Transnasal endoscopic repair of posterior table fractures

Mohamad R. Chaaban, Bryant Conger, Kristen O. Riley, Bradford A. Woodworth

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Objectives/Hypothesis. Conventional treatment of frontal sinus posterior table fractures has included osteoplastic flap or cranialization procedures despite considerable advances in endoscopic technique and experience. The objective of the current study was to evaluate outcomes of frontal sinus fractures involving the posterior table managed using endoscopic approaches. Study Design. Prospective cohort. Setting. Tertiary care, academic university hospital. Methods. Prospective evaluation of patients with posterior table fractures was performed. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of the skull base defect, complications, and clinical follow-up. Results. Thirteen patients (average age 37 years) with posterior table fractures were treated using endoscopic techniques from 2008 to 2012. Mean follow-up time was 68 weeks (range, 2-206 weeks). Patients were primarily managed using Draf IIb frontal sinusotomies with 1 individual requiring a concomitant trephine. A Draf III procedure was performed in 1 patient. Average fracture defect (length vs width) was 13 3 4.5 mm, and average length involving the posterior table was 9.7 mm (1-30 mm). Skull base defects were covered with a septal flap and/or free tissue grafts. Although 1 individual required a revision frontal sinusotomy and followup was short in several patients, all sinuses remained patent on last clinical examination. Conclusion. Management of frontal sinus posterior table fractures using minimally invasive endoscopic techniques provides excellent outcomes in selected cases. Fractures of up to 30 mm in length were adequately managed in this series and indicate this approach can be a viable alternative in the treatment of these fractures.

Original languageEnglish (US)
Pages (from-to)1142-1147
Number of pages6
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume147
Issue number6
DOIs
StatePublished - Dec 1 2012

Keywords

  • CSF
  • Cerebrospinal fluid leak
  • Cranialization
  • Endoscopic sinus surgery
  • Endoscopic skull base surgery
  • Frontal sinus
  • Nasoseptal flap
  • Posterior table fracture
  • Skull base reconstruction
  • Vascularized repair

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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