Crumple zone effect of nasal cavity and paranasal sinuses on posterior cranial fossa. 2014

Thomas S Lee, and Robert Kellman, and Andrew Darling
Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia.

OBJECTIVE Examine a protective crumple zone effect of paranasal sinuses and nasal cavity on skull base fractures. METHODS Randomized-control, cadaveric study. METHODS In the experimental group (n = 4), the nasal cavity and bilateral sinuses of cadavers were obliterated with bone cement, whereas the control group (n = 4) had native sinus architecture. Increasing frontal, glabellar impacts were introduced. Each impact event was examined with a high-speed video camera and sphenoid sinus pressure sensor. After each impact, computed tomography scans were performed and fracture sites were analyzed. RESULTS The control group with intact sinuses showed statistically longer time duration, during which kinetic energy transfer occurred, and longer sphenoid wall pressure equilibrium time after an impact (P < 0.05). In the experimental group, there were statistically higher fracture incidences of clivus, petrous portion of internal carotid, occipital bone, and foramen magnum (P < 0.05). The type A pattern (n = 6) had anterior skull base failure occurring before posterior skull base failure. Type B pattern (n = 2), seen only in two experimental specimens, is marked by premature posterior skull base collapse occurring before anterior skull base failure with grossly disrupted posterior cranial fossa structures. CONCLUSIONS The presence of nasal cavity and paranasal sinuses behaves as a crumple zone to protect the cranial structures, preferentially posterior cranial fossa. Obliteration of the nasal cavity and paranasal sinuses with bone cement significantly increased structural tolerance of the anterior cranial vault to frontal, glabellar impacts at the cost of premature, posterior cranial fossa failure.

UI MeSH Term Description Entries
D008297 Male Males
D009296 Nasal Cavity The proximal portion of the respiratory passages on either side of the NASAL SEPTUM. Nasal cavities, extending from the nares to the NASOPHARYNX, are lined with ciliated NASAL MUCOSA. Nasal Cavities,Cavities, Nasal,Cavity, Nasal
D010256 Paranasal Sinuses Air-filled spaces located within the bones around the NASAL CAVITY. They are extensions of the nasal cavity and lined by the ciliated NASAL MUCOSA. Each sinus is named for the cranial bone in which it is located, such as the ETHMOID SINUS; the FRONTAL SINUS; the MAXILLARY SINUS; and the SPHENOID SINUS. Nasal Sinuses,Osteomeatal Complex,Ostiomeatal Complex,Ostiomeatal Unit,Sinonasal Tract,Supraorbital Ethmoid Cell,Cell, Supraorbital Ethmoid,Complex, Osteomeatal,Ethmoid Cell, Supraorbital,Osteomeatal Complices,Ostiomeatal Complices,Ostiomeatal Units,Sinonasal Tracts,Sinuses, Nasal,Supraorbital Ethmoid Cells,Tract, Sinonasal
D001843 Bone Cements Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. Bone Cement,Bone Glues,Bone Pastes,Bone Glue,Bone Paste,Cement, Bone,Cements, Bone,Glue, Bone,Glues, Bone,Paste, Bone,Pastes, Bone
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D003388 Cranial Fossa, Posterior The infratentorial compartment that contains the CEREBELLUM and BRAIN STEM. It is formed by the posterior third of the superior surface of the body of the sphenoid (SPHENOID BONE), by the occipital, the petrous, and mastoid portions of the TEMPORAL BONE, and the posterior inferior angle of the PARIETAL BONE. Clivus,Cranial Fossas, Posterior,Fossa, Posterior Cranial,Fossas, Posterior Cranial,Posterior Cranial Fossa,Posterior Cranial Fossas
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D012887 Skull Fractures Fractures of the skull which may result from penetrating or nonpenetrating head injuries or rarely BONE DISEASES (see also FRACTURES, SPONTANEOUS). Skull fractures may be classified by location (e.g., SKULL FRACTURE, BASILAR), radiographic appearance (e.g., linear), or based upon cranial integrity (e.g., SKULL FRACTURE, DEPRESSED). Linear Skull Fracture,Skull Fracture, Linear,Skull Fracture, Non-Depressed,Non-Depressed Skull Fracture,Fracture, Non-Depressed Skull,Fracture, Skull,Fractures, Linear Skull,Fractures, Non-Depressed Skull,Fractures, Skull,Linear Skull Fractures,Non Depressed Skull Fracture,Non-Depressed Skull Fractures,Skull Fracture,Skull Fracture, Non Depressed,Skull Fractures, Linear,Skull Fractures, Non-Depressed

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