10.6
Trauma

Frontal Sinus Fracture (Figure 10.8)

Evaluation
- Clinical examination
- CT
- Evaluate for presence of CSF
  - β₂ transferrin
  - Glucose reading less than 30 mg/dl
  - Ring/halo sign
    - Annular ring appearance on filter paper
- Displaced fracture or comminuted fracture of the posterior table of frontal sinus
  - Possible cerebral injury
- Impaired drainage of the frontal sinus via the nasofrontal duct into the hiatus semilunaris of the middle meatus
Treatment
- Observation
- Surgery
  - Open reduction with rigid fixation of the anterior table
  - Cranialization of the frontal sinus or obliteration of the frontal sinus with obstruction of the nasofrontal duct opening
Anesthesia Management
- General anesthesia with oral ETT

Evaluation
- Clinically observed cosmetic deformity
  - Depressed zygoma
- Entrapment of inferior rectus muscle
  - Deficient upward gaze
- Subconjunctival hematoma
- CT
  - ZMC fracture and displacement
  - Zygomaticofrontal suture
  - Orbital walls and floor
  - Maxillary sinus
Treatment
- Observation
- Surgery
- Open reduction with rigid internal fixation
  - Orbital floor reconstruction
Anesthesia Management
- General anesthesia with oral ETT
- Consider difficult airway
  - Depressed zygomatic arch fracture may interfere with coronoid process, thus limiting oral opening for intubation
- Possible activation of the oculocardiac reflex [17] (Figure 10.10
  
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Oct 16, 2024 | Posted by mrzezo in Oral and Maxillofacial Surgery | Comments Off