Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIII: Maxillofacial Wounds and Injuries

Regional Fractures: Fractures of the Paranasal Sinuses

United States Department of Defense

Frontal Sinuses

Simple nondisplaced fractures of the anterior and posterior walls of the frontal sinus require no specific therapy. If the anterior wall is depressed, open reduction and direct wire fixation are indicated. When the anterior wall is comminuted, it can be supported with packing material, such as medicated gauze or Penrose drains. The frontal sinus may be approached through the open wound or via a brow incision.

If the nasofrontal duct is destroyed, it will be necessary to remove the mucosal lining of the frontal sinus and obliterate the sinus, preferably with fat harvested from the abdomen. When the posterior wall of the frontal sinus is depressed and the dura is torn, resulting in CSF leak or spinal fluid rhinorrhoea, neurosurgical consultation should be sought.

Ethmoidal Sinuses

Partial ethmoidectomy may be required in the debridement of some wounds. If there is evidence of CSF rhinorrhoea, neurosurgical consultation is indicated.

Maxillary Sinuses

Simple effusion of blood into the maxillary sinuses is best left alone, as it usually is absorbed. If infection develops, nasal antrostomy and lavage is performed. Missile wounds of the maxillary sinuses are debrided through a Caldwell-Luc approach if foreign body removal is necessary.

Occasionally, it may be necessary to pack the maxillary sinuses for hemostasis or support of comminuted fractures; however, it should be borne in mind that such packing of the sinus is a source of infection that should be avoided whenever possible. All wounds and injuries of the paranasal sinuses should receive antimicrobial coverage Empirically, penicillin is the antibiotic of choice.  

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Operational Medicine 2001

Health Care in Military Settings

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