Frontal sinus injuries: primary care and management of late complications.

An approach to treatment of frontal sinus injuries is proposed. For injuries involving the anterior wall of the sinus in which the nasofrontal duct is patent, the anterior wall is reconstituted either primarily or using a bone graft. Injuries involving the posterior wall of the frontal sinus generally necessitate a craniotomy; the frontal sinus in these situations is cranialized and the nasofrontal duct is plugged. In primary injuries of the frontal sinus in which the nasofrontal duct is badly damaged but the posterior sinus wall intact and in late mucoceles or mucopyoceles, all sinus mucosa is stripped and the sinus is packed with cancellous bone. The authors feel that cancellous bone is a better material than fat with which to pack a sinus, particularly in the face of active infection. Three cases are presented in which infected mucopyoceles draining to the skin were treated with removal of all sinus mucosa and packing with cancellous bone, with primary healing.