Srbislav Pajić, Tanja Boljević, Svetlana Antić, Milutin Mrvaljević, Milena Cojić, Jovan Janić, Zoran Pešić

DOI Number
First page
Last page


In the trauma of craniofacial junction, frontal sinus wall fractures take up 5-15% of all facial bone fractures. The most common mechanism of their occurrence comes as a result of the action of high-energy impact force on the frontal area. Treatment of the injuries in frontal-orbital-ethmoidal regions largely depends on the responsible experts (otolaryngologist, maxillofacial surgeon or neurosurgeon)  in all cases, because of the implementation of diverse surgical technics  in order to achieve the best possible outcome for the patient. Bearing in mind the complex anatomical features of this region, it is clear that these procedures are often accompanied by series of possible complications, all of which are certainly neurosurgical. These can be expressed as early or late complications, and  could be characterized by diverse clinical manifestations. Mucocele is formed, either due to partial obstruction of the sinus mucosa or due to the obstruction of the frontal sinus. The long term existence of mucocele and its progressive growth will result in strong pressure on the adjacent bones, and lead to their destruction followed by the process-propagation into  surrounding tissues  and spaces. In the further development  if a bacterial contamination is detected, it will lead to the purulent inflammatory process and clinical picture of mucopyocele. In most clinical cases with complications proptosis and diplopia are dominant ophthalmic manifestations. In this paper we will  present our experience in the treatment of proptosis and diplopia, as well as the ways of diagnostic evaluation  in order to achieve timely diagnosis  and assure swift healing of patients.


diplopia, proptosis, frontal sinus, craniofacial trauma

Full Text:



Diaz F, Latchow R, Duvall A J 3rd, Quick C A,Erickson D L. Mucoceles with intracranial and extracranial extensions. J Neurosurg 1978; 48:284-288.

Alberti P W, Marshall H F, Black J I. Fronto-ethmoidal mucocele as the cause of unilateral proptosis.Br J Ophthalmol 1968; 52:833-838.

Sabari R,Singh SP, Reddy N, Post Traumatic Frontal Swelling with Propoptosis and Diplopia. Arch CranOroFac Sc. 2013; 1(1):1-5

Abrahamson I A, Baluyot S T, Tew J M, Scioville G. Frontal sinus mucocele. Ann Ophthalmol 1979; 2:173-178.

Avery G, Tang R A, Close G C. Ophthalmic manifestations of mucoceles. Ann Ophthalmol 1983; 15:734-737.

Kaufman S J. Orbital mucopyoceles. Two cases and a review. Surv Ophthalmol 1981; 25:253-262.

Fazakas A. A contribution to the symptomatology of a mucocele in ophthalmology. Ophthalmologica 1953; 25:175-182.

Jain SA, Manchio JV, Weinzweig J. Role of the sagittal view of computed tomography in evaluation of the nasofrontal ducts in frontal sinus fractures. J Craniofac Surg 2010; 21(6):1670-1673.

Mortada A. Radiography in mucocele of the frontal sinus. Am J Ophthalmol 1967; 64:1162-1167.

Iliff C E. Mucoceles in the orbit. Arch Ophthalmol 1973; 89:392-395.

Donald PJ, Bernstein L. Compound frontal sinus injuries with intracranial penetration. Laryngoscope 1978; 88(2 Pt 1):225-232.

Lee JC, Andrews BT, Abdollahi H, Lambi AG, Pereira CT, Bradley JP. Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures. J Craniofac Surg 2015; 26(1):e64-e7.

Fujitani T, Takahashi T, Asai T. Optic nerve disturbance caused by frontal and frontoethmoida mucopyoceles. Arch Otolaryngol 1984; 110:267-269.

Ehrenpreis S J, Biedlingmaier J F. Isolated third nerve palsy associated with frontal sinus mucocele. Neuro-ophthalmol 1995; 15:105-108.

Bordley JE, Bosley WR. Mucoceles of the frontal sinus: causes and treatment. Ann Otol Rhinol Laryngol. 1973 Sep-Oct. 82(5):696-702.

Gerbino G, Roccia F, Benech A, Caldarelli C. Analysis of 158 frontal sinus fractures: current surgical management and complications. J Craniomaxillofac Surg 2000; 28(3):133-139.

Yavuzer R, Sari A, Kelly CP, et al. Management of frontal sinus fractures. Plast Reconstr Surg 2005; 115(6):79e-93e; discussion 94e-95e.

Cormier J, Manoogian S, Bisplinghoff J, Rowson S, Santago A, McNally C. The tolerance of the frontal bone to blunt impact. J Biomech Eng 2011 Feb. 133(2):021004.

Yoo A, Eun SC, Baek RM. Transcutaneous reduction of frontal sinus fracture using bony tapper device. J Craniofac Surg 2012; 23(6):1835-1837.

Choi M, Li Y, Shapiro SA, Havlik RJ, Flores RL. A 10-year review of frontal sinus fractures: clinical outcomes of conservative management of posterior table fractures. Plast Reconstr Surg 2012; 130(2):399-406.

Garg RK, Afifi AM, Gassner J, et al. A novel classification of frontal bone fractures: the prognostic significance of vertical fracture trajectory and skull base extension. J Plast Reconstr Aesthet Surg 2015; 68 (5):645-653.

Stanwix MG, Nam AJ, Manson PN, Mirvis S, Rodriguez ED. Critical computed tomographic diagnostic criteria for frontal sinus fractures. J Oral Maxillofac Surg 2010; 68(11):2714-2722.

Kim YJ, Kim HR, Jun YJ, Seo BC. Usefulness of vascularized galeal frontalis myofascial flap as treatment for postoperative infection in frontal sinus fracture. J Craniofac Surg 2011; 22(5):1968-1671.

Noury M, Dunn RM, Lalikos JF, Fudem GM, Rothkopf DM. Frontal sinus repair through a frontalis rhytid approach. Ann Plast Surg 2011; 66(5):457-459.

Massarelli O, Gobbi R, Soma D, Raho MT, Tullio A. An aesthetically possible alternative approach for craniomaxillofacial trauma: the "pretrichial incision". Craniomaxillofac Trauma Reconstr 2011; 4(3):161-170.

Muderris T, Bercin S, Sevil E, Kiris M. Management of frontal sinus fracture: reconstruction of the sinus with iliac bone graft. J Craniofac Surg 2013; 24(2):e194-e195.

Koento T. Current advances in sinus preservation for the management of frontal sinus fractures. Curr Opin Otolaryngol Head Neck Surg 2012; 20(4):274-279.

de Melo WM, Colete JZ, Mariano RC, Shinohara EH, Souza FA, Garcia IR Jr. Anterior pericranial flap for frontal sinus duct obliteration: is it a valuable resource? J Craniofac Surg 2013; 24(2):e147-e149.

Morais de Melo W, Koogi Sonoda C, Garcia IR Jr. Vascular pericranial graft: a viable resource for frontal sinus obliteration. J Craniofac Surg 2013; 24(1):e5-e7.

Bui TG, Bell RB, Dierks EJ. Technological advances in the treatment of facial trauma. Atlas Oral Maxillofac Surg Clin North Am 2012; 20(1):81-94.



  • There are currently no refbacks.

ISSN 0354-2017 (Print)

ISSN 2406-0526  (Online)