Paranasal sinus injuries: treatment

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.

Indications for hospitalization

Isolated or combined lesions of the paranasal sinuses.

Non-medicamentous treatment of injuries of the paranasal sinuses

With closed lesions of the paranasal sinuses in the first 5-6 hours after injury, ice is applied to the area of injury, in the case of epistaxis, anterior loop or posterior tamponade of the nose can be used. If the grating labyrinth and sphenoid sinus are damaged, hemosyne is allowed against the backdrop of conservative treatment. With hemosyne of the frontal sinus without cosmetic defect and displacement of bone fragments, conservative treatment is indicated.

Medicamentous treatment of traumas of paranasal sinuses

When the brain is concussed, bed rest is prescribed in an elevated position (semisidea), dehydration means (intravenous administration of 40% dextrose solution, hypertonic solutions of calcium chloride and sodium chloride, as well as furosemide, acetazolamide), sedatives and a diet with limited fluid intake. Assign non-narcotic analgesics (metamizole sodium, tramadol), sedatives (oxazepam, phenobarbital). To combat wound infection and prevent secondary complications, general antibiotic therapy is used, the advantage is given to cephalosporins of II-III generation. Also, haemostatic and symptomatic therapy is performed. It is mandatory to introduce tetanus antitetanus according to the scheme.

Surgical treatment of injuries of the paranasal sinuses

The tactics of treatment depend on the nature and depth of the trauma, the severity of general and neurologic symptoms. All surgical interventions on damaged paranasal sinuses should be performed early in the post-trauma period (1-14 hours). In case of trauma with damage to soft tissues and bone structures of the facial part of the skull, primary surgical treatment is performed.

With penetrating injury of the frontal sinus with the presence of a small bone defect in its anterior wall, a revision and endoscopic examination of the sinus is performed through the wound channel. If the aperture of the frontal sinus is intact, the mucous membrane of the sinus is retained, the wound is sutured with a cosmetic suture and the sinus is placed in the sinus through the wound channel, through which, for 3-4 days, the antiseptic solutions are washed with a sinus.

With a closed fracture of the anterior, lower and even posterior frontal sinus wall without signs of rinolikvorei and brain damage, it is recommended to perform frontal sinus wall plasty. The access to the damaged walls is the minimum cuts of the skin in the region of the greatest wall walling. Further, the damaged area is inspected and a conglomerate of bone fragments is repaired by a traction movement through the small hole through the small hole. Through the opening, the sinus is examined with an endoscope and if there is no damage to the aperture of the frontal sinus (always revealed with a fracture of only the anterior and in most cases of the antero-lower wall) and the stability of the repaired wall, the operation is completed by applying a cosmetic suture to the wound. With mobility, and especially separation from each other fragments, it is necessary to make them fixation to each other and to the surrounding carbs of the whole frontal bone. To do this, surgical burs along the edges of fragments and intact frontal bone make milling holes through which a non-absorbable thread fixes fragments to the edges of the defect and to each other. In some cases, in order to avoid further failure of the formed wall, it is necessary additionally to fix the non-absorbable filament to the skin of the frontal region. When the traumatic edema of the mucous membrane of the sinus is expressed, even with the functioning aperture of the frontal sinus, a sinus drainage is established, through which, for 2-5 days, the sinus is washed with antiseptic solutions.

With considerable open injuries of the frontal sinus, in most cases a radical operation is performed, consisting in removal of the mucous membrane and bone fragments with the formation of the aperture of the frontal sinus and fixation of drainage according to B.S. Preobrazhensky for 3 weeks (a rubber tube with a diameter O, 6-0.8 cm, connecting the frontal sinus and the nasal cavity, fixed with a roller on the skin next to the incision). With careful examination and sounding of the posterior frontal sinus wall, it is possible to reveal its fracture, which requires exposure of the dura mater. Identification of cerebrospinal fluid at this site serves as an indication for suturing the rupture with the plastic of the defect.

With penetrating wounds of the maxillary sinus with a slight defect in the anterior wall, endoscopic examination of the sinus is also performed, with preservation of the mucous membrane and installation of drainage through the lower nasal passage. Rapa is sutured as much as possible with a cosmetic suture.

With open damage to the maxillary sinus with fragmentation of the anterior, upper and other walls, a radical operation is shown, consisting in the formation of the sinus sinus with the nasal cavity below the inferior nasal shell. In case of damage to the orbital wall with prolapse of the orbital fiber in the sinus, considering that in the future it is possible to form a cosmetic defect (ocellation of the eyeball) and diplopia, plasticize this wall using artificial materials (titanium plates, etc.). If the orbital wall is damaged, it is recommended to keep the bone fragments and re-arrange them by inflating a bulk rubber bulb in the sinus. In addition, the front wall is formed from large bone fragments fixed between themselves and the entire edges of the anterior wall with a non-absorbable filament. The balloon is filled with 15-20 ml of radiocontrast substance, which allows further x-ray monitoring of the full filling of the sinus with a balloon and sufficient reposition of the walls. The tube of the balloon is withdrawn through an artificial fist outward and fixed to the cheek. The balloon should be in the bosom for 10-14 days.

Further management

The term of hospitalization of patients depends on the degree of involvement of the paranasal sinuses and the presence of combined damage to other important organs. If the primary surgical treatment of the face wounds was performed, the stitches are daily treated with a solution of brilliant green or iodine and removed after 7-8 days by patients who underwent radical surgery on the maxillary sinus, in the postoperative period (7-10 days), wash the sinuses with antiseptic solutions through the formed artificial anastomosis. Patients who underwent a radical surgery in the frontal sinus are washed daily by the frontal sinus through a drainage tube, which is removed after 21 days. With gentle plastic surgery on the frontal sinus, the fixing sutures on the skin are removed after 3-7 weeks. After discharge from the hospital, the patient is observed at the otorhinolaryngologist in the polyclinic at the place of residence.

It is necessary to inform the patient that he should observe a sparing regimen within a month after injury, protect himself and do not feel the area of injury or place of operation on his own, nor should he be marked strongly (prevention of subcutaneous emphysema). Exclude physical activity, visiting the sauna, sauna. It is advisable to use vasoconstrictive drops in the nose and for 7-10 days. Within one month after injury, it is recommended to take sinupret according to the scheme and conduct an independent nasal shower with the use of 0.9% sodium chloride solution, seawater preparations, etc.

Forecast

In the case of isolated closed damage to the paranasal sinuses, the prognosis is favorable; in severe combined trauma depends on the degree of damage to the brain, orbit and other structures, as well as possible purulent complications. Approximate terms of incapacity for work are 20-30 days from the date of surgery.

Prevention

It is necessary to avoid blows to the face when doing sports, traffic accidents, etc.

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