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Review | Journal Club

Frontal Sinus and Naso-orbital-Ethmoid Fractures

Sachin S. Pawar, MD1; John S. Rhee, MD, MPH1
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
JAMA Facial Plast Surg. 2014;16(4):284-289. doi:10.1001/jamafacial.2014.14.
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Importance  Frontal sinus and naso-orbital-ethmoid (NOE) fractures are among the most challenging injuries in the treatment of maxillofacial trauma.

Objective  To summarize the current knowledge regarding frontal sinus and NOE fractures and to present some of the more recent, evidence-based literature to support current treatment recommendations.

Evidence Review  A PubMed search of articles from 1990 through 2013 was performed. Search terms included frontal sinus fracture, NOE fracture, naso-orbito-ethmoid fracture, naso-ethmoid-orbital fracture, and nasoethmoid fracture.

Findings  Advances in sophisticated imaging and evolution in minimally invasive surgical techniques are introducing more conservative options that may provide better patient outcomes while minimizing the risks and morbidity associated with more traditional treatment approaches.

Conclusions and Relevance  The treatment of frontal sinus and NOE fractures is challenging, given the complex anatomy and associated pattern of injuries. Traditional treatment paradigms are evolving and support the role of more conservative treatment algorithms in selected patients.

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Figure 1.
Classification of Naso-orbital-Ethmoid Fractures12

Type I involves large, single-segment fractures; type II, comminuted fractures of the medial orbital rim segment with the medial canthal tendon still attached; type III, extensive comminution of medial orbital rim segment extending into the medial canthal insertion. Reprinted with permission from Hopper et al.13

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Figure 2.
Treatment Algorithm for Treatment of Frontal Sinus Fractures

The algorithm is based on 5 anatomic parameters: anterior table fracture, posterior table fracture, frontal recess injury, dural integrity, and fraction comminution. Reprinted with permission from Strong.8

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