Endoscopic sinus surgery in the treatment of paranasal sinus injuries with metallic foreign bodies

Objective. To evaluate the use of modern endoscopic approaches for the removal of metallic foreign bodies in the treatment of patients with paranasal sinus injury. Patients and methods. We present our experience in treating patients with paranasal sinus injuries caused by shrapnel (94%) and bullets (6%) containing metallic foreign bodies. In 56% of cases, foreign bodies were located in the maxillary sinuses, in 19% and 8% of cases — in the frontal and sphenoid sinuses, respectively, and in 17% — in the ethmoid labyrinth. Results. The surgical procedure was performed using endoscopic endonasal and combined (external and endoscopic) approaches to varying extents. In interventions on the maxillary sinus, the choice of approach was determined by the course of the wound tract, which most often passed through the medial wall of the maxillary sinus. In case of gunshot shrapnel wounds of the frontal sinus, different types of Draf interventions were performed depending on the location of the foreign body and the course of the wound tract. For foreign bodies localized in the ethmoid cells adjacent to the lamina papyracea and under the skull base, the intervention extended to a partial anterior or total ethmoidectomy using the “front-to-back” technique, followed by revision of the involved areas. Conclusions. The use of endoscopic endonasal approaches enables minimally invasive and precise removal of foreign bodies from the paranasal sinuses, thereby reducing the rehabilitation period for patients with paranasal sinus injuries.