Trauma to the paranasal sinuses

Trauma of the paranasal sinuses (traumatic damage to the paranasal sinuses) is a traumatic injury that usually results in a fracture of the walls of a particular 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 nasal bones.

Epidemiology

According to various studies, up to 53% of all ENT injuries are due to injuries to the nose and paranasal sinuses, of which half of the cases involve damage to the frontal sinuses. They are more common in men aged 15-40 years.

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Pathogenesis of paranasal sinus injuries

Type 1 injuries occur with a direct blow to the nasal dorsum. In less severe cases, the nasal bones and part of the medial orbital walls are displaced into the interorbital space as a single segment or are slightly fragmented. These fractures may be impacted and present difficulties in repositioning. In a more typical injury, the nasal processes of the frontal bone remain intact. The frontal process of the maxilla is separated along the frontonasal suture, along the medial part of the infraorbital margin, and is displaced posteriorly and laterally in the form of one or two fragments. The cartilaginous part of the nose is usually not affected.

Trauma of the paranasal sinuses - Causes and pathogenesis

Symptoms of Sinus Injuries

In case of paranasal sinus injuries, as a rule, a concussion of the brain is always noted, manifested by loss of consciousness, nausea, and vomiting. Usually, diffuse headache and pain in the area of injury, short-term or prolonged nosebleeding, requiring urgent stopping with anterior or posterior tamponade, are observed. In case of closed injuries of one frontal or maxillary sinus, there may not be a concussion of the brain, and the patient's complaints may be limited to pain at the site of injury upon palpation, local edema of soft tissues, and short-term nosebleeding.

Sinus Injuries - Symptoms and Diagnosis

Classification of paranasal sinus injuries

Depending on the force of the impact and the characteristics of the wounding object, its direction and depth of penetration, injuries to the paranasal sinuses can be open (with damage to the skin) or closed (without damage to the skin).

The identification of certain types of injuries has led to the creation of a comparative classification of injuries to the naso-orbital-ethmoid complex.

The classification according to Gruss JS includes unilateral and bilateral injuries (5 clinical types):

• Type 1 - isolated injury to the bones of the naso-ethmoid complex.
• Type 2 - trauma to the bones of the naso-orbital-ethmoid complex and maxilla:
  • 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 trauma to the naso-ethmoid complex:
  • a) in combination with traumatic brain injury;
  • b) in combination with fractures For-1 and For-2.
• Type 4 - trauma to the naso-orbital-ethmoid complex with displacement of the orbit:
  • a) oculo-orbital displacement:
  • b) orbital dystopia.
• Type 5 - trauma to the naso-orbital-ethmoid complex with loss of bone tissue.

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Screening

Identification of individuals with traumatic injuries of the paranasal sinuses is carried out taking into account complaints of pain, determination of deformation in the projection area of the paranasal sinuses, anamnesis data (trauma) and examination - swelling of soft tissues in the paranasal sinus area, deformation of the anterior and inferior wall of the frontal sinus, pain and crepitation of bone fragments upon palpation, the presence of hematomas, bruises in the area of injury.

Goals of Treatment for Sinus Trauma

Eliminate the cosmetic defect resulting from the injury and restore the functional state of the paranasal sinuses and nose in order to prevent post-traumatic inflammatory diseases of the paranasal sinuses, leading to formidable intracranial and intraorbital complications.

Sinus Injuries - Treatment