21344 Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches

Name of the Procedure:

Open Treatment of Complicated Frontal Sinus Fracture (e.g., comminuted or involving posterior wall), via Coronal or Multiple Approaches

Summary

This surgical procedure involves the treatment of complex fractures of the frontal sinus, which is a hollow space in the forehead bone. These fractures are typically severe, involving multiple broken pieces or damage to the sinus walls. Surgery may involve one or more approaches through the scalp to access, repair, and stabilize the fracture.

Purpose

• Medical Condition: Complicated frontal sinus fractures.
• Goals: To repair and stabilize the broken bones, restore normal sinus function, and prevent complications such as infection or cosmetic deformity.

Indications

• Visible deformity or depression in the forehead.
• Severe pain and swelling in the forehead and surrounding areas.
• Leakage of cerebrospinal fluid from the nose.
• Eye injuries or symptoms affecting vision.
• Symptoms of sinusitis or infection.
• Patients who have sustained significant facial trauma.

Preparation

• Patients may need to fast for 8-12 hours before surgery.
• Avoid certain medications like blood thinners as advised by the doctor.
• Pre-operative imaging (CT scan or X-rays) to assess the extent of the fracture.
• Blood tests and possibly an EKG to ensure fitness for surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to keep the patient unconscious and pain-free.
2. Incision: A coronal incision is made across the scalp from ear to ear or other necessary access points to expose the forehead area.
3. Exposure: Skin and soft tissues are lifted to reveal the frontal bone and sinus.
4. Repair: The surgeon assesses and repairs the fractured bones, possibly using plates, screws, or bone grafts to stabilize the area.
5. Closure: After repair, tissues are sutured back in place, and the incision is closed.

Duration

The procedure typically takes 3-6 hours, depending on the complexity.

Setting

Performed in a hospital operating room.

Personnel

• Surgeon (usually a craniofacial or ENT specialist)
• Anesthesiologist
• Surgical nurses
• Possibly a plastic surgeon or neurosurgeon in complex cases

Risks and Complications

• Common: Infection, bleeding, swelling, pain.
• Rare: Nerve damage, cerebrospinal fluid leak, sinusitis, cosmetic asymmetry, prolonged numbness.

Benefits

• Stabilized and repaired sinus structure.
• Improved appearance and function of the forehead.
• Reduced risk of infection and other complications.
• Benefits can be realized a few weeks to months post-surgery.

Recovery

• Hospital stay of 1-2 days for monitoring.
• Pain management with prescribed medications.
• Avoiding strenuous activities for several weeks.
• Follow-up appointments to monitor healing.
• Full recovery may take several months.

Alternatives

• Non-surgical management with observation and medication for less severe fractures.
• Endoscopic repair for minor fractures without extensive damage.
• Pros: Less invasive, shorter recovery.
• Cons: May not be sufficient for complex fractures.

Patient Experience

• During: Patient will be asleep due to general anesthesia.
• After: Initial pain and swelling managed with medications.
• Discomfort in the forehead area, strict post-operative care, and activity limitation.
• Pain typically subsides within a few weeks, with cosmetic and functional improvements visible over time.