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Paranasal sinus injuries - Symptoms and diagnosis
Last reviewed: 06.07.2025
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Symptoms of Sinus Injuries
In case of paranasal sinus injuries, as a rule, a concussion is always noted, manifested by loss of consciousness, nausea, and vomiting. Usually, diffuse headache and pain in the area of injury, short-term or prolonged nosebleeding are observed, requiring urgent stopping with anterior or posterior tamponade. In case of closed injuries of one frontal or maxillary sinus, there may not be a concussion, and the patient's complaints may be limited to pain at the site of injury upon palpation, local edema of soft tissues, and short-term nosebleeds. Over time, after the edema of soft tissues decreases, patients note a cosmetic defect (depression of the anterior wall of the frontal sinus). The general condition of the patient, in the absence of pronounced neurological symptoms, is usually satisfactory. Subfebrile temperature is noted on the first day. If purulent complications do not occur against the background of general antibiotic therapy, the body temperature normalizes.
Diagnosis of paranasal sinus injuries
Based on the examination data and the data from the radiological examination methods, it is necessary to determine the degree and volume of damage to the paranasal sinuses, in combination with or without damage to the orbit, zygomatic complex and brain, and, depending on this, make an accurate diagnosis.
Physical examination
Includes an external examination - determine the degree of soft tissue swelling in the area of damage, the presence of wounds. Palpation of the projection of the paranasal sinuses should be carried out carefully, as excessive pressure causes severe pain and may worsen the damage to their walls. With minimal swelling of soft tissues, it is possible to determine the degree of cosmetic defect. If there is a wound in the soft tissue projection area of the paranasal sinuses, probing through it will make it possible to assess the depth of the wounded cord and the integrity of the sinus walls.
Laboratory research
A general clinical examination, including a complete blood count, urine analysis, biochemical blood analysis, ECG and other methods, makes it possible to assess the degree of blood loss, changes in other organs and systems, which can make adjustments to the patient's management tactics.
Instrumental research
Radiographic examination methods such as radiography, and especially CT and MRI are highly informative and irreplaceable in paranasal sinus injuries. X-ray and CT data indicate that bone changes are not limited to the nasoorbital region and include the entire middle and sometimes upper face area and the structures of the anterior cranial fossa. There are direct and indirect radiographic signs of fractures of the nasoorbital-ethmoidal complex. Direct signs include the presence of a fracture plane, displacement of fragments, and divergence of the sinuses. Indirect signs include hemosinus of the ethmoid labyrinth, maxillary and frontal sinuses, orbital emphysema, and pneumocephalus. CT of the paranasal sinuses can show the number of fragments, their size, location, and degree of their prolapse into the sinus, which plays an important role in determining the tactics of surgical intervention.
In some cases, ultrasound echography and endoscopic sinusoscopy help to clarify the extent of traumatic injury.
Anterior rhinoscopy determines the degree of swelling of the nasal mucosa, the location of the rupture of the mucosa in the anterior sections and the source of nosebleeds, as well as possible curvature of the nasal septum.
During an endoscopic examination of the nasal cavity, the posterior sections of the nasal cavity and the nasal septum are examined. In this case, microhematoma lines corresponding to the fracture lines of the nasal septum are detected, as well as ruptures of the mucous membrane with exposure of cartilage or bone,
In case of damage to the maxillary sinus without displacement of the damaged walls in the presence of a hemosinus, a therapeutic and diagnostic puncture of the sinus with aspiration of the contents is performed.
Indications for consultation with other specialists
In case of combined damage affecting the eye socket, brain and zygomatic bone, the patient is treated together with other specialists: a neurosurgeon, ophthalmologist and maxillofacial surgeon.
If there is concomitant pathology of the cardiovascular system, lungs and other organs, consultation with a therapist, cardiologist, etc. is necessary.
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