Complications following open treatment of frontal sinus fracture: A nationwide analysis of 1492 patients

Abstract

Purpose

Prior studies characterizing surgically managed frontal sinus fractures are small, institutional studies from major trauma centers (1–5). The current study characterizes the concomitant injuries and complications following open treatment of frontal sinus fractures across the United States.

Methods

Patients who underwent open treatment for a frontal sinus fracture between 2010 and 2022 were identified in a United States administrative database. Patients <18 years old and with <90 days of follow-up were excluded. Type of fracture (simple or complex), frontal sinus obliteration and concomitant fractures (facial, vertebral, extremity) were identified. 90-day surgical site infection, sinusitis, meningitis, brain abscess and cerebrospinal fluid leak were identified, as well as mucocele any time after surgery.

Results

There were 1492 adult patients with open treatment of frontal sinus fractures: 654 (44%) with simple fractures and 838 (56%) with complex fractures. There were 157 (11%) patients with frontal sinus obliteration. Concomitant fractures included facial (715 patients, 48%), vertebral (55, 4%), upper extremity (40, 3%) and lower extremity (53, 4%). Within 90 days of surgery, 155 (10%) patients had a complication: surgical site infection (42, 2.8%), sinusitis (29, 1.9%), meningitis (25, 1.7%), brain abscess (23, 1.5%), and cerebrospinal fluid leak (63, 4.2%). There were 11 (0.7%) patients who developed a mucocele, and <11 (<0.7%) underwent reduction of contour deformity. On multivariate analysis, complex frontal sinus fracture and concomitant vertebral/extremity fracture were associated with increased likelihood of a complication.

Conclusion

Over the last thirteen years, complication rates are low following surgically managed frontal sinus fractures. Comminuted fractures and those involving the posterior table increase the likelihood of a complication, likely due to increased injury severity. The results of the current study generally align with the published single-institution studies on complications of frontal sinus fractures treated with surgery. These findings from a large, nationwide cohort strengthen prior conclusions and increase the generalizability of reported complication rates.