Injury of the Frontal Sinuses Caused by RecreationalPyrotechnics

Overview

A 30-year old man suffered a frontobasal injury type I, according to Escher an extensivehigh frontobasal fracture. According to the classification of gunshot wounds it was an openintracranial injury with damage of the dura mater caused by a slow projectile with low energy. Theprojectile struck the frontal region where it caused a lacerated skin wound. The patient was notunconscious. He attended for definite treatment only on the 8th day after the injury. He had nocomplaints, did not have an apparent cosmetic defect and did not have obvious liquorrhoea not evenafter provocation manoeuvres. Superficial examination could have led to quite incorrect conserva-tive treatment. Only CT examination revealed a comminuted fracture of the anterior and posteriorwall of the frontal sinuses with intracranial impression of the fragments. Except for a minorpneumocephalus there were no signs of brain damage. Examination of the nasal secretion for betatransferrin revealed nasal liquorrhoea. Indication for surgery was a bone fragment detected by CTwhich penetrated the brain about 1 cm deep, and nasal liquorrhoea detected by laboratory tests.This finding threatened to be a late life endangering complication. The patient was submitted tosurgery on the 13th day after the injury. A bicoronary section was done and access to intracraniumwas made via the bone defect - cranialization of the frontal sinuses, plastic operation of the duramater by a free pericranial flap and plastic operation of the anterior wall of the sinuses by a bonegraft from the external lamina of the calva. The surgical finding confirmed the serious character ofthe injury and the necessity of a surgical approach.

Key words:
injury of the frontal sinus, nasal liquorrhoea, cranialization, calvar graft.