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Broken Sinus Cavity Due to Head Injury: is This Dangerous?

His head injury was severe, he has a fractured skull and bleeding in the brain. As we are primarily concerned about the other injuries, I didn't know how serious the sinus cavity injury is. He used to suffer from sinuses, so will this change that?

Doctor Answers 3

Broken Sinus Cavity and Head Injury - Is This Dangerous?

Thank you for your question and the photo.

In and of themselves, skull fractures of any kind are serious - they are evidence of a significant trauma that can lead to brain injury and other problems.  Involvement of the sinuses (usually the frontal sinuses in the forehead) adds another layer of complexity to the problem that can often be even more concerning.  

There are 2 major walls of the frontal sinus - the anterior table (just under the skin) and the posterior table (just outside the brain).  The frontal sinus is the air pocket that resides between these two tables.  In the event of a frontal sinus fracture, the question becomes which of those two tables is injured, and if the duct that drains fluid out of the sinus and allows air into the sinus (nasofrontal duct) is involved as well.

If the fracture only involves the anterior table, and not the nasofrontal duct or the posterior table, then usually it's mainly a cosmetic concern.  If, however, there is involvement of either the nasofrontal duct or the posterior table, then surgery is necessary to avoid more serious problems like meningitis, encephalitis, or other infections in the brain.

Ultimately, you would be best-served by an in-person consultation with a board-certified otolaryngologist / ENT surgeon who can fully evaluate the injury, the scans, and determine the best course of action.

Best wishes.

Broken Sinus Cavity Due to Head Injury: is This Dangerous?

If he had frontal sinus injury, then yes, that needs to be addressed and the correction depends on what's injured.  Frontal sinus fractures involve the anterior table usually, but can also involve the posterior table; in either case if displaced need immediate attention.  If mucosa is trapped in the fracture line or the sinus outflow tract is blocked, then it can lead to mucocele formation.

Ramtin Kassir, MD
Wayne Facial Plastic Surgeon
4.5 out of 5 stars 57 reviews

SINUSITIS AFTER HEAD INJURY

From the picture it looks as if the injury has been to the left forehead.  He probably had a head CT which would show a fracture.  In that location is the left frontal sinus which has the anterior table forming the part of the forehead you can feel.  Behind the anterior table is an airspace lined by mucous membrane.  The posterior table separates the sinus airspace and the brain cavity.  Fractures through the anterior table  are mostly cosmetic and don't predispose to frontal sinusitis.  Posterior table fractures are another story.  If there is a nondisplaced posterior fracture then no treatment is needed.  However with displaced posterior table fractures there can be entry into  the space containing spinal fluid so that this fluid drains into the sinus and then into the nose.  Should bacteria from the nose and sinus get into the spinal fluid space then meningitis can occur.  This leak would present with clear watery fluid dripping from just one nostril.   The other concern is if mucous membrane gets trapped in the fracture line which could form an expanding mucous cyst that can erode bone and get infected causing meningitis or a brain abscess.  These displaced fractures require surgery to remove the mucous membrane and obliterate the sinus with a fat graft to prevent these complications.  Separate from these fractures there could be injury to the drainage system of the sinus which could lead to sinusitis especially if there has been a history of it.  In this case surgery can be done through the nose to open the frontal sinus drainage route.  The best evaluation is a sinus CT scan done in both coronal and axial planes (saggital reconstruction is helpful but not necessary) with a consultation by an ENT specialist.  Hope your friend recovers fully. 

Mark Loury, MD, FACS
Fort Collins Facial Plastic Surgeon
4.5 out of 5 stars 11 reviews

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