Jain Sonu A, Manchio Jeffrey V, Weinzweig Jeffrey
Division of Plastic Surgery, University of Florida, Gainesville, Florida, USA.
J Craniofac Surg. 2010 Nov;21(6):1670-3. doi: 10.1097/SCS.0b013e3181f3c5f1.
Frontal sinus fractures are relatively uncommon due to the high-impact force required to produce these. However, their management is quite complex, with the treatment algorithm incorporating many factors in which the status of the nasofrontal ducts is critically important. Traditionally, this has been evaluated by both axial and coronal computed tomographic (CT) scan views. Anatomically, we propose that this is better evaluated by coronal and sagittal CT views. We evaluated the role of sagittal CT scan views in determining the status of the nasofrontal ducts in patients with frontal sinus fractures.
A retrospective analysis examining 8 patients with frontal sinus fractures, from August 2004 to January 2008, was performed. Axial, coronal, and sagittal CT scan views were obtained routinely as part of the facial trauma workup. These views were assessed to determine the status of the nasofrontal ducts. The operative findings were also reviewed.
Five of the 8 patients had displaced anterior and posterior table frontal sinus fractures. Of these, 4 required surgical intervention that included addressing the nasofrontal ducts. Two of the 8 patients had displaced anterior table fractures that required no intervention of the nasofrontal ducts. One patient had nondisplaced anterior and posterior table fractures and did not require surgery. The sagittal CT view clearly demonstrated the anatomy of the nasofrontal ducts in all 8 patients, including patients in whom the axial and/or coronal views were questionable. Intraoperatively, where the patency of the nasofrontal ducts was directly evaluated, there was a direct correlation with the sagittal image findings.
The sagittal CT view provides invaluable information for evaluating the patency of the nasofrontal ducts in frontal sinus fractures. The ability to evaluate the frontal sinus in an anteroposterior dimension (the usual vector of the injury) and in a superoinferior dimension (the anatomic pathway of the ducts) is the reason for this imaging advantage.
由于产生额窦骨折需要较大的冲击力，因此额窦骨折相对少见。然而，其治疗相当复杂，治疗方案纳入了许多因素，其中鼻额管的状况至关重要。传统上，通过轴向和冠状位计算机断层扫描（CT）视图对此进行评估。从解剖学角度来看，我们认为通过冠状位和矢状位CT视图能更好地进行评估。我们评估了矢状位CT扫描视图在确定额窦骨折患者鼻额管状况中的作用。
对2004年8月至2008年1月期间的8例额窦骨折患者进行回顾性分析。作为面部创伤检查的一部分，常规获取轴向、冠状位和矢状位CT扫描视图。对这些视图进行评估以确定鼻额管的状况。还回顾了手术结果。
8例患者中有5例发生了前后壁移位的额窦骨折。其中，4例需要手术干预，包括处理鼻额管。8例患者中有2例发生了前壁移位骨折，无需对鼻额管进行干预。1例患者前后壁骨折未移位，无需手术。矢状位CT视图清楚地显示了所有8例患者的鼻额管解剖结构，包括轴向和/或冠状位视图显示情况存疑的患者。在术中直接评估鼻额管通畅情况时，与矢状位图像结果存在直接相关性。
矢状位CT视图为评估额窦骨折中鼻额管的通畅情况提供了宝贵信息。能够在前后维度（损伤的通常方向）和上下维度（鼻额管的解剖路径）评估额窦是这种成像优势的原因所在。
