FRONTAL BONE FRACTURE IN ORAL & MAXILLOFACIAL SURGERY DETAILED

1. FRONTAL BONE
FRACTURE
PRESENTED BY –
Dr.ANKITA RAJ (MDS Reader)
Oral & Maxillofacial Surgery Department
Rama Dental College, Kanpur

2. INTRODUCTION
 Fractures of the frontal bone occur among 2 to 15% of patients with
facial fractures.
 Its fracture can cause devastating complications because of
its close proximity to the brain, eyes, and nose.
 Most victims are male (66–91%) and young (usually 20–30 yr
of age, range 6–72 yr)
 Injuries are sustained in motor vehicle or motorcycle collisions
(44–85%)
 The frontal bone is like half of a shallow, irregular cap forming
the
forehead or frons .
 It has three parts and contains two cavities, THE
FRONTAL SINUSES.

3. EMBRYOLOGY
 The frontal bone is an
intramembranous bone that develops
from 2 paired structures that begin to
ossify at the 8th or 9th week in utero.
 The ossification begins in the frontal
processes of the squamous regions,
progresses to the orbital and
squamous regions, and reaches the
frontal and temporal regions by the
12th week.
 The metopic suture in the midline
closes during the second year of life.
 The forehead is displaced anteriorly
by sutural growth, inner table
resorption, and outer table deposition

4.  The frontal sinus is Absent at birth
 The frontal sinuses are derived from the
frontal recess portion of the middle
meatus or occasionally from an air cell
of the ethmoid infundibulum
 Initial pneumatization begins during
the 4th month in utero.
 Secondary pneumatization begins at the
age of 6 months to 2 years and develops
laterally and vertically.
 The sinuses are radiologically evident at
5 to 6 years of age.
 Most pneumatization is completed by the
time the child is 12 to 16 years old but it
continues until the age of 40 .

6. SURGICAL ANATOMY
 From the nasion the bone extends approximately 12.5 cm
superiorly,8.0 cm laterally, and 5.5 cm posteriorly.
 Two frontal tuberosities are noted lateral to the midline and superior
to the supraorbital rim.
 The thickest area of the bone is the supraorbital rim from the
frontozygomatic process to the nasal bones.

7.  The supraorbital foramen are located at the most superior portion of
the orbital rim.
 The supratrochlear foramen is located medial to the supraorbital
foramen or notch and lateral to the nasal bones.
 A spine or concavity exists on the frontal bone along the medial
anterior orbital roof; the trochlea of the superior oblique muscle is
attached to this spine

8.  FRONTAL SINUSES are paired air filled asymmetric triangular cavity lined by
pseudo stratified ciliated columnar epithelium found within the frontal bones and
are separated by a frontal septum.
 The dimensions are-
 Height 32mm
 Width 26mm
 Depth 17mm
 Surface area 720 mm2
 The outer and inner bony walls are
referred to as inner and outer tables .
 The anterior wall of the sinus is stronger
than the posterior wall, but it also has low
resistance to either low-energy or high-
energy impact.
 The posterior wall of the sinus is thinner
and weaker and separates the sinus from
the dural covering of the brain in the ACF

9.  The sinus floor consists of membranous bone and is the thinnest of the sinus
boundaries.
 Importantly, the floor of the frontal sinus is on average 3.1 mm below the
nasion (i.e., the frontonasal suture).
 Drainage of the frontal sinus is variable. A true FND exists in only 15% of
the population, varying from a few millimeters to 1 cm in length. In the
remaining 85%, the frontal sinus drains directly into the anterosuperior
portion of the middle meatus via an ostium without a true duct or
occasionally by a communication through the ethmoids.

12. FUNCTIONS OF FRONTAL
SINUS
 Production and storage of mucus
 Resonator for voice
 Humidification and warming of inhaled
air
 Accesory area of olfaction.
 Conservation of heat from the nasal
fossae
 Definition of facial contour
 Surge tank to dampen the pressure
differential that develops during

13. DIAGNOSIS
 The diagnosis of the frontal sinus fracture based on the proper
history and physical examination of the patient which includes
inspection and palpation of the affected area.
 The detailed history includes the following points:
 1. Information about events
 2. Visual difficulties
 3. Numbness
 4. Pain
 5. Rhinorrhea
 6. Sense of smell
 7. Previous history of nasal or sinus disease surgery.

14. Clinical Features
 1. Forehead laceration
 2. Forehead pain
 3. Swelling
 4. Frontal bone depression
 5. Periorbital ecchymosis
 6. CSF rhinorrhea

15. Today computed tomography
(CT) scans are the gold
standard for imaging
these fractures

17. CLASSIFICATIONS
1)Stanley’s Classification of Frontal Sinus Fracture
• Type I: Anterior Table Fracture
–– Isolated to anterior table
–– Accompanied by supraorbital rim fracture
–– Accompanied by naso-ethmoid complex fracture
• Type II: Anterior and Posterior Table Fractures
–– It is a linear fracture either on transverse direction or in
vertical direction
• Type III: Comminuted Fractures
–– Isolated to both tables
–– Accompanied by naso-ethmoid complex fracture

18. 2)Gonty Et al. Classification of Frontal Sinus
Fracture
• Type I: Anterior Table Fracture
–– Isolated to anterior table
–– Accompanied by supraorbital rim fracture
–– Accompanied by naso-ethmoid complex fracture
• Type II: Anterior and Posterior Table Fractures
–– A linear fracture either on transverse direction or in
vertical direction
–– Comminuted fracture either isolated to both tables or
accompanied by naso-ethmoid complex fracture
• Type III: Posterior Table Fracture
• Type IV: Through and Through Frontal Sinus Fracture

19. MANAGEMENT

33. REFERENCES
 Maxillofacial trauma by Peter Ward Booth
 Petersons Principles of Oral and Maxillofacial Surgery
2 Vol. set by Michael Miloro, G. E. Ghali, Peter E.
Larsen
 Fonseca Volume 3 –Trauma
 Grays anatomy – 41ST Edition
 McMinn and Abrahams' Clinical Atlas of Human
Anatomy

34. THANK YOU