Značaj veličine i strukture zidova čeonog sinusa na nastanak kontuzije mozga kod traume čeone regije

The anatomy of frontal sinus may vary individually, concerning volume and shape differences or, in rare cases, the absence of sinus. However, there are scarce data about the influence of these variations on the structure of fracture, which occurred with the force of a blunt stroke. Therefore, the aim of this study was to analyze the influence of frontal sinus volume on stress distribution and structure of fracture in frontal area. This dissertation studies objective parameters used for evaluation of the size of frontal sinus in condition after the high intensity blunt stroke effect on the appearance of brain contusion. The fracture pattern of trauma is reflected in anterior and/ or posterior wall fractures with or without fractures of nasofrontal canal. The injury of frontal sinus is characterized by a high risk of possible complications, while their management further remains a subject of different attitudes. Dissertation contains epidemiological, experimental and clinical study. Using descriptive method and retrospective study, the epidemiological study inspected the incidence and etiology of fracture of frontal sinus in the Center of Emergency and Neurotrauma – Emergency Center at Clinical Center of Serbia. The cause of fractures of frontal sinus and craniofacial massive injuries is presented, as well as epidemiological and etiological characteristics, clinical parameters and applied surgical procedures for frontal sinus fracture management. All patients placed in trauma department from January 1st 2012 to December 31st 2017 were managed by the same surgeons who were guided by good clinical practice for this type of injury at Clinical Center of Serbia. In accordance with the set goals, the research related to the experimental part of study is conducted in the Laboratory for Numerical Simulations at Bioengineering desk of Faculty of Engineering Sciences, University of Kragujevac. Using computer simulation, the experimental part of the study has analized the voltage distribution and deformation in a complex system of frontal sinus and neurocranium. The study includes four Finite Element skull model representatives. The reference model is made by computerized tomographic scan of human head with normally developed frontal sinuses. Modifying the reference model, there were three additional models generated: a model without sinus, the one with hypoplasia and a model with hyperplastic sinuses. The force of 7,7 kN was applied straightforward on forehead of each model, to simulate the frontal impact. The results show that distribution of force impact in frontal area depends on the volume of frontal sinus. External sinus wall showed the greatest fragility in case of hyperplastic sinus, while posterior wall/ internal plate showed greater fragility in hypoplastic or undeveloped sinus. Well-developed frontal sinuses, through absorption of the impact energy of anterior wall, can protect the posterior wall and intracranial structures. Our results prove that the distribution of stress caused by impacts in frontal region of the head or fracture of bone structures largely depend on the size of the volume of sinus cavity. Well-developed frontal sinuses may have a survival role, acting like „shock absorbers― and protecting intracranial and surrounding vital structures. This study explains for the first time mechanisms of this, previously only assumed – protective role of frontal sinuses. According to the results of clinical study, the main etiological reason for occurrence of the frontal sinus fracture is traffic accident – in particular, the category of co-driver. In our sample, the injury of the frontal sinus is identified at 11,3%. Based on the results, the fracture of sinus wall predict increasing the risk of contusion occurrence by 2,071 times. In case of joint injuries, the risk of contusion occurrence will increase by 1,7 times. The treatment process of this trauma largely depends on complexity and associated injuries, as well as intracerebral conditions which are very common in this type of traumatism