: Yoh Sawatari
: Surgical Management of Maxillofacial Fractures
: Quintessence Publishing Co Inc USA
: 9780867158427
: 1
: CHF 134.80
:
: Zahnheilkunde
: English
: 256
: DRM
: PC/MAC/eReader/Tablet
: ePUB
The facial skeleton is comprised of vertical and horizontal buttresses and the intersections they create; maxillofacial fractures occur when these buttresses sustain more force than they can withstand. The objective when managing these fractures is to reverse the damage that these buttresses sustained and restore appropriate facial dimensions. Not all fractures propagate in the same pattern, so surgeons must compartmentalize the face and define the character of the individual bones. This book approaches the face one bone at a time, outlining how to evaluate each type of fracture, the indications for surgery, the surgical management, and any complications. Specific protocols for clinical, radiographic, and CT assessment are included, as well as step-by-step approaches for surgical access and internal reduction and fixation. Isolated fractures are rare with maxillofacial trauma, and the author discusses how to sequence treatment for concomitant fractures to ensure the most successful outcome. This book is a must-have for any surgeon managing maxillofacial fractures.

Frontal Sinus Fractures

The frontal sinus fracture is a facial fracture that occurs mostly in adults. Although the frontal sinus begins development in utero and undergoes a secondary phase of pneumatization between 6 months and 2 years, it is not identifiable on a radiograph until the age of 6 years.1 The fact that frontal sinus fractures seldom occur in children and adolescents is consistent with this pattern of development. In the general population, the leading cause of frontal sinus fracture is blunt trauma, with the majority occurring from motor vehicle crashes.2–4 Considering that the frontal bone can sustain between 800 to 2,200 pounds of force,5 it is understandable that the incidence of frontal sinus fractures is lower than that of other facial fractures. The incidence of frontal sinus fractures ranges from 5% to 15% of all facial fractures,6 and one-third to one-half of all frontal sinus fractures are associated with other facial fractures, including orbital and naso-orbitoethmoidal (NOE) fractures.7 Males sustain the majority of frontal sinus fractures, with a distribution between 66% and 91%, and the peak age is between 20 and 30 years of age.2–4 Of the frontal sinus fractures included in three studies, 43% to 61% had isolated anterior table damage, 0.6% to 6% had isolated posterior table damage, 19% to 51% had a combination of anterior and posterior table damage, and 2.5% to 25% had damage to the nasofrontal ducts.4,8,9

The frontal sinus fracture is a unique facial fracture often requiring complex management. The location of the frontal bone with the inclusive sinus is adjacent to vital structures including the brain and eyes (Fig 2-1). The frontal bone fracture often occurs concomitantly with fractures of the skull, orbital roof, and nose, and many times it is associated with Le Fort, zygomaticomaxillary complex (ZMC), and NOE fractures10 (seeFig 2-13).

Fig 2-1 Frontal bone.(a and b) Frontal and lateral views.

The anatomy of the frontal sinus is one of the most variable in the maxillofacial complex. The frontal sinus is a set of paired cavities in the frontal bone that communicates with the nasal cavity. Frontal sinuses are absent at birth, become well-developed at age 6 years, and reach full size around 12 to 16 years, developing as the superior extension of the anterior ethmoidal sinus. Approximately 4% of the general population has absent frontal sinuses,2 and the left and right aspects of the frontal sinus are usually asymmetric. The frontal sinus is generally separated by a bony septum and drains into the hiatus semilunaris of the middle meatus via the nasofrontal ducts. The presence of a well-defined nasofrontal duct is also variable, with an incidence limited to 15%, whereas in the remaining population the frontal sinus drains via a large hole emptying into the frontal recess.11

The typical size of a frontal sinus is 3.5 × 2.5 × 1.5 cm, with significant variation. The floor of the frontal sinus forms the orbital roof, while the posterior wall separates the anterior cranial fossa from the sinus. The arterial blood supply to the sinus is via the supraorbital arteries off of the ophthalmic artery and the anterior ethmoidal arteries. Venou