Pediatrics in Review
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 Vol. 18 No. 4, April 1997
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(Pediatrics in Review. 1997;18:120-121.)
© 1997 American Academy of Pediatrics

Frontal Sinus Fractures

Charles M. Ginsburg, MD*
* Professor and Chairman of Pediatrics, The Marilyn R. Corrigan Distinguished Chair in Pediatric Research, The University of Texas Southwestern Medical Center, Dallas, TX.


   IMPORTANT POINTS
 

  1. Because of the forces required to fracture the bones of the frontal sinuses, these fractures rarely are isolated injuries; in 80% to 95% of cases, they are associated with other facial (80%) and skull fractures (55%).
  2. The frontal sinuses are only potential spaces that are undetectable by either computed tomography or conventional radiography until 4 to 6 years of age; their complete pneumatization generally does not occur until mid to late adolescence.
  3. Cerebrospinal fluid (CSF) rhinorrhea is nearly twice as common in pediatric than adult patients who have sustained frontal sinus fractures. Although CSF rhinorrhea is rare in children, they are more likely than adults to have no abnormal physical findings.
  4. Computed tomography is the preferred diagnostic modality for frontal sinus fractures.
  5. The initial management of a child or adolescent who has a fracture of the frontal sinus is dictated by the extent and severity of other injuries to the face and head. A cervical spine injury should be excluded with the initial physical and radiologic evaluations. In more than 50% of patients, there will be an associated intracranial injury that requires initial management.

Trauma is an occupational hazard of childhood. In most cases, the trauma sustained by children is relatively minor and does not require emergency or operative management. Although head and facial trauma to young children and adolescents is relatively common, rarely does it result in sinus fractures, particularly to the frontal sinuses. The incidence of frontal sinus fractures following trauma is related to the age of the child and the type and mechanism of injury. Diagnosis and management of the child who is suspected of having a frontal sinus fracture require an understanding of sinus development and anatomy.

. . . [Full Text of this Article]






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Copyright © 1997 by the American Academy of Pediatrics.