Resident Manual of Trauma to the Face, Head and Neck

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.

A

B

Figure 3.5 Fascia graft being tucked into position to stem CSF leak in a posterior wall fracture.

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.

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