Management of Trauma to the Nose and Paranasal Sinuses

Abstract

Accident and emergency departments see a great deal of maxillofacial trauma cases. Above 50% of maxillofacial trauma occurs in the context of trauma affecting multiple organ systems and thus necessitates joint management by accident and emergency clinicians, oral and maxillofacial surgeons, ENT and plastics, ophthalmology and trauma surgeons. A number of different situations lead to facial bone fractures, such as road traffic accidents (RTAs) or physical blows sustained either lawfully during sporting activities or unlawfully through fights. Regarding sporting injuries, players may collide (opponent’s head, fist, elbow striking the face), equipment may cause the injury (e.g. handlebars, hockey pucks, cricket balls) or the sports area may contribute to the injury, such as when obstacles are present (goalposts, trees, gymnastic apparatus) or the surface is unyielding (like a wrestling mat). Direct contact between players’ bodies is the reason behind most injuries in sport, and the most frequently encountered accompanying soft-tissue trauma occurs in the head and neck area. The introduction of airbags has greatly mitigated the effects of RTAs on facial injury, making injuries less common and less severe. Whilst, in general, sports-related trauma to the face is mild, there still remains the possibility of a grave injury. A clinician whose task is to assess such trauma must proceed consistently and methodically, thus expediting diagnosis and the correct management, whilst bearing in mind that the patient may will to return to competition. A facial bone fracture can also occur in association with head and neck spinal trauma. Breaking the facial bones necessitates considerably forceful injury. The clinician’s assessment must evaluate the way the injury occurred alongside interpreting physical findings. In this chapter, we discuss management of trauma to the nose and paranasal sinuses.