Frontal Sinus Morphology: A Reliable Factor for Classification of Frontal Bone Fractures?

Publication date: Available online 22 June 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Johannes Buller, Volker Maus, Andrea Grandoch, Matthias Kreppel, Matthias Zirk, Joachim E. Zöller
PurposeThe frontal sinus shows a wide range of morphologic variations. The aim of this study was to evaluate the influence of frontal sinus size on fracture characteristics in frontal bone trauma.MethodsIn this cross-sectional study, patients with traumatic fractures of the frontal bone were retrospectively collected from the institution's database. Radiometric analysis of computed tomography (CT) and cone-beam CT data sets was performed. Frontal sinus size was measured as variables height, width and depth. The secondary predictor was morphologic sinus type according to Guerram's classification of hyperplasia, medium size, hypoplasia or aplasia of the frontal sinus. To determine outcomes, we classified fractures into the following categories: isolated to the anterior table, combined fractures of the anterior and posterior table, isolated to the posterior table and frontal bone fracture without sinus involvement. Further study variables were patients' demographics, combined midfacial fractures, orbital rim involvement, fracture displacement and surgical approach. For statistical analysis, fracture types were assessed for frontal sinus metric size and morphologic type using bivariate tests with p-value <0.05 defined as significant.ResultsWe enrolled 53 consecutive patients with a mean age of 35 years, including 93% males. Fracture types differed significantly in sinus width, height (both p < 0.001) and depth (p = 0.002). Frontal sinus morphology was hyperplastic in 66%, medium in 30.2%, and hypoplastic in 3.8%. Hyperplastic frontal sinus had an increased likelihood of isolated anterior table fractures (odds ratio: 6.0, p = 0.007) compared to medium-sized types. Fractures without sinus involvement were more likely in hypoplastic and medium types (p < 0.001).ConclusionThe morphology of the frontal sinus determines the probability of fracture types from craniofacial trauma. Thus, the frontal sinus size appears to be a major factor for frontal bone resistance to traumatic force impingement.



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