Medical expert of the article
New publications
Paranasal sinus injuries - Causes and pathogenesis
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Causes of Sinus Injuries
A fracture of the walls of the paranasal sinus can occur as a result of various types of injuries:
- domestic (criminal, falling from one’s own height, falling as a result of an epileptic seizure or while intoxicated);
- sports (mainly when practicing boxing, various types of martial arts, etc.);
- transport (as a result of a road traffic accident);
- industrial (mainly due to failure to comply with safety regulations);
- military injuries.
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.
Type 2 injuries occur with a direct blow to the bone-cartilaginous part of the nose and the central part of the maxilla. In addition to the listed fractures, there are extensive crushing of the perpendicular plate, nasal crest, vomer and central part of the maxilla, cartilaginous part of the nasal septum, which leads to a saddle-shaped deformation of the nose. Type 2a injury occurs with a direct central blow to the midface. With type 2b injury, the blow is tangential. With type 2c fracture, the force directed to the central part of the midface is so powerful that it leads not only to a backward displacement of the frontal part of the maxilla, but also spreads in the lateral directions. Type 2c injury leads to the most severe deformations of the naso-orbital-ethmoid complex.
Type 3 injuries are considered a continuation of other craniofacial injuries. Type 3a is a frontobasilar injury, when a blow of significant force, falling on the frontal bone, the area of the paranasal sinus, the central part of the supraorbital rim, the glabella, can lead to concomitant injury to the nasoorbital-ethmoidal complex. The area of damage affects the anterior wall of the frontal sinus or includes the posterior wall of the frontal sinus, the roof of the ethmoid labyrinth and the ethmoid plate, the walls of the sphenoid sinus, leading to penetrating wounds, rhinocerebrospinal fluid rhinorrhea and damage to brain tissue. Type 3b fractures occur with a blow to the area of the upper or lower jaw, and the bones of the nasoorbital-ethmoidal complex are involved due to fractures passing through the medial parts of the orbit and the bridge of the nose.
Type 4 injuries involve damage to the naso-orbital-ethmoid complex with downward and lateral displacement of the globe and orbit. In a type 4a fracture, the orbit is separated from the naso-ethmoid complex laterally and inferiorly due to combined fractures of the zygomatic bone and maxilla. The lower two-thirds of the orbit and its contents are displaced downward and outward. A type 4b fracture involves type 4a damage combined with a supraorbital fracture, causing true orbital dystopia.
Type 5 injuries are characterized by extensive crushing or loss of bone tissue through defects in the integumentary tissues.