Sinus injuries: causes, symptoms, diagnosis, treatment

Traumatic injuries of the paranasal sinuses are much more rare than injuries and injuries to the nose pyramid, but if they occur, it proceeds clinically much more severely. The causes of traumatism of the paranasal sinuses are the same as the pyramids of the nose. In the jaws of the maxillofacial and frontal areas, fractures of the anterior paranasal sinuses may occur, and with bruises of the frontal region and fractures of the base of the skull in the region of the anterior cranial fossa with or without breaks of the rigid meninges. In the case of blunt injuries, soft tissue lesions, cicatricial sinus wall fissures, closed and open fractures of the upper jaw, frontal, latticed, and sphenoid bones can occur, which are often accompanied by vibratory, comorbital and compression lesions of the brain. Symptoms and clinical course vary depending on the traumatic injury of one or another paranasal sinus.

Lesion of the frontal bone. The general condition is most often manifested by various signs of traumatic shock and the corresponding lesions of the brain. Locally: pain in the area of trauma, swelling and bruising, bruised and other wounds of soft tissues penetrating to the bone. At a fracture of a forward wall of a frontal sinus at a palpation the sharp pain and crefitation of fragments of a bone is felt. Often there is an emphysema of soft tissues in periorbital tissues, the face, etc. With bruises of the frontal bone and fractures of its walls, nosebleeds are often observed. In cases where there is a fracture of the brain wall with rupture of the solid meninges, nasal liquorrhea is observed. Radiography of the frontal bone allows to establish the character of the fracture, to reveal the condition of the base of the skull, the presence of hemosyne and subarachnoid hemorrhage in the anterior cranial fossa.

Gunshot and splinter wounds of the frontal bone are characterized by considerable severity of the lesion, as they are most often combined with wounds of the orbit and the frontal lobes of the brain. Such injuries are in the competence of neurosurgeons, and only those injuries of the frontal sinus, which are mostly tangential (tangential), breaking only the entire front wall of the frontal sinus and combined with wounds of the nasal cavity and lower parts of the latticed bone without penetrating the cranial cavity and rupture of the meninges , are treated in a specialized ENT department.

Frontal sinus injuries, especially penetrating both into the sinus itself, and into the cavity of the nose and skull, are fraught with severe complications, which are reflected in the classification of N.S. Blagoveshchenskaya (1972).

Classification of complications after injuries of the frontal sinus

• Suppurative complications after injuries of the frontal sinus.
  • Traumatic purulent-polyposic frontitis.
    • Fronts accompanied by extracerebral purulent complications:
      • frontal and epidural abscesses:
      • frontitis and SDA.
    • Fronts accompanied by intracerebral purulent complications:
      • frontal and intracerebral abscesses:
      • frontitis and suppuration of the cerebral cicatrix.
  • Limited purulent pachymeningitis in the frontal region.
• Non-nasal complications after injuries of the frontal sinus:
  • persistent nasal liquorrhea;
  • valve pneumocerephaly;
  • nasal bleeding.

Of the listed complications, the most frequent are purulent-polyposic frontitis and frontoethmoiditis. The most severe lesions of the frontal sinus, with intracerebral suppurative complications. In addition to the above complications, it should be noted such as acute inflammatory processes in the skin of the frontal region (erysipelas, furuncles, subcutaneous empyema, extending to the convectional integument) or in bone tissues (osteomyelitis), which can cause severe intracranial complications.

Combined injuries and injuries of the frontal and latticed bones are characterized by a special severity of the course, since 86% are accompanied by extra- or intradural lesions. Such lesions, especially involving the brain substance in the process, are accompanied by many neurological, mental and eye complications.

When injuries of the bone frontal-latticed array with the penetration of the wound channel into the anterior cranial fossa, into the orbital and infraorbital regions, a variety of neurological symptoms arise due to the lesion of the lesions on the base of the skull of the anterior cranial fossa, the most important of which is the substance of the frontal lobes with nerve centers , olfactory and optic nerves, as well as the first branch of the trigeminal nerve, the upper branches of the facial nerve and the nerves innervating the extraocular muscles - the oculomotor, bl kovoy and outlet. The defeat of these formations causes the corresponding symptoms (anosmia, amaurosis, paralysis of the eye, etc.).

Defects of the upper jaw can be open and closed (in relation to the maxillary sinus). Most often, there are everyday injuries caused by blunt strokes in the zygomatic area and the area of the upper alveolar process. Usually such traumas are accompanied by hemosynus, violation of the integrity of the teeth of the upper jaw, nosebleeds, concussion of the brain. Often fractures of the maxillary sinus are combined with bruises of the nose pyramid and fractures of its bones, as well as the malar bone, so such traumas are usually combined and, as a rule, the injured enter the department of maxillofacial surgery. Often, the trauma of the maxillary sinus occurs when teeth are extracted, mainly the upper 6th tooth, as well as when removing the basal cysts of the 5th, 6th and 7th upper teeth - a fistulous hole is formed in the hole, which is a sign of fluid entering the nose through hole. When the nose is blown, air from its cavity through the exit aperture of the maxillary sinus enters the sinus and out of it into the oral cavity through the perforated socket of the tooth.

Isolated fractures of the trellis and sphenoid sinus are very rare. Usually they are combined with fractures of the base of the skull and severe head injury. Gunshot wounds of the sphenoid sinus and latticed bone usually result in the death of the injured person at the site of injury.

The clinical course of traumatic lesions of the paranasal sinuses is determined primarily by the severity of the trauma, repercussion traumatic brain lesions and the type of damage caused by the traumatic object. As a rule, with untimely rendering of specialized surgical care and carrying out antibacterial treatment, such traumas are complicated by severe maxillofacial, orbital abscesses and phlegmon. With injuries of the nasal cavity with a fracture of the base of the skull and access to the infection, the cerebral membranes develop severe meningoencephalitis, whose prognosis is on the verge of unfavorable.

Treatment of trauma to the paranasal sinuses. In the case of light injuries of the paranasal sinuses without open fractures and malfunctioning of the mucous membrane, the treatment is usually nonoperative (systemic antibiotic treatment, with hemosyne - puncture with blood elimination and sine administration of antibiotics, vasoconstrictor drugs - into the nasal cavity, antihistamines).

For injuries of moderate severity, accompanied by deforming fractures of the paranasal sinuses, with the wound of soft tissues, the same surgical interventions are used as for chronic suppurative inflammatory diseases of these sinuses. Primary surgical treatment should be carried out in the mode of specialized care with reposition of fragments, plastic elements and optimal drainage of sinuses. Simultaneously, systemic anti-inflammatory and analgesic treatment is performed.

In severe injuries with a fracture of the base of the skull and the threat of meningoencephalitis, the victims are sent to the neurosurgical department. In the surgical intervention with such combined injuries, it is advisable to participate in a rhinologist and maxillofacial surgeon.

The prognosis is very cautious for severe injuries; outcome depends on the timing of surgical intervention and the timeliness and intensity of antibiotic treatment. In the case of lung injury and moderate severity, the prognosis is usually favorable.