Surgical management of paediatric frontal fractures with and without sinus pneumatisation: a multicentre study

OBJECTIVE(S): Paediatric frontal fractures are uncommon injuries that may lead to significant complications. This study aimed to analyse patterns, surgical management, and outcomes of paediatric frontal sinus fractures in 14 maxillofacial centers worldwide. METHODS: This multicentric retrospective study included patients ≤ 16 years of age operated for frontal fractures from January 2011 and December 2022. Collected data included: age, sex, cause of injury, site and type of fracture, surgical approach, nasofrontal outflow tract (NFOT) involvement, treatment, and outcome. Patients were divided based on the absence (group A) or presence (group B) of frontal sinus pneumatisation. Minimum follow-up was 6 months. RESULTS: Thirty-two patients (mean age, 11.5 years) were included. Road traffic accidents were the main cause of injury (50%). In group A, 5/6 patients underwent open reduction and internal fixation (ORIF). In group B, 15 patients reported an isolated anterior table fracture, fixated with ORIF in 88% of cases. Nine patients reported combined anterior + posterior table fractures, 67% managed with anterior table fixation and cranialisation. One patient had an isolated posterior table fracture and underwent cranialisation. NFOT involvement was statistically associated with combined fractures (67%) (p=0.028) and managed with obliteration in 8/9 cases. Residual contour deformities of the frontal convexity were the most frequent complication (19%). CONCLUSION: The surgical management varied by fracture site and sinus pneumatisation. Clinical outcomes were generally favourable, with residual contour deformities being the most common complications. Centers showed consistent approaches, but further multicenter studies are needed to establish definitive treatment strategies. Level of evidence: 3