Paranasal sinus injuries: causes and pathogenesis

Causes of traumas of the paranasal sinuses

Fracture of the walls of the paranasal sinus can occur as a result of various types of injuries:

• household (criminal, falling from the height of its own growth, burning and the result of an epileptic fit or in a state of intoxication);
• sports (mainly in boxing, various types of martial arts, etc.);
• transport (as a result of a traffic accident);
• production (mainly due to non-compliance with safety regulations);
• military trauma.

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.

Traumas of type 2 arise with a direct impact on the bone-cartilaginous part of the nose and the central part of the upper jaw. In addition to the listed fractures, there are extensive fractures of the perpendicular plate, nasal crest, vomer and the central part of the upper jaw, the cartilaginous part of the septum of the nose, which leads to saddle-shaped deformation of the nose. Trauma type 2a occurs with a direct central stroke in the area of the middle zone of the face. In a type 2b injury, the blow is tangent. With a type 2b fracture, the force directed to the central part of the middle zone is so powerful that it leads not only to the displacement of the frontal part of the upper jaw back, but also spreads in the lateral directions. Trauma type 2c leads to the most severe deformities of the nocicepto-lattice complex.

Injuries of type 3 are considered as a continuation of other craniofacial lesions. Type 3a is a fronto-basilar trauma, when a significant force impact on the frontal bone, the area of the paranasal sinus, the central part of the supraorbital margin, the nadper, can lead to concomitant injury to the nasoglacial-lattice complex. The area of damage affects the front wall of the frontal sinus or includes the posterior frontal sinus wall, the roof of the grating labyrinth and the grating plate, the walls of the sphenoid sinus, leading to penetrating wounds, rinolikvoree and damage to brain tissue. Fractures of type 3b occur when they strike the upper or lower jaw, and the bones of the lumpy-latticed complex are involved due to fractures passing through the medial parts of the orbit and the back of the nose.

Injuries of type 4 include damage to the naso-ophthalmic-trellis complex with a shift of the eyeball and the orbit down and sideways. With a type 4a fracture, the orbit separates from the naso-latticelial complex from the side and from below due to the combined fractures of the malar bone, the upper jaw. The lower two-thirds of the orbit and its contents shift down and out. Fracture type 4b includes lesions of type 4a in combination with the supraorbital fracture, causing true orbit dystopia.

Injuries of type 5 are characterized by extensive fragmentation or loss of bone tissue through defects in the cover tissues.