Swelling and bruising
The forehead swells, bruises appear around the eyes; there may be a wound on the skin.
CONDITION / FACE
Fracture of the frontal bone and frontal sinus.
Fracture of the frontal bone is an injury to the forehead, behind which lies the frontal sinus, a cavity connected to the nose. A fresh fracture is often combined with a head injury and requires urgent care, and the consequences - forehead depression or mucocele - can appear years later.
CONCEPTUAL VISUALIZATION- What it is
- A fracture of the forehead bone, often together with the walls of the frontal sinus behind it.
- How common
- 5–15% of all facial fractures; usually after a strong impact, most often in a road accident.
- The main risk
- Concomitant head injury; later - forehead depression, mucocele, infections.
- Who treats it
- A facial surgeon together with a neurosurgeon, an ENT doctor and an ophthalmologist.
01 / WHAT IS ITWhat is
What is
frontal sinus fracture.
Behind the forehead bone above the eyebrows lies the frontal sinus - a cavity with air. Its front wall is the bone that can be seen under the skin of the forehead, the back wall borders the brain, and a narrow channel below drains the mucus into the nose. Doctors call it the fronto-nasal channel.
Such fractures are rarer than other facial fractures: they account for 5–15% of all fractures of the facial skeleton. But this is usually the result of a very strong impact. According to a meta-analysis of 2,388 patients, half of the fractures (50.7%) occurred in a road accident, and 61.8% had intracranial trauma.
All treatment depends on which wall is broken and whether the canal is damaged. If only the front wall is broken, the main risk is forehead depression. If the channel or the back wall is damaged, infections, mucocele and leakage of cerebrospinal fluid.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
fracture presents.
Immediately after an injury, changes on the forehead can hide swelling. Some of the signs appear later — after months or even years.
A depression on the forehead
When the swelling subsides, a dent or step is visible on the forehead - this is what a displaced anterior wall looks like.
Cicatricial deformation of the foreheadClear liquid from the nose
Watery fluid dripping from the nose may be cerebrospinal fluid. Doctors call it liquorice.
eyes
Diplopia, impaired vision, swelling of the eyelids: the frontal sinus borders the orbit and is often broken together.
Fractures of the orbitMucocele
Years later, swelling appears above the eye, double vision. This mucocele is a cyst that stretches the sinus when the outflow of mucus is blocked.
03 / REASONSWhy does it occur?
Why does it occur?
and what is nearby.
The frontal sinus is usually broken by a very strong blow, and it rarely breaks on its own—there are often other injuries nearby.
Road accident and strong impact
Most frontal sinus fractures are the result of high-energy trauma, more often in young men.
Other facial fractures
In a series of 140 patients from a trauma center, 79% had a fractured orbit, 66% had a fracture of the upper jaw, and 64% had a fracture of the nose; 30% had eye injuries.
Post-traumatic deformation of the faceHead and neck injury
There is often an injury inside the skull, and in 16% of patients from the same series, there is also an injury to the cervical spine.
Damaged channel
If the fronto-nasal canal is broken or blocked, the mucus does not leave the nose - hence late inflammation and mucocele.
Chronic frontal sinusitis
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A fresh fracture of the frontal bone is always a reason for urgent care: the first thing to rule out is a brain injury. Do not drive to the hospital alone. According to the NHS, call 103 if you have any of the following symptoms after a stroke (with meningitis at the bottom of the list and any time later, even years later):
103 immediately if:
- the person has fainted and does not regain consciousness;
- cannot help falling asleep, eyes close by themselves;
- convulsions;
- a clear watery liquid flows from the nose or ear;
- impaired vision, double vision or impaired hearing;
- a dent on the forehead or something stuck in the wound;
- bleeding from the ear or bruising behind the ear;
- new numbness or weakness in any part of the body;
- impaired speech, gait or balance;
- behavior has changed: irritability, inattention, indifference to everything;
- impact at high speed, such as in a car accident, or falling from a height of more than 1 meter or 5 steps;
- at any time after the fracture — very severe headache;
- the neck is stiff and it hurts to look at the light;
- confusion or slurred speech;
- a rash that does not fade if a glass is pressed against it.
Do not delay:
Immediately to the reception department (do not get behind the wheel) after a fresh head injury, if there was vomiting, dizziness in the head, you briefly lost consciousness or you do not remember the events surrounding the injury, the headache does not go away, you are taking blood-thinning drugs, or the injury occurred while intoxicated. On the same day: if the fracture was a long time ago, and there is swelling above the eye or double vision, go to the doctor on the same day: this may be a sign of a mucocele. If the vision deteriorates or the eye protrudes forward, immediately go to the reception department. In the coming days: if you have been diagnosed with a fracture of the frontal sinus and you are being treated without surgery - a control examination and a CT scan in the terms prescribed by the doctor. Planned: depression on the forehead after healing, repeated sinusitis after a fracture - make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to treat
- Urgent review
First, consciousness and the condition of the brain, neck and eyes are assessed: these injuries are more dangerous than the fracture itself.
- CT
Computed tomography shows which wall of the sinus is broken, how far the fragments have moved and whether the canal is damaged.
- Liquorice
If a clear liquid is flowing from the nose, they check whether it is cerebrospinal fluid and look for the place of leakage.
- Eyes and other bones
Examination by an ophthalmologist and evaluation of fractures of the orbit, nose, and upper jaw.
- Control
After treatment, a follow-up CT scan, in particular to check whether the sinus is filling with air again.
06 / TREATMENTHow we treat
How we treat
frontal sinus fracture.
There is no single generally accepted algorithm, so the plan is made according to the structure of the fracture. The doctor evaluates three things: the front wall, the back wall and the canal leading to the nose. Some fractures are treated without surgery.
01
Without surgery
Small fractures.
- Follow-up
- If the fragments are almost not displaced, and the channel is not blocked, they are observed with control CT. According to a meta-analysis of 23 studies (2,911 patients), complications during observation occurred in 7% of cases.
- When there is no depression
- In a study of 125 patients, an isolated anterior wall fracture with a displacement of less than 4.5 mm did not result in late forehead depression, so such fractures can be treated without surgery.
- Liquorice
- The leakage of cerebrospinal fluid may stop within 10 days; if it lasts longer, surgery is considered.
02
Surgery
Displaced fragments, blocked channel, fracture of the back wall.
- Alignment and fixation
- The displaced front wall is returned to its place and fixed with titanium plates. In a series of 201 patients, 76.2% of those operated on were operated in this way.
- Obliteration
- If the channel is blocked, obliteration is considered: the sinus is filled and it no longer functions as a cavity.
- Cranialization
- With a severe, comminuted fracture of the back wall, it is removed, and the sinus becomes part of the skull cavity.
- Endoscopically
- Some fractures and liquefaction are treated through the nose with an endoscope. In a series of 46 patients (41 had fluid leakage), endoscopic closure was successful in 97.6% of cases.
- Risks
- The more severe the fracture, the higher the frequency of complications, no matter how it was treated: in a meta-analysis, it ranged from 9.4% after fixation with plates to 11% after cranialization.
03
Late effects
Months and years after the injury.
- Forehead sinking
- The late depression is leveled with own bone, titanium mesh, hydroxyapatite cement, or a PEEK implant. The method is chosen according to the severity and age of the fracture.
- Mucocele
- It can appear many years later - cases have been described 13, 22 and 35 years after the injury, so people at risk are advised to follow up for life.
- Infections
- Untreated or incomplete sinus fractures can be complicated by repeated sinusitis, osteomyelitis of the frontal bone, meningitis or brain abscess. Repeat operations are postponed until the infection has passed.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Fractures of the frontal bone and their consequences are treated at the Institute of Surgery of Dr. Valikhnovskyi in the "New Face" direction. The clinic is responsible for the bones and contour of the face; brain injury is handled by a neurosurgeon, eyes by an ophthalmologist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Titanium plates — displaced fragments are compared and fixed.
- Osteotomy — bones that have fused with displacement are dissected and rearranged.
- Contour of the forehead — a bone defect or depression is restored with one's own bone or an implant.
- Individual implants — from titanium or PEEK according to the 3D model, with mirror CT planning.
- Lipofilling — own fat aligns the soft tissues of the forehead after reconstruction.
- Scar correction — scars are excised and covered with local tissues.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend CT scans, reports and photos of the face before the injury - the doctor will pre-evaluate the situation.
- ConsultationExamination of the forehead, eyes and nose; if necessary, a new CT scan and consultations of related specialists.
- PlanIs an operation necessary, what to restore and with what, which specialists are involved.
- TreatmentFragment fixation, contour alignment or an individual implant — depending on the fracture.
- Follow-upFollow-up examinations and CT scans: some frontal sinus complications appear years later.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is surgery always necessary?
No. If the fragments are almost not displaced, and the sinus canal is not blocked, the fracture is often treated without surgery, with control CT.
A clear liquid flows from the nose after the impact. What is it?
It could be cerebrospinal fluid, a sign that the fracture has reached the meninges. Call 103.
The fracture has healed, but there is a dent on the forehead. Can it be fixed?
Yes. The late cavity is leveled with own bone, titanium mesh, cement or individual implant. The doctor will choose the method after a CT scan.
What is a mucocele and why is it talked about years later?
This is a cyst that stretches the sinus when the mucus does not drain into the nose. It can appear many years after the injury, so it is important to know its signs: swelling above the eye and double vision.
How much should be observed after a fracture?
For a long time Late complications can appear even after 10 years, so doctors advise long-term, and for people at risk - lifelong observation.
Will there be a scar?
A trace of the incision always remains. Access to the frontal bone, where possible, is made along the line of hair growth; some fractures are treated endoscopically, without an incision on the forehead.
Sources
18 sources · systematic reviews, meta-analyses, patient series, NHS and NICEshowCollapse
- Frontal sinus fracture management: a systematic review and meta-analysisInternational Journal of Oral and Maxillofacial Surgery, 2021doi:10.1016/j.ijom.2020.06.004 ↗
- Treatment of Frontal Sinus Fractures: A Systematic Review and Meta-analysisJournal of Oral and Maxillofacial Surgery, 2021doi:10.1016/j.joms.2021.06.013 ↗
- Frontal Sinus Fractures: Evidence and Clinical ReflectionsPlastic and Reconstructive Surgery Global Open, 2022doi:10.1097/GOX.0000000000004266 ↗
- Frontal Sinus Fracture Management Meta-analysis: Endoscopic Versus Open RepairJournal of Craniofacial Surgery, 2021doi:10.1097/SCS.0000000000007181 ↗
- Contemporary Management of Frontal Sinus FracturesOtolaryngologic Clinics of North America, 2025doi:10.1016/j.otc.2025.03.007 ↗
- Management of Aesthetic and Functional Deficits in Frontal Bone TraumaMedicina, 2022doi:10.3390/medicina58121756 ↗
- Frontal Sinus Fracture Management: A Single-Center 13-Year Retrospective AnalysisORL, 2025doi:10.1159/000548926 ↗
- A Review of Frontal Orbital and Frontal Sinus Fractures and Associated Ocular Injuries - Level I Trauma Center - University Hospital ExperienceJournal of Craniofacial Surgery, 2021doi:10.1097/SCS.0000000000007422 ↗
- Secondary Reconstruction of Frontal Sinus FractureArchives of Craniofacial Surgery, 2016doi:10.7181/acfs.2016.17.3.103 ↗
- Frontal Sinus Fractures: Management and ComplicationsCraniomaxillofacial Trauma & Reconstruction, 2019doi:10.1055/s-0038-1675560 ↗
- Repair of frontal sinus fractures: clinical and radiological long-term outcomesThe Journal of Laryngology & Otology, 2021doi:10.1017/S0022215121001006 ↗
- Post-trauma mucocele formation in the frontal sinus; a rationale of follow-upInternational Journal of Oral and Maxillofacial Surgery, 2004doi:10.1016/j.ijom.2004.01.019 ↗
- Frontal sinus fractures and cerebrospinal fluid leaks: a change in surgical paradigmCurrent Opinion in Otolaryngology & Head & Neck Surgery, 2020doi:10.1097/MOO.0000000000000602 ↗
- Treatment strategies for frontal sinus anterior table fractures and contour deformitiesJournal of Plastic, Reconstructive & Aesthetic Surgery, 2016doi:10.1016/j.bjps.2016.06.006 ↗
- Algorithms for the management of frontal sinus fractures: A retrospective studyJournal of Cranio-Maxillofacial Surgery, 2022doi:10.1016/j.jcms.2022.09.007 ↗
- Head injury and concussionNHS, 2025nhs.uk/conditions/head-injury-and-concussion ↗
- Head injury: assessment and early management (NG232)NICE, 2023nice.org.uk/guidance/ng232/chapter/Recommendations ↗
- MeningitisNHS, 2026nhs.uk/conditions/meningitis ↗
The figures on the page are from these sources.
After the impact
has the forehead changed?
Submit CT scans, discharges, and facial photos prior to the injury. The doctor will tell you whether and what treatment is needed.