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Fourteen Air Force pilots and one Scuba diver exhibiting a severe form of aerosinusitis — frontal sinus hematoma — were evaluated and treated. The physiology of the sinuses during flight is presented as a basis for clinical staging of sinus barotrauma. Despite prompt and intensive medical therapy, 13 pilots with Grade III sinus barotrauma required trephination of the frontal sinus.

One of the most dramatic complications of tracheostomy is a fistula between the trachea and the innominate artery. Our study has shown that patients at highest risk are those requiring ventilatory assistance with a cuffed tracheostomy tube placed below the level of the fourth tracheal ring. Median sternotomy has been the initial surgical procedure reported for the control of the attendant massive hemorrhage. We have found that immediate control of bleeding can be rapidly and safely accomplished by making a small suprasternal incision and compressing the innominate artery between the surgeon's finger and the undersurface of the sternum. This previously unreported use of the mediastinoscopy approach is also applicable in traumatic wounds of the lower neck, trachea and great vessels.

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