Gunshot wound to the frontal sinus.
Immediate treatment of this patient, evaluation of the wound, the use of antibiotics, and eventual reconstruction are all concerns in this complicated gunshot wound to the frontal sinus. The consultants agree that the first priority in this patient is to assess and stabilize the airway, examine the wound, and obtain a CT scan to ascertain the extent of the defect. Dr. Key feels that these wounds are contaminated and would prophylactically order a broad-spectrum cephalosporin and/or chloramphenicol. Dr. Tami would use antibiotics aimed at Staphylococcus and oral flora; Dr. Donald prefers to treat specific infections as they develop. They also agree that initial reconstruction should be conservative, aimed at covering exposed bone and minimizing local/regional flaps; however, Dr. Donald suggests using an arch bar on the intact side and eyelet wires on the injured side to address the maxillary defect. Drs. Key and Donald feel that it was a mistake to close this wound primarily and use a skin graft, because there was an inadequate soft tissue bed. Dr. Tami states that the initial management of the wound was reasonable. All agree on a basic approach to frontal sinus fractures. CT scanning is the imaging modality of choice. Nondisplaced fractures may be observed. Disruption of the posterior wall or the nasofrontal duct usually require exploration and obliteration of the sinus. Dr. Key would ablate the sinus only in cases where the anterior table is completely lost. Drs. Tami and Donald agree that cranialization should be reserved for comminuted posterior table fractures. After recognizing a CSF leak, Dr. Key would begin a broad-spectrum antibiotic.(ABSTRACT TRUNCATED AT 250 WORDS)
Key
J M
JM
Department of Otolaryngology, University of California-San Francisco.
Tami
T
T
Donald
P J
PJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000502:physiology; D005151:Facial Injuries / Q000188:drug therapy / Q000601:surgery; D005626:Frontal Sinus / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D008793:Metrizamide; D013406:Suicide, Attempted; D014946:Wound Infection / Q000517:prevention & control; D014948:Wounds, Gunshot / Q000601:surgery / Q000628:therapy*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008793:Metrizamide