Computed tomography exclusion of osseous paranasal sinus injury in blunt trauma patients: the "clear sinus" sign.
OBJECTIVE
This prospective study was designed to assess the association of clear paranasal sinuses (no free fluid) as shown by facial computed tomography (CT) with the absence of fractures involving the paranasal sinus walls.


METHODS
All facial CT scans performed during a 12-month period to rule out maxillofacial injury in blunt trauma patients were reviewed. The scans were made using 5-mm slice thickness and 4-mm table incrementation. They were assessed for the presence or 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. Twenty-two (12%) of these 180 CT studies showed isolated nasal fractures (n = 13) or zygomatic arch fractures (n = 9). No patient without free paranasal sinus fluid had any midfacial fracture involving a paranasal sinus wall (P < .001 by Fischer exact test).


CONCLUSIONS
The absence of free paranasal sinus fluid after facial trauma is a highly reliable criterion to exclude fractures involving the paranasal sinus walls. Other fractures involving osseous structures not contiguous with the paranasal sinus walls, such as nasal or zygomatic arch fractures, are not excluded. The CT "clear sinus" sign is a simple, rapid method to exclude paranasal sinus fractures.
Lambert
D M
DM
Department of Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore 21201, USA. DLAMBERT@UMABNET.AB.UMD.EDU
Mirvis
S E
SE
Shanmuganathan
K
K
Tilghman
D L
DL
D005122:Exudates and Transudates; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000293:injuries; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006801:Humans; D008440:Maxillary Fractures / Q000000981:diagnostic imaging; D008446:Maxillofacial Injuries / Q000000981:diagnostic imaging; D009295:Nasal Bone / Q000000981:diagnostic imaging / Q000293:injuries; D009917:Orbital Fractures / Q000000981:diagnostic imaging; D010159:Palate / Q000000981:diagnostic imaging / Q000293:injuries; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000293:injuries*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D015051:Zygomatic Fractures / Q000000981:diagnostic imaging