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Perioperative parameters, operative details, and outcomes in the management of frontal sinus fractures
Ayesha Punjabi
James Gatherwright
University Hospitals Cleveland Medical Center
2019-01-31
Presenter: Ayesha Punjabi
Affidavit:
This work represents the original work of the resident.
Director Name: Anand Kumar, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
While the literature contains many algorithms for the management of frontal sinus fractures, there is a lack of perioperative parameters described for these injuries.
Methods:
We report our experience with ten patients. Charts were reviewed for mechanism of injury, intra-operative details, hospital stay, disposition and outcomes.
Results:
9/10 patients were male. Average patient age was 34.9 years at the time of injury. Mechanisms were gunshot wound (5/10), motor vehicle collision (4/10), and assault (1/10).
Average time from injury to surgery was 11.1 days. Average operative time was 7.1 hours and average EBL was 421.8cc. 8/10 patients had pericranial flaps. Materials to pack the nasofrontal ducts included temporalis muscle, autogenous bone, and Tisseel/Surgicel. The frontal sinuses were sealed with the pericranial flap and fibrin glue in the cases where the pericranial flap was raised. For 3/10 patients, autogenous calvarium harvested from fracture debridement was split on a back table to increase surface area for bone grafting. 7/10 patients had other facial fractures treated.
At the end of their operations, 6/10 patients were extubated. 9/10 went to the ICU. Average post-operative ICU length of stay was 6.3 days. Average total hospital stay was 18.7 days. Three patients had wound infections or hardware complications requiring reoperation. Mean length of follow up was 550 days.
Conclusions:
Our perioperative parameters represent a basis for comparison and can guide preoperative counseling in the surgical treatment of frontal sinus injuries.
