21343 Open treatment of depressed frontal sinus fracture

Name of the Procedure:

Open Treatment of Depressed Frontal Sinus Fracture
Common name(s): Open reduction and internal fixation of frontal sinus fracture

Summary

This surgical procedure involves accessing the frontal sinus (located in the forehead) through an open incision to repair a fracture that has caused a depression or indentation. The surgeon repositions the fractured bone fragments and stabilizes them, often using small plates and screws.

Purpose

The procedure addresses fractures of the frontal sinus that have resulted in bone depression, which can cause cosmetic deformity, sinus drainage issues, and potential risk of infection or complications affecting the brain. The goals include restoring the normal anatomy of the forehead, ensuring proper sinus function, and preventing future complications.

Indications

• Visible indentation or deformity in the forehead due to trauma.
• Persistent symptoms such as pain, swelling, or sinus drainage issues.
• Radiographic evidence of depressed fracture of the frontal sinus.
• Risk of infection or other complications from an untreated sinus fracture.

Preparation

• Patients are generally instructed to fast for at least 8 hours prior to surgery.
• Medication adjustments may be necessary, particularly if the patient is on blood thinners.
• Preoperative imaging studies, such as CT scans, are usually done to evaluate the extent of the fracture.
• Routine pre-surgical blood tests and physical examination to assess overall health.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the forehead, often along the hairline or a natural crease to minimize scarring.
3. The surgeon carefully exposes the fractured area.
4. Bone fragments are repositioned into their correct anatomical locations.
5. Small plates and screws are used to secure the bone fragments in place.
6. The incision is closed with sutures, and a sterile dressing is applied.
7. Sometimes, drainage tubes may be placed to prevent fluid accumulation.

Duration

Typically, the procedure lasts between 2 to 4 hours, depending on the complexity of the fracture.

Setting

The procedure is performed in a hospital or a surgical center equipped with advanced imaging and surgical facilities.

Personnel

• A board-certified surgeon, often with specialization in craniofacial or maxillofacial surgery.
• An anesthesiologist to manage anesthesia.
• Surgical nurses and technicians to assist during the procedure.

Risks and Complications

• Infection at the site of surgery.
• Bleeding or hematoma formation.
• Injury to surrounding tissues or structures, including nerves and blood vessels.
• Anesthesia-related risks.
• Non-union or improper healing of the fracture.
• Cosmetic dissatisfaction due to scarring or contour irregularities.

Benefits

• Restoration of normal forehead contour and appearance.
• Improved sinus drainage and function.
• Reduced risk of complications such as infection or meningitis.
• Alleviation of pain and other symptoms associated with the fracture.

Recovery

• Patients typically stay in the hospital for 1-2 days post-surgery.
• Pain management includes prescribed medications.
• Sutures are usually removed in about a week.
• Instructions include keeping the head elevated, avoiding strenuous activities for several weeks, and attending follow-up appointments.
• Full recovery can take several weeks to months, with gradual resumption of normal activities.

Alternatives

• Non-surgical management: reserved for non-displaced fractures or medically unfit patients.
  • Pros: No surgical risks.
  • Cons: May not correct deformity or functional issues.
• Minimally invasive techniques: applicable in selected cases.
  • Pros: Less invasive, quicker recovery.
  • Cons: Limited application and may not achieve desired outcomes.

Patient Experience

Patients can expect some discomfort and swelling immediately after the procedure. Pain is typically managed with medications. Swelling and bruising around the eyes and forehead are common and can last for a few weeks. Follow-up care includes monitoring for any signs of infection or complications, ensuring proper healing, and cosmetic evaluation.