What Is the Role of the Endoscope in the Sinus Preservation Management of Frontal Sinus Fractures?

Purpose: The management of frontal sinus fractures has remained controversial. The present study investigated the role of minimally invasive endoscopic surgery in a sinus preservation treatment protocol and described the ideal approach for each frontal sinus fracture type. Patients and Methods: We performed a prospective cohort study of patients with multiple frontal sinus fracture types. Patient demographic data, including age, gender, and cause of the fracture, were recorded. Four main management methods were proposed. Group A underwent observation only, group B underwent reduction and fixation of the anterior table, group C underwent endoscopic management of the frontal sinus outflow tract (FSOT), and group D underwent cranialization with an assessment of FSOT. The outcome measurements were the correction of the clinical deformity, which was determined by comparison of the preoperative and postoperative images, and the patent frontal sinus drainage, which was measured on the postoperative radiologic sagittal and coronal views of the frontal recess. The long-term outcomes were confirmed by the absence of long-term complications on postoperative follow-up examinations. Statistical analysis and comparisons were performed using SPSS software (IBM Corp, Armonk, NY). Results: A total of 60 patients (52 men, 8 women; mean age, 29.5 +/- 8 years) were included in the present study. Of the 60 patients, 20 were in group A, 20 in group B, 16 in group C, and 4 in group D. All 60 patients had undergone correction of the deformity and had a patent FSOT postoperatively. No long-term complications were encountered in the follow-up period (median, 24 months; range, 12 to 36 months). Conclusions: Endoscopic evaluation of the FSOT is of great importance in the surgical management of frontal fractures, because it allows for sinus preservation. The outcomes achieved in the present study were the result of selecting the right management plan for each fracture type. (C) 2020 American Association of Oral and Maxillofacial Surgeons