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and obliteration of the sinus are preformed, then careful attention to

complete removal of all mucosa is mandatory. The drilling of the bone

of the interior of the sinus is essential to remove all remnants of

mucosal lining prior to obliteration of the sinus cavity with a carefully

harvested abdominal wall fat graft.

3. Frontonasal Duct Fractures

Fractures to the outflow tract from the frontal sinus are very difficult to

diagnose. There are no idiosyncratic signs or symptoms that are

manifested in these fractures. When suspected by retained fluid in the

sinus after a 2-week period of observation or demonstration of such a

fracture on the facial CT scan, the frontal sinus must be addressed.

Figure 3.4

Suture of dural laceration in

posterior wall frontal sinus

with CSF leakage. (A) Dural

laceration. (B) Fractured

bone debrided until limits

of dural rent are apparent;

tear is sutured with

interrupted sutures.

Figure 3.5

Fascia graft being tucked

into position to stem CSF

leak in a posterior wall

fracture.