**15. Conclusion**

of the frontal sinus as a distinct space. This space is now encompassed within a new, larger

Once the entire posterior table has been removed, all sinus mucosa is taken out. This is done first bluntly, with a hemostat or forceps. Remnant mucosa is then eliminated using a diamond burr. Establishing a secure barrier between the cranial fossa and the nose is necessary to prevent CSF leak, meningitis, and ascending regrowth of the sinonasal mucosa. After the neurosurgery team has accomplished a watertight dural repair (Figure 9), and the bone and mucosa removal are complete, the most superior aspects of the frontal duct mucosa are elevated from the underlying bone and inverted downwards, toward the nose. The superior

Abdominal fat harvested through a small paraumbilical incision is filled in around the dural closure, occupying intracranial dead space. Repair of the anterior table is essential for both

Closure of the coronal incision is performed in layers with interrupted 3-0 Vicryl stitches for the galea and deep dermis, and staples for the skin within the hairline. The skin outside the hairline is closed with interrupted 4-0 nylon stitches. Suction drains are generally avoided if

Some complications of frontal sinus management relate to the surgical technique. The frontal branch of the facial nerve is vulnerable to injury during elevation of the coronal skin flap. The

immature dural closure is present. A neurosurgical head wrap is then applied.

structural and cosmetic concerns. Anatomic reductions are carried out with fixation.

anterior cranial fossa, with the anterior table as its anterior limit.

480 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

portions of the ducts are then packed off using bone, fascia, and muscle.

**Figure 9.** Water tight closure of the dura for prevention of CSF leakage

**13. Flap closure**

**14. Complications**

The appropriate treatment of frontal sinus fractures is a controversial issue. Frontal sinus fractures represent only a small percentage of patients that require the evaluation by a comprehensive trauma service. The majority of patients will also present with concomitant facial fractures. A functional sinus can be preserved in the majority of patients, regardless of the degree of displacement, depending on the status of the nasofrontal duct, the amount of posterior table comminution, and the presence of significant neurologic injury or dural injuries. Frontal sinus obliteration is not a major component in the treatment of patients. The most important factor when treating a patient is to establish a secure barrier between the cranial fossa and the nose to prevent CSF leak, meningitis, and ascending regrowth of the sinonasal mucosa.
