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The Utilization of Endoscopic Techniques in the Management of Frontal Sinus Fractures: A Systematic Review
Robert P. Lesko, BA(1), Eric J. Macdonald, BS(1), Brandon J. De Ruiter BS(1), Edward H. Davidson MD(2)
1. Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New Y
2020-01-25
Presenter: Robert P. Lesko
Affidavit:
The presenter of this abstract contributed the majority of work to this original project.
Director Name: Edward H. Davidson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND
Endoscopic approaches to frontal sinus fracture management are an emerging challenge to the traditional algorithmic paradigm, especially in the management of anterior table fractures. Endonasal cannulation and/or stenting of the nasofrontal outflow tract can obviate the need for obliteration. Endoscopic assistance can also be an adjunct to anterior table reconstruction and obliteration. There have been no systematic reviews analyzing utilization and outcomes of endoscopic management of isolated anterior table fractures of the frontal sinus.
METHODS
A systematic review of PubMed/MEDLINE, Embase, Web of Science, and Cochrane was performed using the terms "frontal sinus fracture" or "frontal sinus injury". All relevant English-language, primary literature was considered for inclusion. Demographic data, diagnosis, treatment method, complications, and outcomes were extracted.
RESULTS
Of 606 articles identified initially, 89 were reviewed in their entirety and 22 were included in our analysis. 786 patients (mean age 28.8) were included in our analysis. 35 patients (4.5%) underwent endoscopically-assisted procedures. 7 (0.9%) underwent endoscopically-assisted reduction and 28 (3.6%) underwent endoscopically-assisted reduction and fixation with no complications reported for patients undergoing either surgery. Nasofrontal outflow tract involvement was discussed in 5 (83%) of the papers utilizing endoscopic techniques and obstruction was noted in 2 patients. Complication rates from traditional treatment methods ranged from 2.13% to 50%.
CONCLUSIONS
Endoscopically-assisted repair of isolated anterior table fractures of the frontal sinus is emerging as a safe evolution from traditional methods. Utilization of endonasal cannulation and stenting of the nasofrontal outflow tract may obviate the need for obliteration but requires further study.
