A fracture of the frontal sinus may create a series of defects that can result in pneumocephalus. A delayed onset of pneumocephalus can occur if a problem develops in how the injury was initially managed or if a bony defect progresses over time.
History: fracture of the frontal sinus
Presentation may include:
(1) progressive headache
(2) CSF rhinorrhea
(3) meningitis
(4) flapping scalp sign (fluctuation of the scalp over the frontal bone during the Valsalva maneuver)
A head CT or MRI will show pneumocephalus.
Pathogenesis:
(1) resorption or other problem with initial repair
(2) progression of a subcritical injury over time
Risk factors:
(1) high pressure event (nose blowing, sneezing, coughing, straining)
(2) use of resorbable material to obliterate the frontal sinus
(3) failure to stabilize the fracture
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