Buller Johannes, Maus Volker, Grandoch Andrea, Kreppel Matthias, Zirk Matthias, Zöller Joachim E
Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
Senior Physician, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany; and Radiologist, Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
J Oral Maxillofac Surg. 2018 Oct;76(10):2168.e1-2168.e7. doi: 10.1016/j.joms.2018.06.020. Epub 2018 Jun 22.
The frontal sinus shows a wide range of morphologic variations. The aim of this study was to evaluate the influence of frontal sinus size on fracture characteristics in frontal bone trauma.
In this cross-sectional study, data from patients with traumatic fractures of the frontal bone were retrospectively collected from the institution's database. Radiometric analysis of computed tomography and cone-beam computed tomography datasets was performed. Frontal sinus size was measured as variables of height, width, and depth. The secondary predictor was morphologic sinus type according to Guerram's classification: hyperplasia, medium size, hypoplasia, or aplasia of the frontal sinus. To determine outcomes, we classified fractures into the following categories: fracture isolated to the anterior table, combined fractures of the anterior and posterior tables, fracture isolated to the posterior table, and frontal bone fracture without sinus involvement. Further study variables were patients' demographic characteristics, combined midfacial fractures, orbital rim involvement, fracture displacement, and surgical approach. For statistical analysis, fracture types were assessed for frontal sinus metric size and morphologic type using bivariate tests with P < .05 defined as significant.
We enrolled 53 consecutive patients with a mean age of 35 years; male patients comprised 91%. Fracture types differed significantly in sinus width and height (both P < .001), as well as depth (P = .002). Frontal sinus morphology was hyperplastic in 66%, medium in 30.2%, and hypoplastic in 3.8%. Patients with a hyperplastic frontal sinus had an increased likelihood of isolated anterior table fractures (odds ratio, 6.0; P = .007) compared with medium-sized types. Fractures without sinus involvement were more likely in hypoplastic and medium types (P < .001).
The morphology of the frontal sinus determines the probability of fracture types from craniofacial trauma. Thus the frontal sinus size appears to be a major factor for frontal bone resistance to traumatic force impingement.
额窦表现出广泛的形态学变异。本研究的目的是评估额窦大小对额骨创伤骨折特征的影响。
在这项横断面研究中，从机构数据库中回顾性收集额骨创伤性骨折患者的数据。对计算机断层扫描和锥形束计算机断层扫描数据集进行放射测量分析。额窦大小通过高度、宽度和深度变量进行测量。次要预测因素是根据格拉姆分类法的窦形态类型：额窦增生、中等大小、发育不全或发育不良。为了确定结果，我们将骨折分为以下几类：仅累及前壁的骨折、前后壁联合骨折、仅累及后壁的骨折以及未累及窦的额骨骨折。进一步研究的变量包括患者的人口统计学特征、合并的面中部骨折、眶缘受累情况、骨折移位以及手术入路。对于统计分析，使用双变量检验评估骨折类型与额窦测量大小和形态类型之间的关系，P < 0.05定义为具有统计学意义。
我们纳入了53例连续患者，平均年龄35岁；男性患者占91%。骨折类型在窦宽度和高度（均P < 0.001）以及深度（P = 0.002）方面存在显著差异。额窦形态增生的占66%，中等大小的占30.2%，发育不全的占3.8%。与中等大小类型相比，额窦增生的患者孤立前壁骨折的可能性增加（优势比，6.0；P = 0.007）。发育不全和中等大小类型的患者未累及窦的骨折更常见（P < 0.001）。
额窦形态决定了颅面创伤骨折类型的可能性。因此，额窦大小似乎是额骨抵抗外力撞击的主要因素。
