Treatment of Displaced Posterior Table Frontal Sinus Fractures: To Cranialize or Not to Cranialize? A Systematic Review and Meta-Analysis.

Frontal sinus fractures account for 5% to 11% of craniofacial traumas in the United States, and up to 40% of them involve the posterior table. Moderate to severe displacement or comminution of posterior table fractures has traditionally been addressed with cranialization. However, noncranialization surgical strategies, endoscopic surgical repair or observation have been proposed as alternative treatment options. A systematic review and meta-analysis were performed to evaluate complication rates and outcomes for cranialization versus noncranialization strategies or endoscopic or observation management of displaced posterior table fractures. A comprehensive literature search on PubMed, Scopus, and Web of Science yielded 10,254 articles. Following screening and full-text review, 55 studies met the inclusion criteria. A total of 2263 patients with displaced posterior table fractures were included. Cranialization was utilized in 56.6% (n=1280) of cases, noncranialization in 20.2% (n=457), endoscopic repair in 6.0% (n=135), or observation in 17.1% (n= 386). The overall complication rate was highest in patients managed with cranialization. For cranialization, the total complication rate was 13.0%, with meningitis and sinusitis being the most common complications (8.59%), followed by cerebrospinal fluid (CSF) leaks (3.28%), and mucocele (0.86%). Contrastingly, the noncranialization strategy demonstrated the lowest complication rate of 5.93%, with infection (3.56%) and mucocele (0.95%) being the most frequent complications. Endoscopic therapy yielded a total complication rate of 6.67%, with CSF leak (3.70%) and infection (2.22%) being the most common. The complication rate in the observation group was 6.48%. However, there was no statistical difference between the complication rates among the different management strategies. Therefore, cranialization remains the most common strategy for managing moderate to severe posterior table fractures. However, other strategies offer potentially promising, less invasive alternatives.