Approach to Upper Maxillofacial Fractures

Upper maxillofacial fractures primarily involve the frontal sinus. The paired frontal sinuses consist of an anterior table, a posterior table, and a frontonasal duct also known as the nasofrontal outflow tract (NFOT). Diagnosis of frontal sinus fractures is best done with a computed tomographic (CT) scan. Indications for repair of fractures of the frontal sinus depend on the location of the fracture, the degree of displacement of the fractures, and the patency of the NFOT. The three mainstays in fracture treatment are open reduction and internal fixation of anterior table fractures when there is no NFOT obstruction, which can be combined with obliteration and/or cranialization of the sinus with posterior table fractures in the presence of NFOT obstruction. Indications and surgical techniques will be reviewed along with some illustrative case examples.