Death due to late complication of paranasal sinus fracture following road traffic trauma

Abstract

The nose and maxilla are components of the danger triangle. Due to the special nature of the blood supply to the human nose can lead to cavernous sinus thrombosis, meningitis or brain abscess. Frontal and maxillary sinus infection leads to early and delayed complications. In this case, lack of information had been given to the patient by the clinicians on discharge regarding review examination. An elderly alcoholic was admitted to a tertiary care hospital following road traffic trauma. He had received fractures of right maxillary bone and frontal sinus with frontal lobe brain contusion. CT scan showed fluid levels in the bilateral maxillary sinus. He was treated inward for two weeks and was discharged. He was advised to come for review examination in one week but defaulted and had not also taken antibiotics regularly.  Two weeks later, he was re-admitted with spiky fever for three days. On admission, he was drowsy and had neutrophil leukocytosis. He died two days after admission. The autopsy revealed yellow pus and abscesses on the brain surface. Other organs showed septic features. The cause of death was brain abscesses and meningitis following blunt force trauma to head.  The brain abscesses and meningitis were complications of sinus fracture following road traffic accident of an alcoholic who had not followed proper medical advice. A multidisciplinary approach and a proper follow up is needed to prevent such deaths due to late complications. We highlight that adequate information should be given to both patient and relatives especially when the patient is an alcoholic to prevent the late complications and death.