Frontal bone fractures
The trauma to the face may be injuries of the soft tissues such as bruises, burns etc or there could be fractures to the face such as jaw fractures or fractures of the frontal bone. Fractures involving the frontal bone are very rare. The fractures of forehead or frontal bone constitute only 5% to 15% of all the injuries.
Anatomy of the frontal bone:-
Within the frontal bone, the frontal sinus is a pyramidal cavity filled with air. The size and shape of the frontal sinus are different in each and every one. In most people generally, the frontal bone area is asymmetrical. It has two walls which are known as the anterior and the posterior table. The posterior table is comparatively weaker than anterior table. Also, the posterior table is located closely to the frontal lobe of the brain. The frontal sinus is made up of the membranous bones and its floor is very weak.
Generally the fractures of the front sinus are considered to be the injuries of the head.
Causes of the frontal bone fractures:-
Most commonly frontal bone fractures are caused by automobile accidents. Physical assault may also cause frontal bone fractures. In addition to these two causes fractures of the frontal bone may also be caused due to occupation or due to extreme recreational or sports activities.
Diagnosis of patients with frontal bone fractures:-
Any patient that is brought with an injury to the face is made to undergo a complete and thorough ophthalmic examination. This is done to eliminate any possibility of damage to the ocular anatomy. Post the ophthalmic evaluation, a CT scan is done on the patient. This is a test which is done for imaging the inside of the skull and it gives a complete picture of the skull and the brain. If due to the injury the patient is falling unconscious the periods of consciousness and unconsciousness are also monitored. The patient should be checked completely for any other injuries cause the frontal bone fractures are caused due to large amounts of force.
The frontal bone fractures are primarily treated with an aim to reset the broken bones and to restore the sinus function. Also, the treatment aims to treat the patient to eliminate any predisposition to the infections. The cosmetic and aesthetic aspects of the face are also restored by the surgery.
Types of fractures of the frontal bone:-
Posterior wall fracture: – the linear fractures which involve the posterior wall should thoroughly be examined. Displaced or entrapped mucosa should be checked. The frontal sinus bone should be obliterated if there are depressed fractures of the posterior wall. The frontal sinus is cranialized if the bone has broken into many tiny segments. The CSF leaks are sealed by dural repair. Even if the bony fragments are minutely deflected they can cause the sinus mucosa to in grow in to the anterior cranial fossa. Therefore in many cases, where there is fracture of posterior table the frontal sinus is obliterated.
Frontal bone fracture of the anterior wall: – when the depressed fractures of the anterior wall take place, the frontal sinus should be fixed after elevating the frontal wall. Any foreign bodies inside should be removed and all the anterior wall fractures must be treated. If the bone has been broken in to number of minute segments, the frontal sinus should be repaired with abdominal fat. If the gap between the bones is less than 1.5 cm then the bone grafting is not required.
Nasofrontal duct injuries: – such injuries are very difficult to diagnose. If unexplained fluid is present in the frontal sinus for more than four weeks, it could be a sign of nasofrontal duct injury.
Fractures of frontal sinus which run through and through are highly dangerous.
Due to frontal bone fractures there can be bleeding from the wound or from areas near the wound. There can be bruising around the eyes or behind the ears. Severe swelling accompanied with acute pain is inevitably present with frontal bone fractures. Other symptoms which may not directly indicate a skull injury are nausea, headache, loss of balance, stiffness in the neck, excessive drowsiness, loss of consciousness, irritability etc.
The treatment for frontal bone fracture may begin with medication for acute pain, followed by various tests for imaging such as CT scan and MRI scan. In almost all cases, where fractures cause depression in the bones, a surgery is mandatory. If the depression of bones puts pressure on the brain or a cerebrospinal fluid leakage is suspected surgery is performed immediately.