The goals of treatment are the elimination of any factors predisposing to infection, restoration of normal sinus function and repair of cosmetic deficit. Frontal sinus fractures can be classified into anterior wall, posterior wall, frontonasal duct and through and through injuries. Anterior wall fractures that are linear and minimally displaced can be observed. Depressed anterior wall fractures should be explored, elevated and fixated if indicated. Compound anterior wall fractures should be explored and foreign bodies removed.
Comminuted fractures present a management problem when bone is missing.
The sinus should be obliterated with fat and reconstruction of the anterior wall undertaken with free iliac, rib or split calvarial bone grafts or methyl methacrylate. Donald advocates leaving gaps if bone deformity is less than 1.5cm in diameter since the deformity that results is minimal. Linear fractures of the posterior wall require exploration and should be considered for obliteration if there is displacement or entrapment of mucosa. All depressed posterior wall fractures should be obliterated. Extensively comminuted posterior wall fractures should be cranialized and if a CSF leak is present dural closure accomplished through the sinus if it is small or via anterior craniotomy if it is large.