Suspect frontal bone injury. Initial imaging following primary survey. Representing 5% to 15% of all facial fractures, frontal bone fractures are often the result of high-energy blunt trauma, such as motor vehicle collisions, assaults, and significant falls [30]. Thick cortical bone comprises the anterior table of the frontal sinus, allowing it to withstand up to 1,000 kg of force before fracturing, rendering it the sturdiest bone in the face [31]. In contrast, the posterior table of the frontal sinus, separating the sinus from the anterior cranial fossa, is relatively easily fractured secondary to its thin, delicate nature. One-third of injuries are isolated to the anterior table, whereas two-thirds involve both anterior and posterior tables [31]. Injuries along the inferomedial aspect of the frontal sinus and anterior ethmoids may cause occlusion of the nasofrontal duct leading to potential mucocele formation and possibly osteomyelitis [9,15,22,31-33]. Likewise, fractures through the medial aspect of the frontal sinus floor typically involve the cribriform plate and fovea ethmoidalis and may result in cerebrospinal fluid (CSF) leak or chronic sinusitis. Fractures through the lateral part of the frontal sinus floor may involve the orbital roof. Imaging of Facial Trauma Following Primary Survey CT Maxillofacial Multidetector CT (MDCT) is useful in diagnosing maxillofacial injuries [2,30,31,37-43]. MDCT offers superb delineation of osseous and soft-tissue structures. CT provides high image resolution with thin-section acquisitions allowing for the detection of subtle nondisplaced fractures of the facial skeleton. Also, CT offers multiplanar and 3-D image reconstructions, allowing for better characterization of complex fractures. In particular, many surgeons find the 3-D reformations to be critical in their preoperative planning [13,15,21,39,41,44-46]. CT allows for a faster acquisition time than other modalities such as radiography and MRI.
Imaging of Facial Trauma Following Primary Survey. Suspect frontal bone injury. Initial imaging following primary survey. Representing 5% to 15% of all facial fractures, frontal bone fractures are often the result of high-energy blunt trauma, such as motor vehicle collisions, assaults, and significant falls [30]. Thick cortical bone comprises the anterior table of the frontal sinus, allowing it to withstand up to 1,000 kg of force before fracturing, rendering it the sturdiest bone in the face [31]. In contrast, the posterior table of the frontal sinus, separating the sinus from the anterior cranial fossa, is relatively easily fractured secondary to its thin, delicate nature. One-third of injuries are isolated to the anterior table, whereas two-thirds involve both anterior and posterior tables [31]. Injuries along the inferomedial aspect of the frontal sinus and anterior ethmoids may cause occlusion of the nasofrontal duct leading to potential mucocele formation and possibly osteomyelitis [9,15,22,31-33]. Likewise, fractures through the medial aspect of the frontal sinus floor typically involve the cribriform plate and fovea ethmoidalis and may result in cerebrospinal fluid (CSF) leak or chronic sinusitis. Fractures through the lateral part of the frontal sinus floor may involve the orbital roof. Imaging of Facial Trauma Following Primary Survey CT Maxillofacial Multidetector CT (MDCT) is useful in diagnosing maxillofacial injuries [2,30,31,37-43]. MDCT offers superb delineation of osseous and soft-tissue structures. CT provides high image resolution with thin-section acquisitions allowing for the detection of subtle nondisplaced fractures of the facial skeleton. Also, CT offers multiplanar and 3-D image reconstructions, allowing for better characterization of complex fractures. In particular, many surgeons find the 3-D reformations to be critical in their preoperative planning [13,15,21,39,41,44-46]. CT allows for a faster acquisition time than other modalities such as radiography and MRI.