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Case Stories |
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A 21-year-old fell off his motorcycle and struck the side of his face on the murram road. When seen at the Emergency clinic, he
was found to have a bruised and swollen left cheek. There was a subconjuctival
hemorrhage in the left eye, and the lower orbital margin and maxilla were
tender. Sensation, over the left cheek was normal. The initial radiograph
taken at the clinic did not show a fracture of the maxilla, but there
was a fluid level of blood in the left maxillary air sinus. He was therefore
presumed to have a fracture involving the maxilla. It is important to
examine the sinuses of radiographs of injured patients, because sometimes
an opaque sinus will be the only clue to bony injury. His facial
swelling subsided during the subsequent weeks, and further radiographs
failed to show the fracture. The floor of the orbit was stable and he
did not develop double vision. Sensation remained normal over the cheek,
indicating that the Infraorbital nerve had not been damaged. The student
should test for double vision and cheek sensation whenever he is presented
with an injury to the front of the face. A repeat radiograph 6 weeks after
the injury showed that the blood had cleared from the maxillary sinus. |
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A 40-year-old
nurse, caught a cold from her ward. She remained in bed for
a week and then decided to start work again. She developed a severe left-sided
frontal headache, and pain below the left eye. When seen at the local
health center, she had pyrexia and was tender over both the left maxillary
and left frontal sinuses. A radiograph showed that the left maxillary
sinus was opaque and that there was a fluid level in the left frontal
air sinus. She was given a course of antibiotics, and made some improvement.
Over the course of the next few weeks, the frontal sinusitis cleared,
but the maxillary sinus remained full. She was referred for proof puncture
and antral lavage. (Maxillary air sinus is often called antrum by the
ENT surgeon). Proof puncture was done under local anaesthetic. A trocar
and cannula were driven through the thin bone beneath the inferior turbinate
into the maxillary sinus. The trocar was removed, and a syringe attached
to the cannula.
Pus was aspirated and a specimen sent for culture and antibiotic sensitivity. A syringe was then attached to the cannula and the sinus was washed out with sterile saline at body temperature. This procedure blew open the opening of the maxillary sinus and washed out the sinus. At the end of the operation, a polythene tube was inserted through the cannnula into the sinus and left in place. The nursing staff washed out the maxillary antrum3 times daily for the following 2 days, by which time it was clear. |
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A 46-year-old
chronic alcoholic vagrant, presented himself at the emergency unit with
a swollen and inflamed forehead. On examination, there was bony tenderness
of the forehead and both maxillae. He was pyrexial. A radiograph showed
that both maxillae were opaque; there was also opacity of the left ethmoidal
and frontal sinuses. The frontal bone had a fluffy appearance, indicating
spread of infection from the sinus to bone. He therefore had frontal osteomyelitis
(inflammation of bone).He was admitted for an intensive course of antibiotics
and for rehabilitation. He was discharged after 3 weeks of treatment in
a reasonably fair state of health, but was seen a few weeks later in the
emergency with hepatitis. |
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