Short- and Long-Term Results of the Surgical Management of Frontobasal Fractures

Aim: To evaluate short- and long-term results and complications of the open management of frontobasal fractures. The fractures of the frontal sinus are seldom isolated and often extend into the anterior skull base. The intracranial contents are usually involved in frontobasal trauma. Patients and Methods: One of the important goals of treatment is to decrease immediate postoperative and long-term complications. The procedures are directed toward improvement of the quality of life. First, life-threatening injuries are managed, followed by restorative procedures. The techniques of the restorative procedures are threefold. (1) Isolation of the intracranial content with watertight dural seal is performed using simple sutures, fibrin glue, and fascia lata. (2) Management of the frontal sinus is done in a manner that avoids potential short- or long-term complications (e.g. mucopyocele, osteitis, sinusitis) and esthetically restores facial contours. This procedure has 3 possible methods, depending on the situation: a, b, and c. (2a) In the case of limited anterior table fracture, it is enough to restore the bony contours with a calvarial graft or micromesh. We discourage using small boney fragments because they are often resorbed and are prone to infection. (2b) In the case of combined frontoethmoidal fractures, the frontal sinus drainage outlet is disrupted. The drainage operation consists of minimum Draf IIb or Draf III drainage, which is highly successful as long as the frontal infundibulum is limited with a bony rim. (2c) For obliterative-destructive procedures in posterior table comminution, we exclusively perform cranialization of the frontal sinus and not obliteration with fat or other material. The rationale for avoidance of fat or other material in the acute setting is that the blood supply to the area as a whole, and especially to the reconstructed bone, is disrupted, which creates a potential source of infection. (3) For management of the anterior skull base, the fascia lata is used for reconstruction. We performed a retrospective cohort analysis of all patients with frontobasal fractures with focus on postoperative complications and long-term results. Results: For the analysis of the long-term results, we included 83 patients treated for frontobasal fractures from 1996 to 2003. Thirty-seven percent had some form of concomitant intracranial trauma. The management consisted of anterior table reconstruction only in 37%, drainage operation in 41%, and cra