title: Twenty-six-year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques.
abstract: BACKGROUND
  Frontal sinus fracture treatment strategies lack statistical power. The authors propose statistically valid treatment protocols for frontal sinus fracture based on injury pattern, nasofrontal outflow tract injury, and complication(s).
  
  
  METHODS
  An institutional review board-approved retrospective review was conducted on frontal sinus fracture patients from 1979 to 2005. Fractures were categorized by location, displacement, comminution, and nasofrontal outflow tract injury. Demographic data, treatment, and complications were compiled.
  
  
  RESULTS
  One thousand ninety-seven frontal sinus fracture patients were identified; 87 died and 153 were excluded because of insufficient data, leaving a cohort of 857 patients. The most common injury was simultaneous displaced anteroposterior walls (38.4 percent). Nasofrontal outflow tract injury constituted the majority (70.7 percent), with 67 percent having a diagnosis of obstruction. Of the 857 patients, 504 (58.8 percent) underwent surgery, with a 10.4 percent complication rate; and 353 were observed, with a 3.1 percent complication rate. All complications except one involved nasofrontal outflow tract injury (98.5 percent). Nasofrontal outflow tract injuries with obstruction were best managed by obliteration or cranialization (complication rates: 9 and 10 percent, respectively). Fat obliteration and osteoneogenesis had the highest complication rates (22 and 42.9 percent, respectively). The authors' treatment algorithm provides a receiver operating characteristic area under the curve of 0.8621.
  
  
  CONCLUSIONS
  A frontal sinus fracture treatment algorithm is proposed and statistically validated. Nasofrontal outflow tract involvement with obstruction is best managed by obliteration or cranialization. Osteoneogenesis and fat obliteration are associated with unacceptable complication rates. Observation is safe when the nasofrontal outflow tract is intact.
authors.affiliation: Baltimore, Md. From the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Johns Hopkins School of Medicine.
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Stanwix
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Nam
authors.forename: Hugo
authors.initials: H
authors.lastname: St Hilaire
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Simmons
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy
authors.forename: Michael P
authors.initials: MP
authors.lastname: Grant
authors.forename: Paul N
authors.initials: PN
authors.lastname: Manson
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002555:Cerebrospinal Fluid / Q000378:metabolism; D005626:Frontal Sinus / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010012:Osteogenesis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014754:Violence; D055815:Young Adult