Lambert D M, Mirvis S E, Shanmuganathan K, Tilghman D L
Department of Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore 21201, USA.
J Oral Maxillofac Surg. 1997 Nov;55(11):1207-10; discussion 1210-1. doi: 10.1016/s0278-2391(97)90167-1.
This prospective study was designed to assess the association of clear paranasal sinuses (no free fluid) as shown by facial computed tomography (CT) with the absence of fractures involving the paranasal sinus walls.
All facial CT scans performed during a 12-month period to rule out maxillofacial injury in blunt trauma patients were reviewed. The scans were made using 5-mm slice thickness and 4-mm table incrementation. They were assessed for the presence or absence of free paranasal sinus fluid (hemorrhage) and the presence and location of facial fractures.
A total of 366 CT scans of the face were performed during the study. Among them, 180 scans (49%) were identified that showed no evidence of free paranasal fluid. Twenty-two (12%) of these 180 CT studies showed isolated nasal fractures (n = 13) or zygomatic arch fractures (n = 9). No patient without free paranasal sinus fluid had any midfacial fracture involving a paranasal sinus wall (P < .001 by Fischer exact test).
The absence of free paranasal sinus fluid after facial trauma is a highly reliable criterion to exclude fractures involving the paranasal sinus walls. Other fractures involving osseous structures not contiguous with the paranasal sinus walls, such as nasal or zygomatic arch fractures, are not excluded. The CT "clear sinus" sign is a simple, rapid method to exclude paranasal sinus fractures.
本前瞻性研究旨在评估面部计算机断层扫描（CT）显示的鼻窦清晰（无游离液体）与鼻窦壁无骨折之间的关联。
回顾了在12个月期间对钝性创伤患者进行的所有面部CT扫描，以排除颌面损伤。扫描采用5毫米层厚和4毫米床进。评估鼻窦游离液体（出血）的有无以及面部骨折的有无和位置。
研究期间共进行了366次面部CT扫描。其中，180次扫描（49%）显示无鼻窦游离液体证据。这180次CT检查中有22次（12%）显示孤立性鼻骨骨折（n = 13）或颧弓骨折（n = 9）。无鼻窦游离液体的患者均无涉及鼻窦壁的面中部骨折（费舍尔精确检验，P <.001）。
面部创伤后鼻窦无游离液体是排除鼻窦壁骨折的高度可靠标准。不排除涉及与鼻窦壁不相邻骨结构的其他骨折，如鼻骨或颧弓骨折。CT“鼻窦清晰”征是排除鼻窦骨折的一种简单、快速的方法。
