Frontal sinus fractures are among the most challenging maxillofacial injuries — rare but high-stakes, with potential for meningitis, brain abscess, and lifelong sinus complications if mismanaged. In this episode of Plastics in Practice, we break down the stepwise algorithm for diagnosis and management of frontal sinus trauma.

We’ll walk through the embryology and anatomy that make these fractures unique, the critical role of the frontonasal duct, and how to decide between preservation, obliteration, or cranialization. You’ll learn the management principles for anterior vs posterior wall fractures, when to use a galeal frontalis flap, and how to recognize and prevent long-term complications such as mucopyocele formation.

Key Takeaways:

• Diagnosis: Forehead lacerations and glabellar hematomas are red flags; always evaluate with CT scans.

• Anterior wall fractures: Non-displaced can be observed; displaced require reduction and fixation.

• Posterior wall fractures: CSF leak, duct injury, or dural tear dictate sinus obliteration or cranialization.

• Frontonasal duct injury: Always mandates obliteration with grafts or flap coverage.

• Complications: Chronic infection, meningitis, contour deformities — long-term follow-up is essential.

References:

Yavuzer R, Sari A, Kelly CP, Tuncer S, Latifoglu O, Celebi MC, Jackson IT. Management of Frontal Sinus Fractures. Plast Reconstr Surg. 2005;115(6):79e–93e. doi:10.1097/01.PRS.0000161988.06847.6A

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