Proptosis and diplopia as consequences in trauma of craniofacial junction

Abstract

In the trauma of craniofacial junction, frontal sinus wall fractures take up 5-15% of all facial bone fractures. The most common mechanism of their occurrence comes as a result of the action of high-energy impact force on the frontal area. Treatment of the injuries in frontal-orbital-ethmoidal regions largely depends on the responsible experts (otolaryngologist, maxillofacial surgeon or neurosurgeon) in all cases, because of the implementation of diverse surgical technics in order to achieve the best possible outcome for the patient. Bearing in mind the complex anatomical features of this region, it is clear that these procedures are often accompanied by series of possible complications, all of which are certainly neurosurgical. These can be expressed as early or late complications, and could be characterized by diverse clinical manifestations. Mucocele is formed, either due to partial obstruction of the sinus mucosa or due to the obstruction of the frontal sinus. The long term existence of mucocele and its progressive growth will result in strong pressure on the adjacent bones, and lead to their destruction followed by the process-propagation into surrounding tissues and spaces. In the further development if a bacterial contamination is detected, it will lead to the purulent inflammatory process and clinical picture of mucopyocele. In most clinical cases with complications proptosis and diplopia are dominant ophthalmic manifestations. In this paper we will present our experience in the treatment of proptosis and diplopia, as well as the ways of diagnostic evaluation in order to achieve timely diagnosis and assure swift healing of patients.