title: Spontaneous ventilation of the frontal sinus after fractures involving the frontal recess.
abstract: OBJECTIVE
  Frontal sinus fractures (FSF) have potentially catastrophic consequences due to frontal recess (FR) obstruction and proximity to the brain and orbit. Lack of follow-up and ability to predict which type of fractures predispose to complications has biased surgeons toward definitive interventions such as sinus obliteration and cranialization. These procedures carry inherent risk and may be unnecessary in a subset of patients. This study seeks to better characterize spontaneous ventilation in subjects with FSFs, including those involving the FR.
  
  
  METHODS
  Review of a prospectively maintained trauma database between 2009 and 2013 at a level 1 trauma center. Patients with frontal sinus fractures with follow-up imaging (>6 weeks) available were included. The medical records and imaging were reviewed for evidence of spontaneous ventilation of the frontal sinus.
  
  
  RESULTS
  Nineteen patients sustained frontal sinus fractures in the study period with mean imaging interval of 67.4 weeks (range, 6-188.4 weeks). Injury mechanisms included fall (32%), assault (31%), motor vehicle accident (17%), pedestrian-versus-automobile (12%), and gunshot wound (8%). 8/19 patients (42%) sustained FSFs involving the FR and 7/8 (87.5%) spontaneously ventilated by time of interval imaging. The one patient with persistent radiographic sinus opacification was associated with a naso orbital ethmoid and medial orbital blowout fracture. 6/19 patients (32%) sustained FSF sparing the FR, and all spontaneously ventilated by the time of interval imaging. 5/19 patients (26%) underwent surgical intervention.
  
  
  CONCLUSIONS
  An expectant, sinus-preserving approach to acute FSFs involving the FR is safe and effective. Etiology of re-ventilation failure may be due to tissue obstruction, rather than the frontal recess fracture itself.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Aria
authors.initials: A
authors.lastname: Jafari
authors.affiliation: School of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Nuyen
authors.affiliation: School of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Courtni R
authors.initials: CR
authors.lastname: Salinas
authors.affiliation: Department of Surgery, Division of Trauma, University of California San Diego, La Jolla, CA, USA.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Smith
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA. Electronic address: adeconde@ucsd.edu.
authors.forename: Adam S
authors.initials: AS
authors.lastname: DeConde
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000293:injuries / Q000502:physiology*; D006801:Humans; D011859:Radiography; D012119:Respiration; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D014193:Trauma Centers