Complications following open treatment of frontal sinus fracture: A nationwide analysis of 1492 patients.

Purpose: Prior studies characterizing surgically managed frontal sinus fractures are small, institutional studies from major trauma centers (1-5). The current study characterizes the concomitant injuries and complications following open treatment of frontal sinus fractures across the United States.

Methods: Patients who underwent open treatment for a frontal sinus fracture between 2010 and 2022 were identified in a United States administrative database. Patients <18 years old and with <90 days of follow-up were excluded. Type of fracture (simple or complex), frontal sinus obliteration and concomitant fractures (facial, vertebral, extremity) were identified. 90-day surgical site infection, sinusitis, meningitis, brain abscess and cerebrospinal fluid leak were identified, as well as mucocele any time after surgery.

Results: There were 1492 adult patients with open treatment of frontal sinus fractures: 654 (44%) with simple fractures and 838 (56%) with complex fractures. There were 157 (11%) patients with frontal sinus obliteration. Concomitant fractures included facial (715 patients, 48%), vertebral (55, 4%), upper extremity (40, 3%) and lower extremity (53, 4%). Within 90 days of surgery, 155 (10%) patients had a complication: surgical site infection (42, 2.8%), sinusitis (29, 1.9%), meningitis (25, 1.7%), brain abscess (23, 1.5%), and cerebrospinal fluid leak (63, 4.2%). There were 11 (0.7%) patients who developed a mucocele, and <11 (<0.7%) underwent reduction of contour deformity. On multivariate analysis, complex frontal sinus fracture and concomitant vertebral/extremity fracture were associated with increased likelihood of a complication.

Conclusion: Over the last thirteen years, complication rates are low following surgically managed frontal sinus fractures. Comminuted fractures and those involving the posterior table increase the likelihood of a complication, likely due to increased injury severity. The results of the current study generally align with the published single-institution studies on complications of frontal sinus fractures treated with surgery. These findings from a large, nationwide cohort strengthen prior conclusions and increase the generalizability of reported complication rates.