sinus trauma
Introduction
Introduction to sinus trauma According to the anatomical features, the sinus trauma is the most common in the sinus, the second is the frontal sinus, the ethmoid sinus is less, and the sphenoid sinus is the least Sinus trauma often combined with craniocerebral and eyelid injuries, often accompanied by cerebrospinal fluid rhinorrhea. The main cause of the disease is nasal trauma, sinus trauma often combined with craniocerebral and eyelid injuries, often accompanied by cerebrospinal fluid rhinorrhea. Sinus damage varies with the distance, speed, shape, and location and angle of the violence or shrapnel, and varies depending on the presence or absence of damage to adjacent organs. The main preventive measure of this disease is to pay attention to safety and avoid trauma. basic knowledge Proportion of the disease: the incidence of the disease caused by trauma is about 0.3% - 0.5% Susceptible people: no specific people Mode of infection: non-infectious Complications: sinusitis
Cause
Cause of sinus trauma
Trauma factors (99%):
Nasal trauma is the main cause. Sinus trauma often involves brain and eyelid injuries, often accompanied by cerebrospinal fluid rhinorrhea. Sinus damage varies with the distance, speed, shape, and location and angle of the violence or shrapnel, and varies depending on the presence or absence of damage to adjacent organs.
Congenital factors (1%):
Due to congenital hypoplasia, the sinus development is imperfect or the nasal bone is weak, and the sinus damage is caused by the pressure of certain factors.
Prevention
Sinus wound prevention
For traumatic diseases, prevention is to pay attention to safety.
Complication
Sinus trauma complications Complications sinusitis
If accompanied by eyeballs and optic nerve damage, vision loss or blindness, large local soft tissue defects appear in the case of large shrapnel, often accompanied by comminuted fractures, and easily combined with sinusitis or osteomyelitis after injury, if foreign bodies or dead bones remain, Wounds can be cured for a long time, forming a chronic fistula, rich in bone marrow in the frontal sinus, and easy to form osteomyelitis after infection.
Symptom
Sinus trauma symptoms Common symptoms Nasal bleeding Sinus tenderness Nasal root edema Cerebrospinal fluid Rhinorrhea comminuted fractures Transfusion Nasal split Nose above the nose defect
The sinus injury varies with the distance, speed, shape and position and angle of the violence or shrapnel, and the damage is different depending on the presence or absence of the adjacent organs. Therefore, the clinical manifestations are more complicated, mainly as follows:
(1) Bleeding: The amount of bleeding varies depending on the location of the injury. Closed fractures, less bleeding when only the sinus mucosa is damaged, and more bleeding when combined with nasal mucosa injury. When the bullet or shrapnel damages the maxillary artery or the sphenopalatine artery, not only bleeding More, and not easy to stop bleeding, often lead to shock, some patients with less initial bleeding, combined infection can occur a week after injury, secondary hemorrhage, ethmoid sinus and frontal sinus injury can occur cerebrospinal fluid rhinorrhea, mixed in the blood, It is difficult to distinguish in the early stage, and special attention must be paid to it in time.
(B) facial deformation: with the size of the violence, direction, shrapnel volume and distance can cause jaw fracture, nasal bone fracture and facial deformation, most commonly for the maxillary sinus anterior wall and frontal sinus anterior wall concave occult fracture, often combined with nasal bone , eyelids, humerus, maxilla, upper alveolar and other fractures, showing the forehead, maxillary area and nasal bridge collapse, local can be found in the sag fracture line, such as sacral arch fracture into the maxillary sinus caused by limited mouth, combined with maxillary fracture , the dentition is misplaced, and the upper and lower teeth are abnormally engaged.
(3) Blasting at the bottom of the sputum: When the front of the eyelid is injured by a blunt instrument, the internal pressure of the iliac crest increases, causing the bottom wall of the iliac crest to fracture. The bottom of the iliac crest is broken, the fracture of the sacral floor and the tibia are touched, the fat, the inferior rectus muscle, the lower Tissues such as the oblique muscles are trapped in the maxillary sinus, and there is eyeball collapse, upper and lower movement disorders and diplopia. If accompanied by eyeball and optic nerve damage, vision loss or blindness.
(D) cerebrospinal fluid rhinorrhea: the frontal wall of the frontal sinus can cause epidural hematoma, cerebrospinal fluid rhinorrhea and gas brain, sieving mesh plate and skull base dura mater adhesion is very tight, sieve plate fracture is also prone to dural tear Cerebrospinal fluid rhinorrhea.
(5) Injury performance: The sinus injury is divided into open injury and closed injury according to the surface skin.
Open injury is different due to different local manifestations of wounds. For example, a bullet wound or a small shrapnel injury is often a blind tube injury or a penetrating injury. After the wound passes through the soft tissue, it penetrates the sinus bone wall and passes through the sinus cavity. The buffering effect causes the wound (shrap, etc.) to remain in the sinus, or pass through the sinus cavity to other parts, often the entrance is small, the soft tissue and bone tissue are less damaged, and the deep tissue damage is heavier, and the large piece of shrapnel is injured. Apparent local soft tissue defects, often accompanied by comminuted fractures, are also associated with sinusitis or osteomyelitis after injury.
Closed injury shows local skin integrity, but the skin is swollen, blood stasis, subcutaneous hematoma, such as sinus fracture, fracture joint and nasal cavity communication, local subcutaneous emphysema can occur after the nose, palpation has sputum pronunciation, such as swelling due to soft tissue If you can't find out whether there is a fracture, you can make a diagnosis by sinus X-ray. (6) Infection: The sinus and the nasal cavity are connected, the mucous membranes are connected to each other, and the bacteria easily enter the injured sinus through the nasal cavity to cause infection. Therefore, the closure is closed. Sinus injury should also be regarded as open injury. When open injury, soil, cloth, etc. can enter the sinus with shrapnel or wounds to cause infection. If foreign bodies or dead bones remain, the wound can be cured for a long time, forming a chronic fistula. The frontal wall of the frontal sinus is rich in bone marrow and is prone to osteomyelitis after infection.
(7) Dysfunction: simple sinus fractures, no nasal injury or infection, do not affect the function, ethmoid sinus damage to the olfactory nerve can occur olfactory disorders, nasal adhesions or stenosis, respiratory dysfunction can occur, affecting Nasal resonance function.
With the injury factors and the direction of violence, the clinical manifestations are mainly bleeding, malformation, dysfunction and infection.
Examine
Sinus wound examination
Detailed medical history, comprehensive physical examination, feasible X-ray, CT examination to confirm the diagnosis.
Diagnosis
Diagnosis of sinus trauma
Identification with sinus pressure trauma.
