Maxillary sinusitis in patients ventilated for a severe head injury and with nostrils free of any foreign body

Background: This study aims to determine the frequency of maxillary sinusitis in the patients with traumatic head injury and nostrils free of any foreign body. In addition, the sensitivity and specificity of ultrasonography (US) for the detection of the presence of fluid in maxillary sinuses were evaluated. Patients and methods: Forty patients with severe traumatic head injury were included in the study. The patients who had displaced maxillary sinus fracture at the medial wall and naso-tracheal and/or naso-gastric tube were excluded. Paranasal computed tomography (CT) was performed along with the routine cranial CT scanning or in case of unknown source of infection and compared with the results of ultrasonographic examination of maxillary sinuses performed by a single radiologist who was unaware of the CT results. In the patients, who had clinical and radiological signs of sinusitis, a trans-nasal puncture was performed using sinoject (SinoJect (R), ATOS Medical, Sweden), a spring-activated puncture instrument, to take a sample for microbiologic examination and to drain maxillary sinuses. Results: Eighty-five percent of the patients were tracheotomised on the fifth day (on average) of their intensive care unit (ICU) stay. The frequency of sinusitis in the study group was found to be 32.5% (13 patients). The most frequently isolated species were Pseudomonas spp. (37.5%), Escherichia coli (20.8%) and Peptostreptococcus (16.7%). Five of the aspirates were polymicrobial. The sensitivity, specificity, positive predictive value and negative predictive value of B-mode US, compared with CT for the detection of fluid presence in maxillary sinuses in a 100 maxillary sinus examinations, were 92.2%, 81.6%, 83.9% and 90.9%, respectively. Conclusion: Maxillary sinusitis should be considered as a source of infection or sepsis in patients with traumatic head injury because of its high frequency. US is likely to be used as the first-line diagnostic tool for the determination of fluid in maxillary sinuses, especially in patients who do not require CT or cannot be transported to a radiology unit for CT. (C) 2009 Elsevier Ltd. All rights reserved.