The management of fractures of the maxillofacial complex remains a challenge for the oral maxillofacial surgeon, demanding both skill and expertise 2. The abducens nerve tracks along the clivus before it enters the cavernous sinus and ultimately the superior orbital fissure okudo and anusim, 2016. The lunate acts as a central anchor for the carpal bones. In 51 of the 78 patients these were associated with complex facial fractures. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. Fracture of the scaphoid bone is the most common carpal. Inspection of the zygomaticsphenoid fracture line can contribute significantly to the precise 3dimensional reduction of displaced malar fractures. Analysis of outcome of zygomatic fracture management. The sphenoid bone is located in the center of the cranial base figures 103 and 105. Emergency evaluation and initial management and orbital fractures and retinal detachment and oropharyngeal trauma in children and nasal trauma and fractures in children and adolescents and.
Several cases of sphenoid bone fracture serve as examples of diagnostic and treatment techniques. Sphenoid bone fracture definition of sphenoid bone. In case of a proximal scaphoid fracture, the blood. The literature, however, lacks a comprehensive clinical study specifically addressing the transnasal endoscopic repair of csf leaks of the sphenoid. Patients with a clival metastasis typically have diplopia due to an. Distribution of maxillary fractures in motamedis assessment of maxillofacial trauma patients figure 4.
This report describes an unusual case revealed by bacterial meningitis and cerebral abscess in a 12yearold child. The sphenoid directly or indirectly articulates with every bone in the skull. Sphenoid bone fracture definition of sphenoid bone fracture. This type of fracture occurs most often after a fall onto an outstretched hand. Inadequate clinical evaluation and imaging are main contributors to the. Such fractures are important since they can cause loss of vision and damage to various neural and muscular tissues. Evaluation and surgical management of isolated sphenoid. The facial skeleton is made up of thin segments of bone encased and supported by a more rigid framework of buttresses. His sphenoid fracture has evidently severed the stalk that connects the hypothalamus to the posterior lobe of the pituitary gland. The carpal bones are bound to each other by short intercarpal ligaments for example, the scapholunate and the triquetrolunate. The first four sections should be read prior to the sections on the. Current methods of diagnosis and treatment of scaphoid fractures.
Endonasal endoscopic repair of cerebrospinal fluid leaks. The disease is relatively uncommon comparatively, chronic sphenoid sinusitis is more common and may be limited to the sphenoid sinus or, more commonly, may involve multiple sinuses or pansinusitis. The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. Its name is derived from the greek sphenoeides, to mean wedgeshaped. In 21 patients there were complications that included damage to the internal carotid artery, cerebrospinal fluid rhinorrhea, optic nerve damage, superior orbital fissure syndrome, and posttraumatic. The neural relationships of the sphenoid bone are among the most complex of any bone. Hudgins, md introduction head trauma is one of the most common reasons for visits to the emergency department in the united states.
We report 2 cases of isolated acute isolated sphenoid sinusitis with unusual presentations. The sphenoid bone is one of the eight bones that make up the cranium the superior aspect of the skull that encloses and protects the brain. This includes the nose, cheekbones, the area around the eyes, and the upper and lower jaw. Traumatic intrasphenoidal pseudoaneurysm lodged inside. Management of this fracture is considered one of the most challenging because diagnosis may be difficult and surgical outcomes can be variable. The sphenoid bone is one of the eight bones that make up the cranium the superior aspect of the skull that encloses and protects the brain its name is derived from the greek sphenoeides, to mean wedgeshaped.
The sphenoid bone is an unpaired bone of the neurocranium. A more exhaustive multicentric casecontrol study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. The syndrome is characterized by ophthalmoplegia, ptosis. Midface fractures are common sequelae of motor vehicle accidents, falls, assaults, and other blunt trauma, 1, 2. In each case in our study, the zygomaticsphenoid fracture line remained distracted. Basilar fractures treat only complications csf leak, etc. This is typically caused by a direct blow to the central orbit from a fist or ball. Various deformities and dysfunctions are correlated with imaging data and classified to. It is situated in the middle of the skull towards the front, in front of the basilar part of the occipital bone. Fractures of the sphenoid bone occur following injury to the orbit and base of the skull.
Furthermore, the zygoma is connected to the maxilla and sphenoid bone as part of the inferior orbital floor, and. The orbital apex fracture was associated with loss of vision secondary to compression of the optic nerve by a fragment of the sphenoid arrow with inward angulation of the lateral orbital wall white line. Pneumocephalus intracranial aerocele, defined as intracranial air, is an uncommon complication in head injury patients. Injury can involve the skin and soft tissues as well as resulting in fractures. Direct orbital floor fracturethis is a rim fracture that extends into the lower socket. Head and neck osteology group 4 presentation sphenoid bone 1group 4 presentaion 2. If the fracture is in a certain part of the bone or if the fracture is at all displaced bone ends have shifted, surgery might be the best option. Various deformities and dysfunctions are correlated with imaging data and classified to describe specific clinical syndromes. Sphenoid sinus and sphenoid bone fractures in patients.
The supporting bony structure of the face can be conceptualized as a system of vertical and horizontal buttresses. The vertical buttresses consist of the paired nasomaxillary nm, zygomaticomaxillary zm and pterygomaxillary pm midfacial buttresses as well as the ramus of the mandible. Inspection of the zygomatic sphenoid fracture line can contribute significantly to the precise 3dimensional reduction of displaced malar fractures. This might include the insertion of a screw or pins figure 3. The basic management includes the management of airway, breathing, and circulation. Pdf current methods of diagnosis and treatment of scaphoid. The clivus is a part of the posterior skull base where the basal occipital bone joins the sphenoid bone.
Skull base fractures are of high importance in neurotrauma. The management of nasoorbitalethmoid noe fractures article pdf available in chinese journal of traumatology english edition 695 august 2015 with 785 reads how we measure reads. Ct scan of the head performed the day of the car accident axial view showing frontal and skull base fractures involving the right sphenoid sinus and walls of the right carotid canal. Although these symptoms did not improve for 1 week, displaced bone fragments of the greater sphenoid wing were removed via. The management of midfacial fractures includes the treatment of facial fractures, dentoalveolar trauma, and softtissue injuries, as well as associated injuries, mainly of the head and neck 1. Bone can fracture crosswise, lengthwise, in several places, or into many pieces. The surgical treatment of displaced craniofacial fractures centers. Csf leaks eighty percent of cerebrospinal fluid csf leaks occur following nonsurgical trauma and complicate 2% of all head traumas, and 12% to 30% of all basilar skull fractures themostcommon presentation. Surgical treatment for greater sphenoid wing fracture. We present two cases of extensive pneumocephalus after trauma. The temporal bones are paired structures located on the lateral aspects of the skull inferior to the parietal bones, posterior to the sphenoid bone, and anterior to the occipital bone fig. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Main outcome measures demographic data, presenting signs and symptoms, endoscopic and imaging findings, surgical management, surgical pathology, and clinical outcomes were investigated in patients presenting with sphenoid sinus disease to the medical college of wisconsin, milwaukee, between january 1, 1991, and december 31, 2001. The lateral orbital wall is composed of the frontal process of the zygoma, the orbital plate of the greater wing of the sphenoid and the frontal bone.
Large and giant medial sphenoid wing meningiomas involving vascular structures. Surgical management of zygomatic complex fractures in a major. Fractures of the sphenoid bone can involve either alone or in combinations including fractures of sphenoid sinus, sella turcica, upper clivus, greater wing andor lesser wing, and. Group names abdiwadud ahmed karama abdiaziz abdirashid ahmed said abdalle abdirahman group 4 presentaion 2 3. Hnatuk commented on the aggressive nature of the disease and concluded that nonoperative medical management is not indicated. Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. Mandible fracture epidemiology lefort fractures of the midface structure of tooth. According to the 20 national trauma data bank maintained by the american college of surgeons, of 833,311 adult trauma ad. The patient was referred to the teaching hospital of montpellier, where conservative management of ica dissection was preferred. Fractures of the sphenoid bone wiley online library. Pdf the management of nasoorbitalethmoid noe fractures.
The fracture was emergently reduced, and the patient regained her vision. One characteristic of all types of le fort fractures is the. When a patient suffers a sphenoid fracture, there is a significant chance of brain injury or death. To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. Ct and mr imaging allowed precise extension to the skull base in preoperative management and followup investigations. Background multiple reports have demonstrated the efficacy of the transnasal endoscopic repair of cerebrospinal fluid csf leaks of the anterior cranial base. Sphenoid sinus and sphenoid bone fractures in patients with. Clinical features of visual disturbances secondary to. Scaphoid fractures are rare in young children and the elderly because of the. Management practices are often based on institution and physicianspecific training and preferences developed from anecdotal experience rather than evidencebased medicine as there is a.
Facial fracture management handbook applied anatomy. Its shape somewhat resembles that of a butterfly or bat with its wings extended. The temporal process, which forms zygomatic arch a1frontal process, which forms lateral orbital wall a2maxillary process, which forms infraorbital rim a3category bfracture of all three processes, detaching zygomatic bone from facial skeleton i. After he recovered consciousness, he presented limited abduction of the left eye with diplopia in all gaze directions and mild left proptosis. Traumatic superior orbital fissure syndrome is an uncommon complication of craniomaxillofacial trauma with an incidence of less than 1%. A small strut of lesser sphenoid wing forms the lateral orbital wall between the superior orbital fissure and the optic canal. This manual is written to be used as a rapid reference source in the management of facial bony trauma cases and to provide a sound knowledge base covering the pathophysiology resulting from these injuries.
The frequency of the sphenoid sinus and sphenoid bone fractures was 15. Acute and longterm psychological problems can result from maxillofacial trauma and disfigurement. Some authors advocate early and aggressive surgical and medical treatment for acute sphenoid sinusitis. Traumatic cerebrospinal fluid leaks johns hopkins hospital. Each patient underwent endoscopic surgery as a principal treatment, and. There are four sets of sinuses maxillary, ethmoid, frontal and sphenoid in our skulls distributed around the eyes. Age distribution of midfacial fracture patients according to cook and rowe.
It houses many vital structures, including the cochlear and vestibular end organs, the facial nerve, the carotid artery, and the jugular vein. Furthermore, the zygoma is connected to the maxilla and sphenoid bone as part of the inferior orbital floor, and forms the lateral orbital margin with the frontal bone. Skull base trauma csf leak basilar skull fracture csf rhinorrhea key points skull base fractures are managed based on associated intracranial injury and complications, including vascular and cranial nerve injury and cerebrospinal fluid csf leak. Facial fracture management handbook iowa head and neck. Sphenoid fractures are an indication of high velocity injury, and require reduction to decompress the orbital apex as well as create a reliable reference for reduction of the zygomas.
However, these conclusions were based on a small number of patients, all in their teenage years. The first human face allograft was successfully performed in. The sphenoid bone is one of the seven bones that articulate to form the orbit. Pdf the scaphoid is vitally important for the proper mechanics of wrist function. It can present immediately following head trauma or be delayed for many days before clinical symptoms occur. The proximal pole depends on blood supply from the distal pole through the scaphoid bone.
Each patient underwent endoscopic surgery as a principal treatment, and postoperative management included antimicrobial. As a result, the hypothalamus cannot convey antidiuretic hormone to the pituitary or stimulate the pituitary to release adh into the blood. A bone of irregular shape occupying the base of the skull. It can range from a thin crack to a complete break. Classic tripod fracture, but anatomically these fractures are actually. A scaphoid fracture is a break in one of the small bones of the wrist. An overview 1gk thapliyal, 2h ranga rajan abstract trauma to the midface involves fracture of the maxilla, the zygoma, orbit and the nasoorbital ethmoid complex. Treatment of scaphoid fractures and nonunions journal of hand. Facial fracture management handbook lateral orbital wall. Evaluation and surgical management of isolated sphenoid sinus.
Orbital blowout fracture radiology reference article. One patient had sphenoid bone fracture without involvement of the sphenoid sinus, which corresponded to 0. Facial fractures are broken bones anywhere on the face. A sphenoid subluxation can affect total body structure. In this article, we shall look at the anatomy of the sphenoid bone its location, structure, and clinical significance. It is frequently misdiagnosed because of its vague symptoms and the paucity of clinical findings. It may be a sign that your fracture is not healing if you notice decreased strength, such. Eye injuries, pediatric facial trauma, and other aspects of facial trauma management are discussed separately.
Orbital blowout fractures occur when there is a fracture of one of the walls of orbit but the orbital rim remains intact. Alignment of the zygomaticsphenoid fracture restored premorbid malar position. Inaccurate and delayed diagnoses are still issues in scaphoid fracture management. If the scaphoid fracture is not healing, you may or may not continue to have symptoms. Surgical management of facial fractures vula university of cape. In infants and children, a simple linear fracture, if associated with a dural tear, can lead to subepicranial hygroma or a growing skull fracture leptomeningeal cyst. The zygomaticsphenoid fracture line in malar reduction. Fractures that involve the zygoma often occur at these four suture sites, leading to a tetrapod fracture pattern, known as a zygomatic complex fracture zmc. Diagnosis and management of scaphoid fractures aafp. Sphenoid bone fractures and sphenoid sinus fractures are severe injuries. There were 111 patients with craniofacial fractures, 78 of whom had fractures of the sphenoid bone. Sep 09, 2019 the temporal bone is the most complex bone in the human body. The sphenobasilar sb junction the sphenoid articulates with the base of the occipital bone to form the sphenobasilar.
Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. Pdf fractures of the scaphoid bone mainly occur in young adults and constitute 27% of all fractures. A scaphoid nonunion fracture refers to a wrist fracture that is failing to heal. Jun 12, 2019 when an acute inflammatory response occurs in the sphenoid sinus, the result is sphenoid sinusitis or sphenoiditis. In each case in our study, the zygomatic sphenoid fracture line remained distracted. Spontaneous sphenoid sinus mucocele revealed by meningitis. A fracture that is healing more slowly than expected is a delayed union fracture. This may take up to 6 months to develop, resulting from the brain pulsating against a dural defect that is larger than the bone defect.
Sphenoid bone and sphenoid sinus fractures have a high morbidity due to the complexity of trauma and soft tissue involved at the level of the brain. Management of temporal bone trauma pubmed central pmc. Ct scan of the head performed the day of the car accident axial view showing frontal and skull base fractures involving the right sphenoid sinus and. The middle third of the facial skeleton comprises the following bones 14 figure 5. When trauma occurs to the zygoma and results in fracture of all four suture lines, it is called as a tetrapod fracture. This is reasonable, as these two bony complexes include the cribiform plate and sphenoid sinus, which are described as the two. Traumatic intrasphenoidal pseudoaneurysm lodged inside the. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. Sphenoid sinus mucocele is an uncommon lesion related to inflammatory disease that is diagnosed after surgery or a traumatic event.
Computed tomography ct has become the imaging standard of reference in evaluating these injuries to determine which patients will require surgical intervention for their bony injuries, 3, 4. Sphenoid bone lies at the base of the skull in front of petrous part of temporal bone and basilar part of occipital bone. Jun 05, 20 the frequency of the sphenoid sinus and sphenoid bone fractures was 15. It is divided into anterior, central, and posterior regions, which form the floor of the anterior.
Scaphoid nonunions can present with or without avascular necrosis of the. Pdf fractures of the scaphoid, diagnosis and managementa. Sphenoid bone location structure function teachmeanatomy. Nasoorbitoethmoid fracture management sciencedirect. Anterior cranial fossa fractures, particularly comminuted and oblique frontobasal fractures, are. Midface le fort fracturesblunt force trauma tends to cause fractures along three lines of weakness in the midface. Dec 19, 2014 maxillofacial injuries can be complex and multispecialty involvement in their management may be needed. Cranial treatment and spinal manipulation for a patient. The temporal bones form parts of the middle and posterior cranial fossae and contribute to. Surgical management of zygomatic complex fractures in a. Chronic low back pain is a common problem and its prevalence has increased to around 10% in the last decade. The distal radius articulates with the bones of the proximal carpal row except the pisiform and triquetrum at the radiocarpal joint. Speci c management of skullbase fractures depends on the location, extent, type of injury closed.
248 1090 130 995 220 607 694 950 289 672 1290 710 132 1278 1101 1193 437 1149 587 628 1460 1425 470 138 840 1091 1167 263 409 241 532 1170 697 430 1209 837 194 433 100 1086 925 881