Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis

Abstract

This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF.

Relationship between midfacial fractures and maxillary sinus pathology

“…However, very few studies have reported the incidence of maxillary sinusitis in large samples of patients with maxillofacial injuries. In a study by Jiang et al [ 1 ], maxillary sinus pathology was present in 218 of the 372 imaged maxillary sinuses (58.60%), indicating that maxillary sinus pathology was common following ORIF of a midfacial fractures. In contrast, our study revealed an 11.27% incidence of maxillary sinus pathology.…”

“…Midfacial fractures account for 45.4% to 79.1% of all facial fractures and often involve the maxillary sinus [ 1 ]. These fractures can be caused by motor vehicle accidents, domestic disputes, falls, industrial accidents, or assaults with or without a weapon [ 1 - 5 ].…”

“…Midfacial fractures account for 45.4% to 79.1% of all facial fractures and often involve the maxillary sinus [ 1 ]. These fractures can be caused by motor vehicle accidents, domestic disputes, falls, industrial accidents, or assaults with or without a weapon [ 1 - 5 ]. When a midfacial fracture is accompanied by a maxillary sinus fracture, potential complications may include orbital muscle entrapment, orbital cellulitis, orbital abscess, enophthalmos, hypophthalmos, sinusitis, sinus mucocele, pseudoaneurysm, oromaxillary fistula, dental malocclusion, epistaxis, facial asymmetry, chronic facial pain, pressure sensitivity, and infraorbital nerve paresthesia [ 2 , 3 , 6 , 7 ].…”

“…Sinusitis is the most common disease affecting the maxillary sinus after trauma [ 1 ]. In the majority of midfacial fracture cases, disruption of the mucosa lining the internal wall of the sinuses occurs, increasing the risk of various problematic sequelae.…”

“…However, research on maxillary sinus pathology following open reduction and internal fixation (ORIF) in patients with midfacial fractures is scarce. Although Jiang et al [ 1 ] identified risk factors for maxillary sinus pathology after surgery for a midfacial fracture, their study was limited to patients using titanium plates and focused on maxillary sinus involvement rather than the fracture type. Similarly, Ballon et al [ 3 ] compared outcomes of anterior maxillary sinus wall reconstruction, but their study was also restricted to patients using titanium plates and concentrated on maxillary sinus involvement in the anterior wall.…”