Maxillary Sinus Fracture(Archived)

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).