Paranasal sinuses

The size and degree of pneumatization of the paranasal air sinuses are variable. At birth all the sinuses are rudimentary and do not reach adult proportions until puberty

Frontal Impact
-The

most common mechanism of craniofacial injury is blunt frontal impact. -Blunt impact to the cranium may result in linear fractures, and focal impact may result in depressed fracmres. -Fractures of the anterior skull base may be caused by forces impacting on the cranial vault and transmitted to the skull base or by impact to the facial skeleton. -Fracmres of the skull base are rarely significant in themselves ho!ever, the force re"uired to fracmre the skull base is considerable and fre"uently injures the soft tissues, brain, cranial nerves, major vessels, orbit, and inner and middle ear.

-#ural tears may lead to fismlous communication !ith the nose, paranasal sinuses, or middle ear. The skin of the face or scalp may be lacerated or perforated by the impact -Fracture lines caused by blunt trauma to the facial skeleton or skull follo! points of !eakness and avoid the bony buttresses. -$ence, the fracture patterns of the facial skeleton are determined by the facial struts and buttresses and tl%e honeycomb nature of the facial skeleton and paranasal air sinuses. -The facial fracture pattern is generally described in terms of the upper, middle, and lo!er third divisions of &e Fort. -'iddle third fracmres include orbital blo!-in and blo!-out fractures. The lo!er third com- prises mandibular fractures.

-Air!ay obstruction caused by massive shattering of the facial skeleton, dislodged dentures, or collapse of the mandibular arch !ith retrodisplacement ofthe tongue may result in severe hypo(ia. -There may be profuse bleeding, hypovolemic shock, and hypotension. They are often associated !ith injuries else!here in the body.

Depressed skull fracture

Traditionally, surgery for depressed skull fractures is indicated if )%* the depth of the depressed fragments of the fracture is e"ual to or greater than the !idth of the surrounding bone, )+* the fracture occurs over cosmetic areas such as the forehead, ),* the fracture is of a compound variety, and )-* there is a significant underlying ./$ that re"uires surge
ry.

COMPOUND FRONTAL AIR SINUS INJURY .n patients !ith compound frontal air sinus injuries, careful attention must be paid to fractures involving both the anterior and posterior !alls.

0epair of the fracture re"uires a bicoronal craniotomy, as described previously. To minimize retraction on the frontal lobes, in the majotity of patients it is prudent to induce transient hyperventilation to a 1aco + of +2 to ,3 mm $g and administer an intravenous bolus of mannitol, 1 lk , at the onset of sur ery.