Dm. Lambert et al., COMPUTED-TOMOGRAPHY EXCLUSION OF OSSEOUS PARANASAL SINUS INJURY IN BLUNT TRAUMA PATIENTS - THE CLEAR SINUS SIGN, Journal of oral and maxillofacial surgery, 55(11), 1997, pp. 1207-1210
Purpose: This prospective study was designed to assess the association
of clear paranasal sinuses (no free fluid) as shown by facial compute
d tomography (CT) with the absence of fractures involving the paranasa
l sinus walls. Patients and Methods: All facial CT scans performed dur
ing a 12-month period to rule out maxillofacial injury in blunt trauma
patients were reviewed, The scans were made using 5-mm slice thicknes
s and 4-mm table incrementation, They were assessed for the presence o
r absence of free paranasal sinus fluid (hemorrhage) and the presence
and location of facial fractures. Results: 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. Twent
y-two (12%) of these 180 CT studies showed isolated nasal fractures (n
= 13) or zygomatic arch fractures (n = 9). No patient without free pa
ranasal sinus fluid had any midfacial fracture involving a paranasal s
inus wall (P < .001 by Fischer exact test). Conclusion: The absence of
free paranasal sinus fluid after facial trauma is a highly reliable c
riterion to exclude fractures involving the paranasal sinus walls. Oth
er fractures involving osseous structures not contiguous with the para
nasal sinus walls, such as nasal or zygomatic arch fractures, are not
excluded, The CT ''clear sinus'' sign is a simple, rapid method to exc
lude paranasal sinus fractures.