AAO-HNSF Primary Care Otolaryngology Handbook

MAXILLOFACIAL TRAUMA

from compromise of the dura at the frontal lobe region. The frontal lobe may have other injuries as well. Posterior wall frontal sinus fractures may require a combined surgical intervention by otolaryngology and neurosurgery. If the fracture involves the most inferior aspect of the frontal sinus (the frontal recess—also known as the frontal duct ), drainage of the frontal sinus could be compromised (functional problem). This could lead to problematic recurrent or chronic frontal sinus disease, requiring significant medical therapy or sinus surgery in the future. These patients will need close follow-up by an otolaryngologist. Maxillary Sinus Fractures

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Figure 11.4. Anterior wall frontal sinus fracture. As the patient’s frontal edema resolves, one would surmise that the patient will note a depression in his forehead. This patient elected to have surgery to camouflage this defect.

Maxillary sinus fractures are a part of midface trauma. An isolated anterior maxillary sinus wall fracture may lead to a facial cosmetic change, but the majority may not need any surgery. If the fracture involves the infraorbital nerve (cranial nerve V2) , there may be some numbness along the nerve’s distribution. This is usually due to a compression injury (neuropraxia), as the fracture may involve the infra- orbital canal or infraorbital foramen causing edema around the nerve, or the fractured bone may impinge on the nerve. This rarely needs surgical intervention. If the posterior wall is involved, the neurovascular struc- tures of the pterygopalatine fossa may be violated. If there is significant epistaxis that cannot be controlled by routine nasal packing or endo- scopic sinonasal cautery or ligation, then interventional radiology may be needed to address the bleeding. Le Fort Fractures Dr. René Le Fort first described maxilla fracture patterns based on his research on cadaveric skulls. By causing blunt trauma from various mech- anisms, he determined that there were three general patterns of midface fractures, which have been termed Le Fort I, Le Fort II, and Le Fort III. Today, we recognize Le Fort fractures are typically any combination of Le Fort I, II, or III. All Le Fort fractures involve pterygoid plate fractures

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