title: Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair.
abstract: Management of frontal sinus trauma includes coronal or direct open approaches through skin incisions to either ablate or obliterate the frontal sinus for posterior table fractures and openly reduce/internally fixate fractured anterior tables. The objective of this prospective case-series study was to evaluate outcomes of frontal sinus anterior and posterior table trauma using endoscopic techniques.
  
  
  
  Prospective evaluation of patients undergoing surgery for frontal sinus fractures was performed. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of skull base defects, complications, and clinical follow-up.
  
  
  
  Forty-six patients (average age, 42 years) with frontal sinus fractures were treated using endoscopic techniques from 2008 to 2016. Mean follow-up was 26 (range, 0.5 to 79) months. Patients were treated primarily with a Draf IIb frontal sinusotomies. Draf III was used in 8 patients. Average fracture defect (length vs width) was 17.1 × 9.1 mm, and the average length involving the posterior table was 13.1 mm. Skull base defects were covered with either nasoseptal flaps or free tissue grafts. One individual required Draf IIb revision, but all sinuses were patent on final examination and all closed reductions of anterior table defects resulted in cosmetically acceptable outcomes.
  
  
  
  Frontal sinus trauma has traditionally been treated using open approaches. Our findings show that endoscopic management should become part of the management algorithm for frontal sinus trauma, which challenges current surgical dogma regarding mandatory open approaches.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jessica W
authors.initials: JW
authors.lastname: Grayson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Hari
authors.initials: H
authors.lastname: Jeyarajan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Elisa A
authors.initials: EA
authors.lastname: Illing
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Do-Yeon
authors.initials: DY
authors.lastname: Cho
authors.affiliation: Department of Neurosurgical Sciences, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Kristen O
authors.initials: KO
authors.lastname: Riley
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods; D005260:Female; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D059747:Nasal Surgical Procedures; D019651:Plastic Surgery Procedures; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed
keywords: CSF leak; CSF rhinorrhea; anterior table fracture; cerebrospinal fluid leak; endoscopic CSF leak repair; endoscopic sinus surgery; frontal fracture; frontal sinus trauma; posterior table fracture; skull base fracture