Frontal sinus fracture: Difference between revisions
No edit summary |
|||
| Line 4: | Line 4: | ||
**Must rule-out [[TBI]], additional fracture, and [[cervical spine injury]] | **Must rule-out [[TBI]], additional fracture, and [[cervical spine injury]] | ||
*Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomy- elitis, and CSF leak <ref>Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007</ref> | *Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomy- elitis, and CSF leak <ref>Bell RB. A protocol for the manage- ment of frontal sinus fractures emphasizing sinus preser- vation. J Oral Maxillofac Surg. 2007</ref> | ||
==Clinical Features== | |||
==Differential Diagnosis== | |||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 14: | Line 20: | ||
****Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection | ****Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection | ||
**If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured) | **If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured) | ||
==Management== | ==Management== | ||
| Line 27: | Line 30: | ||
*Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics | *Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
| Line 33: | Line 39: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 22:49, 9 May 2017
Background
- Requires high-energy
- Rarely occurs in isolation, often associated wth intracranial injuries [1]
- Must rule-out TBI, additional fracture, and cervical spine injury
- Long term sequelae include chronic sinusitis, mucocele, meningitis, brain abscess, frontal osteomy- elitis, and CSF leak [2]
Clinical Features
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Assess sinus involvement:
- Crepitus
- Laceration over fracture site is typical
- Imaging
- Head CT indicated if suspect fracture
- Assess anterior and posterior tables
- Through and through fracture require symptoms to prevent pneumocephalus, CSF leak, infection
- Assess anterior and posterior tables
- If ant wall fracture need CT to evaluate posterior wall (75% have both walls fractured)
- Head CT indicated if suspect fracture
Management
- Sinus involvement?
- If yes then give 1st gen cephalosporin or amoxicillin clavulanate
- Isolated anterior table fracture?
- Discharge with facial surgeon follow up
- Depressed fracture?
- Admit for IV antibiotics and operative repair
- Need neurosurgery or ENT for posterior wall fracture since many need surgery and IV antibiotics