Abstract
ObjectiveThe purpose of this study is to determine if removal of ethmoid cell septations as commonly performed in endoscopic sinus surgery leads to a change in orbital wall fracture patterns and the force required to create them.MethodsSix fresh-frozen cadaveric heads were acquired and underwent endoscopic uncinectomy, maxillary antrostomy, and anterior and posterior ethmoidectomy on one, randomized, side. The contralateral sinuses were used as intra-specimen control. Hyaluronic acid gel globe injections were performed to simulate normal intra-ocular pressure. Post-op CT scans confirmed no orbital fractures or violation of the lamina papyracea prior to trauma testing. Orbital trauma was induced using a guided weight-drop technique. Both orbits were tested in random order, and sequentially higher drops were performed until both the test and control side demonstrated an orbital fracture on CT scan.ResultsIn all six heads, the post-sinus surgery side incurred a medial orbital wall fracture, and no orbital floor fractures were identified. On the other hand, on the control side, all six heads incurred orbital floor fractures at drop heights equal to, or higher than, the surgical side. Fisher’s exact test demonstrated a significant difference in fracture pattern (p < 0.001).ConclusionsTo our knowledge, this is the first demonstration that the structures removed during sinus surgery may act as a buttress for the medial orbital wall. The anatomic changes of sinus surgery may alter the biomechanics of the orbit and affect the pattern of subsequent traumatic blowout fractures.
Highlights
The normal functions of the paranasal sinuses have long been postulated and thought to be many
One review of orbital trauma demonstrated an 84.2% rate of isolated orbital floor fracture, compared to a 0.2% rate of isolated medial wall fracture [3]. Rationale for this difference in fracture pattern has been postulated to be that the uncinate process and ethmoid air cells act as a buttress for the medial orbital wall, protecting it from fracture [3]
The fractures seen were quite obvious when present and no discrepancy was seen between the two surgeons reviewing the CT scans
Summary
The normal functions of the paranasal sinuses have long been postulated and thought to be many. Theoretical functions include decreasing the weight of the skull, increasing the surface area of the nasal mucosa, enhancing resonance for speech and the production of nitric oxide [1]. The sinuses have been shown to act as a “crumple zone” to protect the eye during maxillofacial trauma [2]. In the hydraulic theory of orbital fractures, when a Rationale for this difference in fracture pattern has been postulated to be that the uncinate process and ethmoid air cells act as a buttress for the medial orbital wall, protecting it from fracture [3]. The concept of the facial buttress is not new.
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