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The cause of maxillary sinusitis is bacterial infection or obstruction of the natural ostium. The etiology of the obstruction of natural ostium are mucosal hypertrophy, infection, immune disorder, mass and trauma. Recently, secondary sinusitis was sometimes reported after post- traumatic facial bone fracture. Between August 2002 and November 2004, out of 74 cases with midfacial comminuted fracture, four patients were diagnosed as post-traumatic maxillary sinusitis. All patients were treated by open reduction and internal fixation. After several months, the patients complained about the nasal obstruction, discharge, pain and tenderness. They were treated by functional endoscopic sinus surgery. Three patents were recovered from sinusitis, however one patient recurred. This case was treated by persistent antibiotics therapy. In retrospective review of initial paranasal sinus CT, we could detect the obstruction of natural ostium in these four patients. The fractured and displaced segments of ethmoidal bone and maxilla around osteomeatal unit were considered to induce the obstruction of natural ostium. Midfacial bone fracture may induce the secondary sinusitis when osteometal unit were injured. Removal of hematoma, pathologic mucosa and fractured bone segments around of osteomeatal unit are helpful to prevent the obstruction of natural ostium. Therefore, we recommend to do initial reduction of the fractures combined with endoscopic sinus surgery to avoid secondary sinusitis in case of severe osteomeatal injury.
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