hairline and any future scarring pattern 

• Shave the scalp

  • Although a hair-preserving approach is possible, shaving a strip of scalp around the incision can help ease the wound closure by limiting the amount of loose hair that contacts the wound 

• Address the loose hair 

  • Either rubber-band or tape (autoclave tape) the loose hair 

• Local anesthesia 

  • Infiltrate 30 ml of 1% Lidocaine with 1:100,000 Epinephrine locally 

Procedure

Sample operative report

Post-op

• • Admit for overnight observation 

    • Continue peri-operative IV antibiotics 

    • Keep head wrapped overnight

• POD 1

  • Remove head wrap and examine wounds, including neurological exam

  • Replace head wrap and instruct patient on wound care 

  • Discharge home 

• POD 7 - clinic follow up 

  • Remove scalp staples / sutures 

  • Complications 

  • 2009: Complications of Frontal Sinus Fractures 

Pearls & Pitfalls

High-Yield

Links

• UTMB GR - Frontal Sinus Fracture Overview Lecture

• YouTube (4:03) - Frontal Sinus Fracture