Frontal sinus fractures: guidelines to management.

The appropriate management of frontal sinus fractures is controversial. Experience with 78 frontal sinus fractures over a 9-year period was reviewed, and the fractures were classified into anterior wall, anterobasilar, and frontal skull fracture extensions. The presence of a concomitant CSF leak or an air-fluid level in the sinus was a diagnostic clue of posterior wall involvement. Ablation or obliteration of the fractured frontal sinus is not necessary. Primary reconstruction of the sinus and nasofrontal duct drainage constitute the preferred treatment. "Cranialization" of a severely damaged sinus is performed by excision of the posterior wall plugging of the nasofrontal duct and reconstruction of the anterior wall. Reconstruction of the anterior wall with primary bone grafting may be necessary in selected patients.