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Case of the Month: Baseball Foul Tip Causing Frontal Sinus Fracture

From: ENT Today, April 2011

by Brent J. Benscoter, MD, and James A. Stankiewicz, MD

Figure 1.

Figure 2.

Figure 3.

Presentation: A 14-year-old boy sustained blunt trauma to the forehead from a foul-tipped baseball. Significant past medical history consisted of allergic rhinitis treated with over-the-counter cetirizine (Zyrtec). On examination, the patient had right frontal sinus depression with overlying edema. There were no palpable nasal bone or orbital rim abnormalities. Baseball threads were seen on the overlying skin as well as ecchymosis on the nasal dorsum and under both eyes (Figure 1).

The patient had numbness of the right forehead from the eyebrow to the hairline. Visual acuity and ocular movement were normal. Nasal speculum and endoscopic examinations revealed no intranasal abnormalities. There was no evidence of clear rhinorrhea to suggest cerebral spinal fluid leak.

A CT scan (Figures 2 and 3) was obtained.

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