20. Fractures of the paranasal sinuses. Fronto-basal, maxillo-facial, blow-out fractures, Le Fort fractures

From greek.doctor
  • Fronto-basal fractures
    • Trauma to frontal bone or roof of nose
      • Car accidents
    • Escher classification
      • Escher 1 – High fracture (forehead, calvaria)
      • Escher 2 – Central fracture (low forehead)
      • Escher 3 – Low fracture (along nasal cavity? – midface separated from skull base)
      • Escher 4 – latero-orbital fracture (above and lateral to orbit)
    • Clinical features
      • CSF rhinorrhoea
      • Cranial nerve palsy
      • Raccoon eyes – haematoma around eyes
    • Diagnosis
      • High-resolution CT
    • Complications
      • Ascending infection -> meningitis, brain abscess
      • Vision loss
      • Oculomotor palsy
    • Treatment
      • All fractures should be surgically treated
  • Maxillo-facial fractures
    • Etiology
      • Car accident
      • Assault
      • Fall
    • Le Fort classification
      • Le Fort 1 – separates maxilla from mid-face
      • Le Fort 2 – separates nasomaxillary complex (goes above nose)
      • Le Fort 3 – separates mid-face from skull
    • Clinical features
      • Facial oedema
      • CSF rhinorrhoea
      • Epistaxis
      • Mobile maxilla
      • Hypoesthesia of infraorbital nerve
      • Raccoon eyes
    • Treatment
      • Ensure airways
      • Facial reconstruction
  • Blowout fracture
    • Isolated fracture of the orbital floor with herniation of orbital content into maxillary sinus
    • Etiology
      • High-velocity blunt trauma to the eye
      • Punch
      • Tennis ball
    • Clinical features
      • Periorbital pain, oedema, ecchymosis
      • Posteriorly depressed eye
      • Hypoesthesia of infraorbital nerve
      • Epistaxis
    • Treatment
      • Urgent stabilization