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Injury of the paranasal sinuses
Last reviewed: 23.04.2024
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Trauma of the paranasal sinuses (traumatic injuries of the paranasal sinuses) is a traumatic injury that leads, as a rule, to a fracture of the walls of a paranasal sinus with or without displacement of bone fragments, with the possible formation of a cosmetic, functional defect and hemorrhage into the paranasal sinuses.
ICD-10 code
S02.2 Fracture of the bones of the nose.
[Pathogenesis of traumas of the paranasal sinuses
Traumas of type 1 arise with a direct stroke in the region of the back of the nose. In less severe cases, the nasal bones and a portion of the orbital walls of the orbit are displaced into the interorbital space by a single segment or slightly disintegrating. These fractures can be nested and present difficulties in repositioning. In more typical trauma, the nasal processes of the frontal bone remain intact. The frontal process of the upper jaw is separated by the frontal-nasal suture, along the medial part of the infraorbital margin, displaced backward and laterally in the form of one or two fragments. The cartilaginous part of the nose, as a rule, does not suffer.
Symptoms of traumas of the paranasal sinuses
When injuries of the paranasal sinuses, as a rule, always mark a concussion of the brain, manifested by loss of consciousness, nausea, vomiting. Usually there is a diffuse headache and pain in the area of trauma, short or prolonged epistaxis, requiring immediate stop by the anterior or posterior tamponade. With closed injuries of one frontal or maxillary sinus, there may be no concussion of the brain, and the patient's complaints can be limited only by soreness at the site of a palpation injury, by local edema of soft tissues and by short-term nasal bleeding.
Classification of traumas of the paranasal sinuses
Depending on the strength of the impact and the characteristics of the wounding object of its orientation and the depth of penetration, the traumas of the paranasal sinuses may be open (with damage to the skin) or closed (without damaging the skin).
The identification of certain types of injuries led to the creation of a comparative classification of nasal-ophthalmic-trellis complex lesions.
Classification by Gruss JS includes unilateral and bilateral injuries (5 clinical types):
- Type 1 - isolated trauma of bones of the nasoglacial-lattice complex.
- Type 2 injury to bones of the naso-ophthalmic-trellis complex and upper jaw:
- a) only the central part of the upper jaw:
- b) the central and lateral parts of the upper jaw on one side;
- c) central and bilateral fracture of the upper jaw.
- Type 3 - extensive injury of the nasoglacial-lattice complex:
- a) in combination with craniocerebral trauma;
- b) in combination with fractures Fort-1 and Fort-2.
- Type 4 - trauma of the naso-orbital-trellis complex with the orbital offset:
- a) eye-orbital displacement:
- b) orbital dystopia.
- Type 5 - trauma of the naso-ophthalmic-lattice complex with loss of bone tissue.
Screening
Identification of persons with traumatic injuries of the paranasal sinuses is performed taking into account complaints of pain, deformation in the area of the projection of the paranasal sinuses, data of anamnesis (trauma) and examination - soft tissue edema in the region of the paranasal sinus, deformation of the anterior and lower walls of the frontal sinus, tenderness and crepitus of the bony fragments during palpation, the presence of bruises, bruising in the area of trauma.
What do need to examine?
How to examine?
The objectives of treating paranasal sinus injuries
Eliminate the cosmetic defect resulting from trauma, and restore the functional state of the paranasal sinuses and nose in order to prevent posttraumatic inflammatory diseases of the paranasal sinuses that lead to formidable intracranial and intraocular complications.