title: Frontal sinus fractures with suspected outflow tract obstruction: a new approach for sinus preservation.
abstract: OBJECTIVE
  The description of a new approach for the management of patients with frontal sinus fractures and associated obstruction of the frontal outflow tract to, restore sinus function and avoiding sinus obliteration.
  
  
  METHODS
  In a prospective study, 21 patients with anterior wall frontal sinus fractures associated with potential obstruction of the frontal outflow tract, underwent rigid internal fixation and intraoperative guarded nasal endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. Patients were followed up clinically and radiologically by CT to assess the status of the frontal sinus and to detect any manifestations of frontal sinusitis or any other complications.
  
  
  RESULTS
  Seventeen patients completed the postoperative follow-up while four patients were excluded from the study. Postoperative follow-up ranged from 6 to 34 months with a mean of 20 months. All patients had associated craniofacial fractures. Follow-up CT scans showed complete restoration of frontal sinus ventilation and mucociliary clearance for 13 patients. Four patients showed frontal sinus mild mucosal thickening without signs of chronic sinusitis.
  
  
  CONCLUSIONS
  Patients with anterior wall frontal sinus fractures associated with frontal sinus outflow tract obstruction could be successfully managed with rigid internal fixation and intraoperative guarded endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. This type of management could increase the chance of frontal sinus preservation and decrease the need for frontal sinus obliteration for similar patients.
authors.affiliation: Otolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Electronic address: tarek.emara@yahoo.com.
authors.forename: Tarek Abdelzaher
authors.initials: TA
authors.lastname: Emara
authors.affiliation: Otolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ismail Seddik
authors.initials: IS
authors.lastname: Elnashar
authors.affiliation: Oral and Maxillofacial Surgery Department (Head: Consultant Abdelzaher Omara, D.M.D), Al-Ahrar General Hospital, Zagazig, Egypt.
authors.forename: Tharwat Abdelzaher
authors.initials: TA
authors.lastname: Omara
authors.affiliation: Otolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Waleed Mohamed
authors.initials: WM
authors.lastname: Basha
authors.affiliation: Otolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ahmad Mohamad
authors.initials: AM
authors.lastname: Anany
mesh_terms: D000293:Adolescent; D000328:Adult; D003646:Debridement / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005005:Ethmoid Sinus / Q000293:injuries / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D005626:Frontal Sinus / Q000293:injuries* / Q000601:surgery; D015522:Frontal Sinusitis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007430:Intraoperative Care; D008297:Male; D009079:Mucociliary Clearance / Q000502:physiology; D009295:Nasal Bone / Q000293:injuries / Q000601:surgery; D009297:Nasal Mucosa / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery; D011446:Prospective Studies; D012887:Skull Fractures / Q000150:complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: Endoscopic clearance of frontal recess; Frontal outflow obstruction; Frontal sinus fractures; Preservation of sinus function