Plastic Surgery Research Council
Members Only  |  Contact  |  PSRC on Facebook

Back to Annual Meeting Program


SEVERE INFECTIOUS COMPLICATIONS FOLLOWING FRONTAL SINUS FRACTURE: THE IMPACT OF OPERATIVE DELAY AND PERI-OPERATIVE ANTIBIOTIC USE
Presenter: Justin L Bellamy, BS
Co-Authors: Molendijk J; Reddy SK; Flores JM; Mundinger GS; Manson PN; Rodriguez ED; Dorafshar AH
Johns Hopkins SOM

Purpose: To investigate whether delay in operative management of frontal sinus fractures is associated with increased serious infectious complications. The effects of prolonged peri-operative antibiotics, nasofrontal outflow tract obstruction (NFOT), and posterior table involvement were also examined.

Methods: Retrospective chart review was performed for 242 consecutive patients with surgically managed frontal sinus fractures who presented to the R Adams Cowley Shock Trauma Center between 1996-2011. Patient demographics, surgical management, hospital course, and complications were recorded. All CT imaging was reviewed to evaluate involvement of the posterior frontal sinus wall and NFOT. Serious infectious complications included meningitis, encephalitis, brain abscess, frontal sinus abscess, and osteomyelitis. Delayed operative intervention was defined as greater than 48-hours from admission. Relative risk for each exposure was obtained using multivariable logistic regression analysis adjusting for the strongest covariates.

Results: There were 14 (5.8%) serious infections. All patient with serious infections had involvement of both the posterior table of the frontal sinus and nasofrontal outflow tract (NFOT) obstruction. The cumulative incidence of serious infection in these patients with both posterior table and NFOT involvement was 10.8%. Logistic analysis showed that operative frontal sinus management delayed beyond 48-hours was associated with a 4.03-fold increased risk for serious infection (P<0.05); intraventricular catheter use and acquired soft-tissue infection conferred a 4.09-fold (P<0.05) and 5.10-fold (P<0.001) increased risk, respectively. Antibiotic use beyond 48-hours post-operatively was not associated with fewer serious infections.

Conclusion: Delay in operative management of frontal sinus fractures in those that require operative intervention is associated with increased serious infectious complications. Overall, prolonged antibiotic use does not significantly reduce infection risk and should be reserved for those with delayed intervention, intraventricular catheters, or soft-tissue infection.


Back to Annual Meeting Program