Analysis of 158 frontal sinus fractures: current surgical management and complications

A retrospective analysis is presented of 158 patients who sustained frontal sinus fractures and were subsequently treated in the Division of Maxillofacial Surgery, University of Turin, from 1987 to 1998. The fractures were subdivided according to involvement of anterior and posterior walls, and of the nasofrontal duct. While treatment involving only the anterior wall is well standardized and without complications, management of anterior plus posterior wall fractures or involving the nasofrontal duct is still controversial. In dislocated posterior wall fractures, cranialization and obliteration of the remaining dead space and of the nasofrontal ducts using bone grafts, combined with the use of a pericranium flap, allow separation of the nasal cavity from the anterior cranial fossa, preventing ascending infections and thus reducing the rate of complications. When the fracture involves the nasofrontal duct with the posterior wall substantially intact, it is better to re-establish patency of the nasofrontal duct with a drainage tube and preserve the function of the sinus. A protocol used in the management of each group of fractures, clinical and radiological results, timing of operation, surgical procedures, outcomes, and long-term complications are all discussed.

Transudative right pleural effusion due to compression of the brachiocephalic vein caused by an intrathoracic goitre

The case presented in this report is of a female patient who suffered recurrent transudative right pleural effusions, due to a giant benign intrathoracic goitre. The latter caused compression of the brachiocephalic vein, which is a very rare cause of pleural fluid accumulation. Magnetic resonance imaging played a crucial diagnostic role.

Maxillofacial fractures following airbag deployment

Maxillofacial fractures and associated lesions following airbag deployment were studied in six patients who suffered frontal or fronto-lateral car crashes. Installation of airbags in motor vehicles has reduced the morbidity and the mortality following motor vehicle accidents, but the appearance of new types of trauma directly related to airbag deployment raise questions about the potential danger of these devices when used improperly. The results of this limited study suggest that airbag injuries can be aggravated if: (1) seat belts are not worn; and (2) if the driver's chest is too close to the steering wheel as can easily happen with small people (in our study, two women). There needs to be a way of disconnecting the system.

Maxillofacial trauma in the elderly

PURPOSE

This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases.

PATIENTS AND METHODS

A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age.

RESULTS

The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital.

CONCLUSIONS

The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

Inflammatory pseudotumour of the lung presenting as an airway obstructive syndrome

The inflammatory pseudotumour of the lung is a rare and non-malignant neoplasm, which can be asymptomatic or characterized by variable clinical expressions. This report refers to a case occurring in a young woman and presenting as a persistent airway obstructive syndrome. With regard to histopathologic characterization, the present case can be classified as a fibrous histiocytic subtype.