Lenkeit Christopher P., Lofgren Daniel H., Shermetaro Carl
McLaren Oakland Hospital
Vanderbilt University Medical Center
Facial trauma is a common reason for patients to visit the emergency department. Midface trauma, in particular, provides a unique challenge for physicians in regards to treatment. Otolaryngologists (ENT) and oral maxillofacial surgeons are commonly consulted for the evaluation of maxillary sinus fractures (MSFs). Knowledge about the diagnosis and treatment of such fractures is very important as it has a large socioeconomic burden on the patient and the healthcare system as a whole. These patients tend to have multiple facial bone fractures, which may require extensive surgery and rehabilitation. Though a maxillary sinus fracture can be used to describe any fracture involving the borders of the maxillary sinus, this paper focuses mostly on anterior and posterior wall maxillary sinus fractures, as other fractures of the midface are out of the scope of this paper. In order to understand the diagnosis and treatment of maxillary sinus fractures, it is important to be familiar with the anatomy of the midface. The midface consists of the following facial bones: the maxilla, zygoma, sphenoid, lacrimal, nasal, ethmoid, and palatine. Trauma involving any of these bones should raise concern for the possibility of a maxillary sinus fracture. The pyramidal-shaped maxillary sinus is the first sinus to develop embryologically and is the largest of the paranasal sinuses. The anterior wall is made up of the bony maxilla. Posteriorly, the infratemporal surface of the maxilla makes up the anterior border of the pterygopalatine fossa. The floor of the sinus is made up of the alveolar and palatine processes of the maxilla bone. The zygoma makes up the lateral aspect. The delicate bones of the lateral wall of the nasal cavity make up the medial border. The thin orbital floor, which houses the infraorbital nerve via the infraorbital canal, makes up the superior aspect of the sinus. The blood supply for the maxillary sinus is primarily from branches of the maxillary artery, including the posterior superior alveolar artery, infraorbital artery, and the posterior lateral nasal artery. Innervation of the maxillary sinus and its blanketed mucosa comes primarily from the maxillary division of the trigeminal nerve (V2).
面部创伤是患者前往急诊科就诊的常见原因。尤其是面中部创伤，在治疗方面给医生带来了独特的挑战。上颌窦骨折（MSF）的评估通常会咨询耳鼻喉科医生（ENT）和口腔颌面外科医生。了解此类骨折的诊断和治疗非常重要，因为它给患者和整个医疗系统带来了巨大的社会经济负担。这些患者往往有多处面部骨折，可能需要进行广泛的手术和康复治疗。虽然上颌窦骨折可用于描述任何累及上颌窦边界的骨折，但本文主要关注上颌窦前壁和后壁骨折，因为面中部的其他骨折不在本文讨论范围内。为了理解上颌窦骨折的诊断和治疗，熟悉面中部的解剖结构很重要。面中部由以下面骨组成：上颌骨、颧骨、蝶骨、泪骨、鼻骨、筛骨和腭骨。涉及这些骨头中任何一块的创伤都应引起对上颌窦骨折可能性的关注。呈金字塔形的上颌窦是胚胎发育过程中最早形成的鼻窦，也是鼻窦中最大的。前壁由上颌骨构成。在后方，上颌骨的颞下面构成翼腭窝的前边界。鼻窦底部由上颌骨的牙槽突和腭突构成。颧骨构成外侧部分。鼻腔外侧壁的细薄骨头构成内侧边界。容纳眶下神经通过眶下管的薄眶底构成鼻窦的上侧部分。上颌窦的血液供应主要来自上颌动脉的分支，包括后上牙槽动脉、眶下动脉和鼻后外侧动脉。上颌窦及其覆盖黏膜的神经支配主要来自三叉神经上颌支（V2）。
