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Section 5. Medical science
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Ashurov Azimjon Mirzajanovich, Boymuradov Shukhrat Abdujalilovich, Khayruddinova Zulfiya Rafikovna, Ibragimov Davron Dastamovich, Tashkent Institute of Advanced Medical Education, Tashkent Medical Academy, Samarkand branch of the Tashkent State Dental Institute
E-mail: Shuh69@mail.ru
Posttraumatic rhinosinusitis in patients with cranio-facial injuries
Abstract: Post-traumatic sinusitis develops due to combined craniofacial injuries and is accompanied by brain damage, skull, orbit. Post-traumatic inflammation of the frontal sinus is in the first place among post-traumatic lesions of the paranasal sinuses, while the rarest post-traumatic sinusitis after trauma of the facial skeleton is an inflammation of the sphenoid sinus. We have examined 216 patients with cranio-facial injuries. Patients were carried out the following methods of research: rhinoscopy, X-ray, MRI, MSCT of PNS, sinusal probing, diagnostic puncture, in open fractures — revision of the sinuses. According to our data post-traumatic sinusitis amount to 9.7 % of the total number of cranio-facial injuries. When ongoing hemosinus more than 5 days it is necessary to conduct active anti-inflammatory, anti-edematous, biodegradable and mucolytic treatment.
Keywords: Post-traumatic sinusitis, craniofacial injuries, hemosinus, treatment of acute sinusitis.
Post-traumatic sinusitis develops due to combined craniofacial injuries and is accompanied by brain damage, skull, orbit. Damages of the front group of the paranasal sinuses (PNS) develop as a result of injury of the facial skeleton, eye socket, while the posttraumatic sinusitis of the back groups of PNS occur in fractures of the skull base, as well as the long-term presence of a nasogastric tube, nasotracheal and endotracheal tubes [1; 4].
A characteristic feature of post-traumatic sinusitis is the presence of hemosinus, obstruction of the natural sinus by thrombosis, bone fragments, foreign bodies, damage of the mucous membrane etc. [2; 5].
Post-traumatic inflammation of the frontal sinus is in the first place among post-traumatic lesions of the paranasal sinuses, which is due to its anatomical features: a narrow nasofrontal channel, an ex-serted front wall, the large volume of the frontal sinus than the other paranasal sinuses. Injuries of the frontal sinuses can be penetrating and nonpenetrating to the cranial cavity, open and closed. Posttraumatic purulent frontal sinusitis is a frequent serious complication of traumatic brain injury.
The rarest post-traumatic sinusitis after trauma of the facial skeleton is an inflammation of the sphenoid sinus, because sphenoid sinus locates deep and has a protective anatomical structure, so this
sinus damages are rare. However, inflammation of the sinuses is more common in fractures of the skull base, as well as in nosocomial sphenoiditis when, due to the serious condition of the patient a nasogastric tube or conduct artificial pulmonary ventilation by endotracheal tube is installed. The cause of inflammation of the sphenoid sinus is in violation of ciliated airway epithelium function, leading to inflammation in the sphenoid sinus [2; 3].
The hospitalization for the purpose of examination and prescription ofpreventive therapy is indicated for the patients with posttraumatic hematosinus even when drainage function is safe [2; 6; 8].
Complications of traumatic sinusitis are: nasal septum abscess, osteomyelitis, frontoorbital fistula, orbital cellulitis, epidural abscess, sepsis.
The aim of this study was to examine the state of PNS in patients with cranio-facial injuries.
Material and Methods: the work is done in the Department of Neurosurgery and Maxillofacial Surgery, ENT department for adults of the II clinic of the Tashkent Medical Academy. During the period from 2014 to 2015 we examined 216 patients with cranio-facial injuries, from which there were 180 (83.3 %) males, 36 (16.7 %) women. The age of patients ranged from 18 to 70 years (mean age 44 years).
Posttraumatic rhinosinusitis in patients with cranio-facial injuries
Causes of injury were as follows: sports injury, a car accident, home accidents, falls from height, etc. During the survey patients were consulted by maxillofacial surgeon, otorhinolaryngologist, neurosurgeon, resuscitation specialist, traumatologist, surgeon. All the patients at admission were provided medical care (cessation of bleeding, symptomatic treatment, resuscitation if necessary). Patients were undergone clinical-laboratory and additional methods of research as well as computed tomography (CT), multislice tomography (CT), magnetic resonance imaging (MRI). All patients with injuries of PNS were examined at the day of admission and at 4-5 days of treatment. Patients were carried out the following methods of research: rhinoscopy, X-ray, MRI, MSCT of PNS, sinusal probing, diagnostic puncture, in open fractures — revision ofthe sinuses. One ofthe first signs ofPNS damage was the presence of hemosinus. The presence of blood in the sinuses was set according to the radiologic diagnostics and diagnostic puncture. 92 (42.6 %) patients had fractures of PNS walls from the 216 cases of facial injuries. The presence of blood in sinuses was detected only in 68 (31.4 %) patients.
Table 1. - Distribution of patients with cranio-facial injuries depending on the localization of the injury
№ Anatomical structures Number of patients %
1. Fracture of the nose 96 44.4
2. Fracture of the walls of ethmoid sinuses 12 55.5
3. Fracture of the walls of the frontal sinus 44 20.4
4. Fracture of the walls of the maxillary sinus 28 13
5. Fracture of the walls of the sphenoid sinus 8 3.7
6. Combined fracture of the facial skeleton 40 18.5
7. Fracture of orbit walls 18 8.3
8. Fracture of the zygomatic bone 14 6.5
Total 216 100
As its seen in Table 1, among the surveyed there was noted the frequent damage of the walls of the frontal sinus — in 44 patients (20.4 %), followed by the maxillary — in 28 (13 %) and ethmoid sinuses — in 12 (55.5 %) patients. However, these data are relative, since during the sinus damage the adjacent part of the face also injures. In the category of combined injuries of facial skeleton were included damages of 2 or more anatomical structures of the face. According to our data, combined fractures occurred in 40 patients, accounting for 18.5 %.
All patients were divided into 2 groups: 1st group of47 patients with no infection hemosinus; 2nd group with 21 patients with infection hemosinus.
Table 2. - Distribution of patients according to the number of identified hemosinuses
№ Name of the sinnus Quantity of diagnosed sinus fractures % The number of identified hemosinuses %
1. Frontal 44 47.8 32 34.8
2. Maxillary 28 30.4 22 23.9
3. Ethmoid 12 13 8 8.7
4. Sphenoid 8 8.7 6 6.5
Total 92 100 68 73.9
Results and discussion
Results of the study of the group 1 showed that complete clearance of PNS from the blood occur at 8-10 days after injury. Complaints of patients were not observed. Results of the study of the group 2 showed that the evacuation of the blood contents from sinus is labored because of infection of sinus or non-operational fistula. In open fractures infection of PNS occured exogenously. According to our observations, suppuration of hemosinus is 31.4 % of the total number of cranio-facial injuries. In cases ofhemosinus not disappearing at the 5th day after injury previously the emergence of post-traumatic sinusitis can be expected and it is necessary to begin treatment of acute sinusitis.
Table 3. - Frequency of hemosinuses and sinusitis in patients with fractures of the PNS walls
Name of Number of Number of Number of
№ the sin- fractures hemosinuses sinusitis
nus Abs. % Abs. % Abs. %
1. Frontal 44 47.8 32 34.8 9 9.8
2. Maxillary 28 30.4 22 23.9 6 6.5
3. Ethmoid 8 8.7 6 6.5 3 3.3
4. Sphenoid 12 13 8 8.7 4 4.3
Total 92 100 68 73.9 21 22.8
According to data given in Table 3, post-traumatic inflammation of PNS ranges from 3.3 % to 9.8 %. Such a large range associated with different frequency of PNS injury, i. e. frontal sinuses are injured in most cases and post-traumatic frontitis also takes a leading place among the other post-traumatic sinusitis. Equally important is the overall status of the patient, i. e. reactivity, presence of chronic diseases as well as age. According to our observations, chronic diseases such as diabetes, anemia, chronic pneumonia were identified in 8 % of cases.
This diagram (fig. 1) shows the comparison of the age of post-traumatic sinusitis.
Fig. 1. Comparison of the age of post-traumatic sinusitis
Thus, according to our data post-traumatic sinusitis amount to 9.7 % of the total number of cranio-facial injuries. When ongoing hemosinus more than 5 days it is necessary to conduct active anti-inflammatory, anti-edematous, biodegradable and mucolytic treatment.
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