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CHAPTER 3: Upper Facial Trauma

Resident Manual of Trauma to the Face, Head, and Neck

3. Frontonasal Duct Fractures

Fractures of the frontonasal duct have no particularly distinguishing

clinical diagnostic features and are usually picked up on a CT scan.

Though the actual fracture may not be seen, an opacified frontal sinus

that does not clear in 2 weeks raises a strong suspicion of disruption of

the duct. The duct is often fractured as part of a Le Fort III maxillary

fracture.

If at 2 weeks the sinus does not clear, a test can be done to establish

patency of the duct. A small trephine hole in the floor of the sinus is

made through a small incision in or just below the brow. The sinus is

irrigated through the trephine with a saline solution containing cocaine

or epinephrine. A solution containing methylene blue is instilled in the

sinus, and the appearance of the dye in the middle meatus of the nose

is observed with a sinus endoscope. The appearance of the dye indi-

cates duct patency; the dye’s absence is an indication for surgery.

4. Corner Fractures

A corner fracture is usually not displaced. The anterior wall, floor, and

posterior wall are fractured, and the corner fracture is normally in

continuity with a more extensive fracture to the frontal bone. Corner

fractures usually require no treatment.

5. Through-and-Through Fractures

The through-and-through fracture is the most serious of all frontal sinus

fractures. It is a compound comminuted fracture involving the anterior

and posterior walls, entering the anterior cranial fossa (Figure 3.2). The

skin is torn—often extensively, the dura is ripped, and the frontal lobes

Figure 3.2

Endoscopic inspection

of the frontonasal duct.

View through fractured

anterior wall of trephine.