Cranio-orbital trauma

Question 1

What is cranio-orbital trauma

Answer 1

• heterogenous group of injuries involving frontal bone, orbits, ethmoids and upper midface

Question 2

Why do we need to be cautious with cranio-orbital injuries

Answer 2

• due to their proximity to the intracranial space
• necessitating a cautious approach and neurosurgical involvement

Question 3

When does the frontal sinus begin to form

Answer 3

2yrs
adult sized by 15 yrs
seen on plan xrays by 8 yrs

Question 4

Where does the frontal sinus drain into

Answer 4

middle meatutus through frontonasal duct and by ethmoid air cells

Question 5

How do we examine a sinus injury

Answer 5

• ATLS first
• numbness of scalp?
• diplopia?
• scars/wounds?
• open fracture?
• NOE fracture?
• CSF leak?

Question 6

How do we know if there is a CSF leak after a sinus injury

Answer 6

• clear fluid running out of nose
• different consistency to snot

Question 7

What test is done for CSF leak

Answer 7

• beta2 transferritin

Question 8

What image is taken for frontal sinus injury

Answer 8

CT scan

Question 9

What are the key features that determine diagnosis for a frontal sinus injury

Answer 9

• is it the anterior table or frontal table of the frontal sinus
• is the frontonasal duct involved
• what is the degree of displacement of the bones
• is there a brain injury or a bleed

Question 10

How are frontal sinus fractures classified

Answer 10

• fracture involving posterior table (displaced or undisplaced)
• fracture involving the floor of the sinus
• fracture involving dural or cerebral damage

Question 11

Why should we treat sinus fractures

Answer 11

• aesthetic
• wound infection
• chronic sinusitis
• meningitis
• mucocele
• cavernous sinus thrombosis
• encephalitis
• brain abscess

Question 12

Which sinus fractures can be left untreated

Answer 12

• minimally displaced anterior or posterior fractures
• observe for signs of sinusitis
• consider CT to monitor

Question 13

What are indications for surgery of fractured sinuses

Answer 13

• anterior table displacement with significant forehead deformity
• frontonasal duct involvement/obstruction
• displacement of posterior table with underlying neurological injury
• early non-surgical for CSF leak might mitigate need for surgical intervention

Question 14

What are the aims of sinus fracture tx

Answer 14

create a safe sinus
restore appearance

Question 15

What is required for a fonrtonasal duct injury

Answer 15

• high resolution CT
• endoscopy
• methylene blue on table of

Question 16

If there is a confirmed frontonasal duct injury with a cosmetic defect, what should be done

Answer 16

surgery

Question 17

What are NOE fractures

Answer 17

distinct nasal fractures, orbit fractures and frontal fractures
notoriously hard to fix

Question 18

How should we diagnose and investigate a NOE fracture

Answer 18

• blow to bride of nose
• nasal bridge pushed in
• nose tipped up
• increased nasiolabial angle
• assess for telecanthus
• confirm with CT
• check for CSF leak
• eye assessment

Question 19

What are indications to tx a NOE fracture

Answer 19

• CSF leak
• deformity
• part of panfacial repair