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Sinus injury: symptoms and diagnosis
Last reviewed: 23.04.2024
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Symptoms of traumas of the paranasal sinuses
When injuries of the paranasal sinuses, as a rule, always mark a concussion of the brain, manifested by loss of consciousness, nausea, vomiting. Usually there is a diffuse headache and pain in the area of trauma, short or prolonged epistaxis, requiring immediate stop by the anterior or posterior tamponade. With closed injuries of one frontal or maxillary sinus, there may be no concussion of the brain, and the patient's complaints can be limited only by soreness at the site of a palpation injury, by local edema of soft tissues and by short-term nasal bleeding. Over time, after reducing soft tissue edema, patients note a cosmetic defect (occlusion of the anterior wall of the frontal sinus). The general condition of the patient in the absence of severe neurological symptoms is usually satisfactory, In the first day there is a subfebrile temperature. If against a background of general antibiotic therapy there is no purulent complications, the body temperature is normalized.
Diagnosis of injuries of the paranasal sinuses
Based on the data of the examination, these radiation methods of investigation, it is necessary to determine the extent and extent of involvement of the paranasal sinuses in combination or without damage to the orbit, cheekbone complex and brain and, depending on this, to make an accurate diagnosis.
Physical examination
Includes external examination - determine the degree of edema of soft tissues in the area of injury, the presence of wounds. Palpation of the projection of the paranasal sinuses should be carried out carefully, teak as with excessive pressure there is a pronounced soreness and possibly aggravation of damage to their walls. With minimal edema of soft tissues, it is possible to determine the degree of cosmetic defect. If there is a projection of the paranasal sinuses of a soft tissue wound, probing through it will provide an opportunity to assess the depth of the wounded rope and the integrity of the sinus walls.
Laboratory research
General clinical examination, including a general blood test, urine biochemical blood test, ECG and other methods, makes it possible to assess the degree of blood loss, changes from other organs and systems, which can make adjustments to the tactics of the patient.
Instrumental research
Radiation methods of research, such as radiography, and especially CT and MRI in injuries of the paranasal sinuses are highly informative and indispensable. X-ray and CT data indicate that bone changes are not confined to the nasoglossal region and include the entire middle, and sometimes upper, face and structure of the anterior cranial fossa. There are direct and indirect radiographic signs of fractures of the naso-ophthalmic-latticed complex. To the direct attributes include the presence of the plane of the fracture, the displacement of the fragments, the divergence of the fragments. Indirect signs are the hemosyne of the latticed labyrinth, the maxillary and frontal sinuses, emphysema of the orbit and pnenmotsefaliya. CT of paranasal sinuses can show the amount of fragments, their size, the place and extent of their prolapse into the sinus, which plays an important role in determining the tactics of surgical intervention.
Ultrasound echography and endoscopic sinuscopy in some cases help to determine the amount of traumatic damage.
With anterior rhinoscopy, the degree of edema of the nasal mucosa, the site of mucosal rupture in the forelegs and the source of nasal bleeding, as well as the possible curvature of the septum of the nose are determined.
When the endoscopic examination of the nasal cavity, audit the posterior sections of the nasal cavity and the septum of the nose. In this case, the lines are identified with a microhemematous, corresponding to the fracture lines of the septum of the nose, as well as ruptures of the mucosa with the exposure of cartilage or bone,
If the maxillary sinus is damaged without displacement of the damaged walls in the presence of hemosyne, a diagnostic and diagnostic puncture of the sinus with aspiration of the contents is performed.
Indications for consultation of other specialists
With a combined injury affecting the eye socket, brain and cheekbone, the patient is treated together with other specialists by a neurosurgeon, ophthalmologist and maxillofacial surgeon.
In the presence of concomitant pathology of the cardiovascular system, lungs and other organs, consultation of the therapist, cardiologist, etc. Is necessary.
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