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The frontal sinus is irregularly shaped and scalloped at its margins. Asymmetry of the sinus is the rule rather the exception (10% of
individuals have a unilateral sinus, 9% of individuals have a rudimentary or absent sinus).
Dimension of tables
The anterior table is thick (2-12 mm) and the posterior table is thin (0.1 – 4 mm).
Anatomic relationships
The frontal sinus has several critical anatomic relationships. These include:
Sinus floor -> orbital roof/anterior ethmoid air cells
Posterior table -> anterior cranial fossa
Anterior table -> frontal contour
Drainage
The frontal sinus drains via a small outflow tract into the ethmoid sinus/nasal cavity. The outflow tract is hour-glass shaped with the
true ostium (3-4 mm) at the narrowest portion.
The infundibulum is above and the frontal recess is below.
Each frontal sinus drainage pathway is located in the posterior, inferior, and medial portion of the sinus.
Frontal sinus fractures
The anterior wall of the frontal sinus is thick and resistant to injury. It requires greater force to fracture than any other facial bone (3.6
– 7.1 kN, Nahum AM (1975) The biomechanics of maxillofacial trauma. ClinPlastSurg; 2:63).
The majority of frontal sinus fractures are the result of high velocity impacts such as motor vehicle accidents, assaults and sports
injuries. Patients who sustain frontal sinus fractures often have associated facial fractures and systemic injuries.
The goal of frontal sinus fracture treatment is to create a safe sinus, restore facial contour, and avoid short and long term
complications.
Epidemiology
Frontal sinus fractures are relatively uncommon and account for only 5-15% of maxillofacial fractures with a preponderance of male
patients.
The most common frontal sinus fractures involve a combination of the anterior and posterior tables with or without frontal recess
involvement (about 2/3).
Isolated anterior table fractures account for only approximately 1/3.
Isolated posterior table fractures are extremely uncommon (< 1%).
This 3D CT reconstruction shows an isolated anterior table fracture.
Axial CT slice of the same patient.
Clinical evaluation
A focused exam of the frontal sinus should include evaluation for any contour deformity and/or frontal lacerations and neurosensory
deficits. Conscious patients should be questioned for the presence of clear nasal drainage or salty posterior nasal drainage that
might be indicative of a CSF leak.
Examination of deep wounds should be performed under sterile technique, as these can be through and through injuries. The
prognosis for such severe injuries is significantly worse and more aggressive management is indicated.
A high resolution CT scan with axial, coronal, sagittal and 3-D reconstruction is the gold standard for diagnosis.