Sphenoid Sinus and Sphenoid Bone Fractures in Patients with Craniomaxillofacial Trauma

Abstract

Craniomaxillofacial trauma has been reported to occur in 20 to 30% of all trauma patients.1,2 Maxillofacial injuries traditionally have been treated as a separate entity, but clinical research has tried to establish a correlation between them and concomitant skull base injuries. The closeness of these bones to the cranium would suggest that there are chances of cranial injuries also occurring simultaneously, and except for a few studies, there is a general dearth of data trying to establish a correlation between them. A classification based on the mechanism of the trauma was described by Manson et al. In this classification the mechanism of the trauma was divided into low-, middle-, and AbstractBackground and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirtyeight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium-and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.

Comparison of Hand and Semiautomatic Tracing Methods for Creating Maxillofacial Artificial Organs using Sequences of Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT) Images

“…The maxillary sinus is the most frequently affected anatomic landmark in midfacial fractures (44). Furthermore, Cantini Ardila et al (45) concluded that there is a correlation between facial fractures and the sphenoid sinus and also sphenoid bone fractures. For midface trauma cases, the Le Fort classification is a widely used system based on the symmetric arrangement of the fracture lines of this area (46, 47).…”

Trauma of the midface

“…The base has an angle that may make the positioning of a firm underlay impossible, be that cartilage or bone. Hereby, the method presented by PJ Wormald using a fat plug is useful (bath plug technique) [ 187 ], [ 209 ], [ 210 ]. A possible homogenous fatty plug is adapted to the diameter of the defect and cut to a length of nearly 2 cm.…”

“…Injuries of the roof and the lateral wall of the sphenoid sinus are predominantly observed in cases of severe trauma to the midface [ 209 ]. Far laterally located fractures with CSF leak possibly cannot be reached via the transseptal, transnasal, or even transethmoid approach in cases of extended pneumatization.…”

Traumatic Carotid-Cavernous Sinus Fistula in a Patient with Facial Bone Fractures

“…However, the diagnosis is often difficult due to ambiguous ocular symptoms and accompanying severe brain injuries [ 3 ]. These fistulas have even been observed in patients with facial bone fractures, especially those involving the sphenoid sinus and orbital wall [ 3 4 ]. Therefore, CCFs should be suspected in patients with craniofacial injuries and complex ocular symptoms such as sustained chemosis, exophthalmos, dilation of the episcleral veins, decrease in visual acuity, or elevated intraocular pressure [ 3 ].…”