Frontal sinus fractures of the forehead are a common type of facial fracture that often occur with orbital fractures. At Atlantic Surgical Associates, we perform surgical treatment for these complex cases at our West Long Branch, New Jersey location. We welcome patients in surrounding areas of East Brunswick, New Brunswick, and Staten Island, NY.
What is a Frontal Sinus Fracture?
This is a very common type of fracture usually caused by blunt force trauma to the forehead area such as a motor vehicle accident, recreational accident, or altercation. The frontal sinus is usually not present at the time of birth and slowly starts to develop at the age of two reaching full maturity by the age of 15. The size of a fully matured sinus is about 3cm high, 2.5 cm wide, and 2cm deep with an average volume of about 10 cubic centimeters. 80% of patients have two sinuses, one on the right and one on the left. In 20% of patients, the sinus may be absent, under developed, or only one present.
What are the Symptoms of a Frontal Sinus Fracture?
- Most common signs:
- Forehead swelling
- Forehead pain
- Changes is sensation of the forehead
- Concave or indented area on forehead
- CSF (cerebrospinal fluid) leak
How is a Frontal Sinus Fracture Diagnosed?
A CT scan is usually required to diagnose a frontal sinus fracture. A few medical professionals obtain regular sinus x-rays, which is inconclusive. Since the anatomy of the face is quite complex, other facial bone fractures are commonly present with frontal sinus fractures. A facial CT scan is recommended to rule out associated orbital and midface fractures.
It is very important not to focus exclusively on the frontal sinus area for a fracture. In 75% of cases, additional facial fractures are present, and three quarters of patients with frontal sinus fractures also sustain loss of consciousness.
Since these injuries are complex and severe, the treating physician must examine the eye itself, and other portions of the face and neck. Any lacerations or cuts overlying the frontal sinus have to be examined under sterile conditions in the operating room because of possibility of associated CSF leak or communication with the brain cavity.
The nose also has to be examined for possible associated fractures. Patient will be asked about salty postnasal drainage or presence of a watery runny nose.
The movement of the eye and eyelid needs to be thoroughly examined, as orbital (eye bone) fractures are a very common occurrence along with frontal sinus fractures. An exam by an ophthalmologist (eye doctor) is mandatory to determine the integrity of the eye itself.
How is a Frontal Sinus Fracture Treated?
Since the current emergency room treatment guidelines are a bit outdated and questionable, many patients, both adult and pediatric, are routinely sent home without proper treatment. This results in complications down the road requiring surgery. Frontal deformities after frontal sinus fractures are commonly considered cosmetic problems by the insurance companies if addressed later, creating a significant financial burden to the family.
Dr. Volshteyn, our board certified plastic surgeon, is an advocate of the immediate treatment of frontal sinus fractures. He is happy to accept transfers from outside emergency rooms to one of our participating hospitals for severe cases, Due to the complexity of these cases, more than one plastic surgeon often performs the repair surgery. He utilizes a special incision technique underneath the eyebrow resulting in a less noticeable scar for the patient.
If you or your child has sustained a frontal sinus fracture, or if you are in the emergency room waiting to be treated, we recommended asking your treating doctor to call our office and select the emergency line to reach Dr. Volshteyn directly on his cell phone to discuss your case with him to see if transfer is appropriate. You can also contact us to schedule a consultation at Atlantic Surgical Associates. We welcome patients in Monmouth, Ocean, and Essex counties to our West Long Branch, New Jersey office.