Injuries of the nasofrontal orifices in frontal sinus fractures.

Disruption of the nasofrontal ostia or ducts is an important factor in the development of immediate and delayed complications following frontal sinus fractures. Thorough evaluation of 50 consecutive patients with frontal sinus injuries caused by blunt trauma revealed several fracture patterns that frequently include injury to the drainage system. Anterior table fractures, even when displaced, do not produce such injuries unless associated with a fracture of the supraorbital rim or nasoethmoidal complex. Combined fractures of the anterior and posterior tables are almost always accompanied by injuries to the orifices. Severity of these injuries is variable but can be predicted from the sinus wall fracture patterns. Although CT scanning is incapable of directly imaging involvement of the ostia or ducts, it will give sufficient information to allow for accurate prediction of disruption of the drainage system.