Paranasal sinus fractures

Paranasal sinuses are air-filled cavities surrounding the nasal cavity proper which includes maxillary sinus, sphenoid sinus, frontal sinus and ethmoid sinus. Trauma to the superior and middle thirds of the face can often lead to in paranasal sinus fractures are - type involving one of fracturemore paranasal sinuses. Furthermore, mechanism of fracture most common presentation traumatic forces greater than paranasal sinus resistance may result in brain injury ¹.

Epidemiology

Aetiology and demographics willfor facial trauma causing paranasal fractures vary significantly depending on the population demographics and with where patients presentgeographically. In developed countries, assaults and motor vehicle accidents are the setting of amain reasons for facial trauma centre. By contrast, in New Zealanddeveloping countries, 90% of patients are malework related accidents age, with 64% between the ages of 15 and 29 ²:gender

• assault: 50%
• motor vehicle accident (MVA): 1045%
• assault: 22.5%
• fall: 1517.9%
• sport: 157.8%
• otherwork related: 104.5%
• others: 2.3%

Clinical presentation

Presenting complaints will include ³:

• pain
• chin paresthesia (damage to the mental nerve, a terminal branch of the inferior alveolar nerve)
• malocclusion
• trismus
• dental damage
• abnormal mobility
• laceration of the skin of the external acoustic meatus

Pathology

Location

• angle: 20-33% ^1-3
• body: 15-25%
• condyle or neck: 15-36%  (see: TMJ trauma)
• parasymphyseal: 14-15%
• ramus: 5%
• coronoid process: 1-3%
• alveolar ridge: 2%

Unifocal fractures are common, accounting for approximately 40% of all mandibular fractures ¹:

Subtypes

Treatment and prognosis

Treatment can be conservative or involve formal reduction (which may be open or closed). Closed reduction may be supported with intermaxillary fixation or splints (ORIF).

Complications

• osteomyelitis
• permanent malocclusion ³
• permanent paresthesia