Section 5. Medical science

78

3. Beloshitsky M. E. The algorithm of preoperative examination of patients with adrenal incidentalomas//Annals of Surgery. – 2007. – № 3. – P. 58–63.

4. Vetshev P. S., Ippolitov L. I., Vetshev S. P., Kovalenko E. I. Controversial questions and negative trends in the diagnosis and surgical treatment of accidentally discovered adrenal tumors//Surgery. – 2005. – № 6. – P. 11–14.

5. Vetshev P. S., Ippolitov L. I., Polunin G. V. One-stage combined operations in the adrenal glands and other organs//Modern Technolo-gies in General Surgery: Materials Conference. – M., 2001. – P. 121–122.

6. Vetshev P. S., Shkrob O. S., Kondrashin S. A. Accidentally detected adrenal tumors. Surgical treatment and dynamic observation?//Sur-gery. – 1999. – № 5. – P. 4–10.

7. Gogin E. E. The main trends of improving the diagnosis and the increasing importance of invasive research methods//Therapeutic Archives. – 2003. – № 4. – P. 5.

8. Kalinin A. P., Maystrenko N. A., Vetshev P. S. Surgical Endocrinology (manual)//Peter. – 2004. – P. 561–568.9. Nikonenko A. S., Zavgorodniy S. N., Podluzhny A. A., Vilhovoy S. O., Gaydargi E. I. Experience with simultaneous operations in pa-

tients with adrenal tumors//Zaporogsk Medical Journal. – 2010. – Volume 12, № 1. – P. 17–18.10. Nikonenko A. S., Zavgorodniy S. N., Golovko N. G., Klimenko A. V., Gaydarzji E. I., Vilhovoy S. O., Dolya O. S., Detsik D. A., Ru-

sanov I. V., Podluzhny A. A. Simultaneous operations in the surgical treatment of patients with endocrine disorders//Сучаснi медичнi технології. – 2013. – № 3. – P. 137–139.

Ashurov Azimjon Mirzajanovich,Boymuradov Shukhrat Abdujalilovich,

Khayruddinova Zulfiya Rafikovna,Ibragimov Davron Dastamovich,

Tashkent Institute of Advanced Medical Education,Tashkent Medical Academy,

Samarkand branch of the Tashkent State Dental InstituteE‑mail: Shuh69@mail.ru

Posttraumatic rhinosinusitis in patients with cranio-facial injuriesAbstract: Post-traumatic sinusitis develops due to combined craniofacial injuries and is accompanied by brain damage,

skull, orbit. Post-traumatic inflammation of the frontal sinus is in the first place among post-traumatic lesions of the paranasal sinuses, while the rarest post-traumatic sinusitis after trauma of the facial skeleton is an inflammation of the sphenoid sinus. We have examined 216 patients with cranio-facial injuries. Patients were carried out the following methods of research: rhinoscopy, X-ray, MRI, MSCT of PNS, sinusal probing, diagnostic puncture, in open fractures — revision of the sinuses. According to our data post-traumatic sinusitis amount to 9.7 % of the total number of cranio-facial injuries. When ongoing hemosinus more than 5 days it is necessary to conduct active anti-inflammatory, anti-edematous, biodegradable and mucolytic treatment.

Keywords: Post-traumatic sinusitis, craniofacial injuries, hemosinus, treatment of acute sinusitis.

Post-traumatic sinusitis develops due to combined craniofa-cial injuries and is accompanied by brain damage, skull, orbit. Dam-ages of the front group of the paranasal sinuses (PNS) develop as a result of injury of the facial skeleton, eye socket, while the post-traumatic sinusitis of the back groups of PNS occur in fractures of the skull base, as well as the long-term presence of a nasogastric tube, nasotracheal and endotracheal tubes [1; 4].

A characteristic feature of post-traumatic sinusitis is the presence of hemosinus, obstruction of the natural sinus by thrombosis, bone fragments, foreign bodies, damage of the mucous membrane etc. [2; 5].

Post-traumatic inflammation of the frontal sinus is in the first place among post-traumatic lesions of the paranasal sinuses, which is due to its anatomical features: a narrow nasofrontal channel, an ex-serted front wall, the large volume of the frontal sinus than the other paranasal sinuses. Injuries of the frontal sinuses can be penetrating and nonpenetrating to the cranial cavity, open and closed. Posttrau-matic purulent frontal sinusitis is a frequent serious complication of traumatic brain injury.

The rarest post-traumatic sinusitis after trauma of the facial skel-eton is an inflammation of the sphenoid sinus, because sphenoid sinus locates deep and has a protective anatomical structure, so this

sinus damages are rare. However, inflammation of the sinuses  is more common in fractures of the skull base, as well as in nosocomial sphenoiditis when, due to the serious condition of the patient a na-sogastric tube or conduct artificial pulmonary ventilation by endo-tracheal tube is installed. The cause of inflammation of the sphenoid sinus is in violation of ciliated airway epithelium function, leading to inflammation in the sphenoid sinus [2; 3].

The hospitalization for the purpose of examination and pre-scription of preventive therapy is indicated for the patients with post-traumatic hematosinus even when drainage function is safe [2; 6; 8].

Complications of traumatic sinusitis are: nasal septum ab-scess, osteomyelitis, frontoorbital fistula, orbital cellulitis, epidural abscess, sepsis.

The aim of this study was to examine the state of PNS in pa-tients with cranio-facial injuries.

Material and Methods: the work is done in the Department of Neurosurgery and Maxillofacial Surgery, ENT department for adults of the II clinic of the Tashkent Medical Academy. During the period from 2014 to 2015 we examined 216 patients with cranio-facial inju-ries, from which there were 180 (83.3 %) males, 36 (16.7 %) women. The age of patients ranged from 18 to 70 years (mean age 44 years).

Posttraumatic rhinosinusitis in patients with cranio-facial injuries

79

Causes of injury were as follows: sports injury, a car accident, home accidents, falls from height, etc. During the survey patients were con-sulted by maxillofacial surgeon, otorhinolaryngologist, neurosurgeon, resuscitation specialist, traumatologist, surgeon. All the patients at admission were provided medical care (cessation of bleeding, symp-tomatic treatment, resuscitation if necessary). Patients were under-gone clinical-laboratory and additional methods of research as well as computed tomography (CT), multislice tomography (CT), magnetic resonance imaging (MRI). All patients with injuries of PNS were ex-amined at the day of admission and at 4–5 days of treatment. Patients were carried out the following methods of research: rhinoscopy, X-ray, MRI, MSCT of PNS, sinusal probing, diagnostic puncture, in open fractures — revision of the sinuses. One of the first signs of PNS dam-age was the presence of hemosinus. The presence of blood in the si-nuses was set according to the radiologic diagnostics and diagnostic puncture. 92 (42.6 %) patients had fractures of PNS walls from the 216 cases of facial injuries. The presence of blood in sinuses was de-tected only in 68 (31.4 %) patients.

Table 1. – Distribution of patients with cranio-facial injuries depending on the localization of the injury

№ Anatomical structures Number of patients %

1. Fracture of the nose 96 44.42. Fracture of the walls of ethmoid sinuses 12 55.53. Fracture of the walls of the frontal sinus 44 20.44. Fracture of the walls of the maxillary sinus 28 135. Fracture of the walls of the sphenoid sinus 8 3.76. Combined fracture of the facial skeleton 40 18.57. Fracture of orbit walls 18 8.38. Fracture of the zygomatic bone 14 6.5

Total 216 100As its seen in Table 1, among the surveyed there was noted the

frequent damage of the walls of the frontal sinus — in 44 patients (20.4 %), followed by the maxillary — in 28 (13 %) and ethmoid si-nuses — in 12 (55.5 %) patients. However, these data are relative, since during the sinus damage the adjacent part of the face also injures. In the category of combined injuries of facial skeleton were included damages of 2 or more anatomical structures of the face. According to our data, combined fractures occurred in 40 patients, accounting for 18.5 %.

All patients were divided into 2 groups: 1st group of 47 patients with no infection hemosinus; 2nd group with 21 patients with infec-tion hemosinus.

Table 2. – Distribution of patients according to the number of identified hemosinuses

№ Name of the sinnus

Quantity of diagnosed si-nus fractures

%The number of identified hemosinuses

%

1. Frontal 44 47.8 32 34.82. Maxillary 28 30.4 22 23.93. Ethmoid 12 13 8 8.74. Sphenoid 8 8.7 6 6.5

Total 92 100 68 73.9

Results and discussionResults of the study of the group 1  showed that complete

clearance of PNS from the blood occur at 8–10 days after injury. Complaints of patients were not observed. Results of the study of the group 2 showed that the evacuation of the blood contents from sinus is labored because of infection of sinus or non-operational fis-tula. In open fractures infection of PNS occured exogenously. Ac-cording to our observations, suppuration of hemosinus is 31.4 % of the total number of cranio-facial injuries. In cases of hemosinus not disappearing at the 5th day after injury previously the emergence of post-traumatic sinusitis can be expected and it is necessary to begin treatment of acute sinusitis.

Table 3. – Frequency of hemosinuses and sinusitis in patients with fractures of the PNS walls

№Name of the sin-

nus

Number of fractures

Number of hemosinuses

Number of sinusitis

Abs. % Abs. % Abs. %1. Frontal 44 47.8 32 34.8 9 9.82. Maxillary 28 30.4 22 23.9 6 6.53. Ethmoid 8 8.7 6 6.5 3 3.34. Sphenoid 12 13 8 8.7 4 4.3

Total 92 100 68 73.9 21 22.8

According to data given in Table 3, post-traumatic inflammation of PNS ranges from 3.3 % to 9.8 %. Such a large range associated with different frequency of PNS injury, i. e. frontal sinuses are injured in most cases and post-traumatic frontitis also takes a leading place among the other post-traumatic sinusitis. Equally important is the overall status of the patient, i. e. reactivity, presence of chronic diseases as well as age. According to our observations, chronic diseases such as diabetes, anemia, chronic pneumonia were identified in 8 % of cases.

This diagram (fig. 1) shows the comparison of the age of post-traumatic sinusitis.

Fig. 1. Сomparison of the age of post-traumatic sinusitis

Thus, according to our data post-traumatic sinusitis amount to 9.7 % of the total number of cranio-facial injuries. When ongoing he-mosinus more than 5 days it is necessary to conduct active anti-in-flammatory, anti-edematous, biodegradable and mucolytic treatment.

References:

1. Govorun M. I. Injuries of ENT-organs and esophagus during peacetime: Tutorial//M. I. Govorun, A. A. Gorohov. – SPb., 2009. – P. 91.2. Bel’chenko V. A. Prognostication and treatment of fronto-spheno-ethmoiditis in patients with post-traumatic deformities of the upper

and middle parts of the face//V. A. Bel’chenko, I. N. Kosminkova//VestnOtorinolaringol. – 2001. – № 1. – P. 24–26.3. Le-Clech G. Post-traumatic  infections of the frontal sinus/G. LeClech [et al.]//Rev Laryngolotol Rhinol (Bord.)  – 1990. –

№ 111(2). – P.103–105.4. Lekas M. D. Reconstruction of post-traumatic sinus osteomyelitis//Laryngoscope. – 1984. – № 94(10). – P. 1277–1280.