Abstract: A Review of Frontal Sinus Fractures and Associated Ocular Complications - The McGill Experience and Novel Treatment Algorithm
Bibliographic record
Abstract
INTRODUCTION: Frontal fractures result from high force injuries and have significant morbidity and mortality. By gaining a thorough understanding of the mechanism, associated injuries and related complications of this diagnosis, clinicians will be better able to provide optimal treatment of these patients and ultimately improve outcome. The purpose of this study was to evaluate our McGill University Health Centre (MUHC) experience with frontal bone fractures and associated injuries. METHODS: A comprehensive review of the MUHC database was performed. All adult patients presenting with frontal sinus fracture were identified. Patient demographics, mechanism of trauma, fracture type, associated facial injuries, management and related complications were identified. All cases of ocular injury or sequalae were identified and an in-depth review was performed. RESULTS: Between 2008 and 2014, 1277 patients presented to the MUHC Level 1 trauma center with a facial fracture, 140 of whom had a frontal sinus fracture and met the inclusion criteria. Mean age was 43.5 years, 90% were male and mean hospitalization time was 16.2 days, including those who required prolonged ICU admissions. Among the patients treated surgically, only 2 required re-operation for their facial fractures (1.4%). A significant proportion suffered concomitant craniomaxillofacial fractures including orbital (79%), maxillary (66%), nasal (64%), zygomaticomaxillary complex (34%), nasoorbitoethmoid (31%), Lefort types I-III (18%) and mandibular (8%). Associated cervical spine injuries were seen in 16% of patients. Ocular injuries were present in 29% of subjects. The most frequently ocular pathologies were optic neuropathy, ptosis and orbital hematoma, followed by subconjunctival hemorrhage, mydriasis, exotropia, retinal injury, gaze limitation and rectus entrapment. Fifty percent were extraocular in nature, 30% were due to mechanical force, and 6% involved palsy of cranial nerves. CONCLUSION: Due to the intimate association of the frontal bones with the brain and the orbits, frontal sinus fractures rarely occur in isolation and demand a sophisticated multidisciplinary approach. Given this high rate of ocular injury, the authors propose a modified treatment approach and algorithm. In order to optimize the treatment of systemic injuries and preserve eyesight, fracture repair may need to be postponed and performed in a delayed fashion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".