Preservation of Functioning Sinus in Frontal Sinus Posterior Table Fractures

Objective: Sinus preservation after posterior table frontal fractures (PTFF) may be preferable to obliteration/cranialization for minimizing risk of mucocele. This study assessed functional outcomes and complications after open reduction and internal fixation (ORIF) with sinus preservation for PTFF. Study Design: Consecutive case series. Patients and Methods: Patients with PTFF undergoing ORIF with sinus preservation from July 2012 to December 2013 were assessed. Fracture type/extent, presence/extent of dural injury, and cerebrospinal fluid (CSF) leak were recorded. Type of frontal sinusotomy, use of frontal stents, and lumbar drain were recorded. Outcomes evaluated were CSF leak closure, incidence of perioperative meningitis and frontal patency. Results: For two patients with intact dura and no CSF leak, displaced fragments were removed without dural repair. For one patient with CSF leak, a 1 cm dural defect was associated with comminuted PTFF; two-layered closure with underlay Duragen sheet and pericranial flap (PF) was performed. Lumbar drainage was not used. In two patients, Draf 2a frontal sinusotomy was performed with silastic stenting for 3 weeks. Frontal sinuses were aerated with widely patent frontal recess in all cases with no postoperative CSF leak, meningitis or cranial prolapse at mean 14.0 ± 5.0 months. Conclusion: Preservation of frontal sinus is an option for selected PTFF cases. Dural graft plus vascularized PF without a rigid layer may be used for frontal sinus CSF leak repair.