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JOURNAL OF MAXILLOFACIAL TRAUMA
Rivista di Traumatologia Maxillofacciale
Official Journal of the International Society of Maxillofacial Trauma
Journal of Maxillofacial Trauma 2012 December;1(3):77-83
Comparison of immediate and delayed reconstruction of frontal sinus fractures
Buysse A., Mussalem D., Souza D., Piva F.
Oral and Maxillofacial Department, Hospital Santa Paula, São Paulo, Brazil
Aim: The frontal sinus fracture is common among trauma patients, especially in young males. It can involve the anterior and/or posterior wall, with or without involvement of the nasofrontal duct. It has high potential for complications and their management is still a controversy, mainly due to the possibility of late complications and sequelae. The purpose of this study was to evaluate two cases of frontal sinus wall fracture reconstruction, both involving only the anterior wall, one case were the surgery was immediately performed and the other one were the reconstruction was delayed.
Methods: Two patients who were victims of vehicle accidents, presented fracture of the anterior wall of the frontal sinus, without involvement of the posterior wall or nasofrontal duct. One of the patients had a zygomatic, maxillary and nasal fracture associated. This patient was submitted to immediate reconstruction of the fractures. The other patient, who only had the frontal fracture, but had a more severe cranial trauma associated, was submitted to a delayed reconstruction of the frontal defect that had lead to an aesthetic imperfection.
Conclusion: The choice for treating frontal sinus fractures depends on the complexity of the fracture. If there is excessive comminution, dislocation, or instability of the posterior wall, a cranial trauma, an immediate reconstruction would not be the ideal choice. To choose the appropriate treatment we need an accurate diagnosis, focusing on the physical examination and data from computed tomography scans. Care needs to be taken since most complications result from incorrect indication for reconstruction.