Posterior table fractures of the frontal sinus: Ii. Clinical aspects.

The evaluation of fractures involving the frontal sinus is important since significant complications can occur acutely or many years following injury. Thorough roentgenographic analysis, with special emphasis on the status of the nasofrontal duct, is required. The extent of soft tissue injury cannot be used as a guide. Furthermore, the proper treatment of fractures involving the posterior table has been controversial. In general, all fractures of the posterior table should be explored. Complete neurological evaluation is necessary and an observation period of approximately 48 hours is recommended prior to surgery. A coronal incision is suggested since a craniotomy can be performed with the exposure obtained. In selected patients, conservative treatment may be warranted but close follow-up with serial X-rays is necessary. Primary adipose obliteration of the injured sinus is recommended as treatment since complications are eliminated by a single operation which is cosmetically acceptable. This is supported by existing clinical series and experimental evidence. Adipose tissue possesses certain advantages which make it the tissue of choice for obliteration. Infection involving the implanted fat does not appear to be a significant problem. Bony fragments of the posterior table may safely be left in place. Dural lacerations occurring immediately behind the posterior table can be managed through the sinus without the necessity of craniotomy. [ABSTRACT FROM AUTHOR]