[Conservative treatment of frontal sinus inflammation by means of trepanation and puncture of the frontal sinus].
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Anti-Bacterial Agents↗
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A targeted endoscopic approach to chronic isolated frontal sinusitis.
OBJECTIVE: Chronic isolated frontal sinusitis occurs infrequently. In this condition, most of the ethmoid cells are well aerated and the frontal sinus is involved secondary to anatomical obstruction or inflammatory changes confined to the frontal recess. The purpose of this study was to evaluate a targeted endoscopic technique where standard anterior ethmoidectomy is unnecessary in the treatment of chronic isolated frontal sinusitis. STUDY DESIGN AND SETTING: This retrospective study was conducted in a large university-affiliated hospital and included 11 patients with chronic isolated frontal sinusitis who underwent endoscopic sinus surgery limited to the frontal sinus outflow. The ethmoid bulla was untouched in all cases. Follow-up continued for 19 to 40 months (mean 28.6 months). RESULTS: Frontal sinus outflow patency was verified in 9 patients (81.8%). Nine patients, including one with an apparent nonpatent frontal ostium, reported improvement. Two patients-one of whom had a patent frontal ostium-reported no improvement. There were no complications. CONCLUSION: Chronic isolated frontal sinusitis can be effectively treated in selected cases by a targeted endoscopic procedure, limited to reestablishment of frontal sinus outflow. EBM RATING: C-4.
Adult↗
[Squamous cell carcinoma of the frontal sinus caused osteomyelitis of the frontal bone].
A case of the squamous cell carcinoma of the frontal sinus complicated with osteomyelitis of the frontal bone was reported. A 47-year-old male was admitted to Asahikawa Medical College Hospital because of a bulging of forehead and remittent fever of a six-month history and general convulsive seizures on the day before admission. On physical examination, a bulging of forehead with redness, tenderness and fluctuation was noted. Sense of smell diminished bilaterally. Oto-laryngological examination disclosed paranasal sinusitis. Skull X-P and CT scan suggested osteomyelitis of the frontal bone secondary to frontal sinusitis. However, a frontal sinus tumor with osteomyelitis was also possible. Operation was performed and a granulomatous mass attached to the dura with thick epidural abscess was noted. The mass and affected bone edge were removed. Pathological examination of the specimens disclosed findings of squamous cell carcinoma and osteomyelitis. Recurrence of the tumor rapidly occurred and reoperation was performed a month after the first operation. Postoperative irradiation and chemotherapy with pepleomycin were done but failed to control the growth and recurrence occurred immediately. The tumor penetrated the skin of the forehead and the patient died of cachexy 7 months after the first surgery. Osteomyelitis usually occurred in the metaphysis of long tubular bone and rarely in short bone or flat bone such as a skull. This is attributed to the difference of distribution of the bone marrow vessels. Embolization and subsequent growth of bacteria in the blood flow is less liable to occur in short bone and flat bone.(ABSTRACT TRUNCATED AT 250 WORDS)
Carcinoma, Squamous Cell↗
Therapy of invasive mucoceles of the frontal sinus.
Mucoceles of the frontal sinus that extend into the orbits and the anterior cranial fossa can, in certain cases, be difficult to manage therapeutically and may lead to lethal complications. The surgeon will have to make a decision between an endonasal and an extranasal, transfacial procedure to provide an adequate access. Between 1995 and 1998 we treated 12 patients suffering from invasive mucoceles of the frontal sinus. The mucocele was localized medially in 7 cases and in the lateral part of the frontal sinus in 5 cases. Five of the patients exhibited destruction of the orbital roof and in 7 cases combined destruction of the orbital roof and the floor of the frontal sinus were noted. The posterior wall of the frontal sinus was destructed in 6 patients, with one patient additionally showing partial destruction of the anterior frontal sinus wall. The causes of mucocele formation were previous frontal sinus operations (n = 8) and frontal sinus fractures (n = 3). In one case the cause remained unknown. In 7 cases with a medially localized mucocele the mucocele was marsupialized using an endonasal access. The mucoceles with a lateral localization were osteoplastically operated via an external access. Here we performed median drainage in 3 cases and, in one case each, obliteration and cranialization of the frontal sinus. The follow-up period was 2.8 years on average. All patients were free of complaints immediately after the operation. Mucocele recurrence or other complications did not arise. The cosmetic results were satisfactory in all cases.
Adult↗
[Pneumo-sinus dilatans of the frontal sinus].
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Frontal Sinus↗
Association of radiological evidence of frontal sinus disease with the presence of frontal pain.
BACKGROUND: Rhinosinusitis is a common cause of frontal pain. We evaluated the relationship between frontal pain and the type and degree of frontal sinus disease in chronic rhinosinusitis (CRS) patients. METHODS: Inclusion criteria were presence of frontal sinusitis or frontal recess obstruction on computed tomography scan. Office notes and operative reports were reviewed to determine the presence and location of frontal pain and categorization of sinus disease. RESULTS: Two-hundred seven patients were identified with frontal recess obstruction and/or frontal sinus disease. Thirty-one of 37 frontal mucocele patients (84%) had frontal pain. Twenty of 70 polyp patients (29%) had frontal pain, with only 7 of 38 patients (18%) with complete frontal opacification having pain. In patients with CRS without polyps or mucocele, 59 of 100 (59%) had frontal pain, with 21 of 38 (55%) with complete opacification having pain. This difference between the distribution of frontal pain was significant (p < 0.005) among the mucocele, polyp, and nonpolypoid CRS groups. Additionally, among nonmucocele CRS groups exhibiting complete opacification, there was a significant difference in proportion of patients exhibiting frontal pain (p < 0.005). When the nonmucocele groups (i.e., polypoid and nonpolypoid CRS patients) were combined and stratified for disease extent, a difference in the distribution of frontal pain was found (p < 0.025), with the mild-to-moderate thickening group showing the highest proportion of pain. CONCLUSION: Frontal pain was more common in nonpolypoid CRS patients than in polyp patients. Furthermore, in nonmucocele CRS, patients with mild-to-moderate thickening exhibited more frontal pain.
Adolescent↗
The frontal sinus unobliteration procedure.
Although intranasal frontal sinusotomy can now be performed for most cases of chronic frontal sinusitis, the osteoplastic frontal sinus procedure with obliteration, unfortunately, still is considered by many to be the standard for chronic frontal sinusitis against that which other frontal sinus procedures are judged. Unobliterating the previously obliterated sinus is indicated for patients with evidence of frontal sinus pathology on CT or MR images and for patients with chronic symptoms with equivocal radiologic results. The reopened frontal sinus can be reventilated and remucosalized, or reobliterated with the placement of a new fat graft. Complete or partial auto-obliteration by new bone formation or fibrosis is another possible endpoint that can result when unobliteration is attempted.
Adult↗
Light and transmission electron microscopic studies following frontal sinus obliteration with ionomer cement in cats.
Osteoplastic frontal sinus surgery in combination with sinus obliteration can be performed for various indications, including chronic sinusitis, frontal sinus trauma and removal of osteomas. In an experimental study using cats, the mucous lining of the frontal sinus was removed, the nasofrontal duct sealed with semifluid ionomer cement and the cavity filled with Ionogran, a solid and porous bone substitute based on ionomer cement. Histological investigations up to 1 year after surgery showed increasing sinus obliteration by regenerating bone, starting from the sinus wall, and formation of connective tissue between the cement grains. There was no evidence for mucosal regeneration. Electron microscopic examination of the interface between the cement and connective tissue revealed mesenchymal cells, collagen fibers and areas of mineralization in close contact with the implant material. Newly formed connective tissue matrix in intimate contact with the cement was a good indication for biocompatibility of the material and is a possible explanation for the implant's solid adhesion to bone. The present findings indicate that Ionogran is a suitable alloplastic material for experimental frontal sinus obliteration in cats.
Adhesiveness↗
Cranial complications of frontal sinusitis.
Complications of frontal sinusitis are potentially serious. The best prevention is adequate antibiotic treatment of acute sinusitis or of the acute exacerbation of chronic sinusitis. Intracranial complications include extradural, subdural and brain abscesses, meningitis and cavernous sinus thrombophlebitis. Bony complications include localized or spreading osteomyelitis. Surgical intervention is often required to prevent unacceptable mortality.
Adult↗
[Surgery of the frontal sinus in frontobasal fractures with special reference to the reconstruction of the frontal sinus and glabella].
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Accidents, Home↗
[Development of the frontal sinuses].
Variability studies on frontal sinuses, covering the age range from childhood to adulthood have been neglected in literature up to now. On a total of 215 children and youths from 3-17 years (117 boys and 98 girls), the growth rate of the frontal sinuses had been examined. The difference between males and females proved to be quite interesting. The frontal sinuses of girls increase evenly in size during the years, whereby from 1-5 years the development runs parallel with boys and girls. From 8-12 years the growth rate of male frontal sinuses is very low, causing a retardation of growth on boys in comparison to girls. After that period, however, a substantial acceleration of the growth rate takes place, so, that at the age from 14-15 years the frontal sinuses of the males have surpassed the female ones referring to size. At the age of 18 years the forming of frontal sinuses can be considered as finished.
Adolescent↗
Revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement: the frontal sinus rescue procedure.
Frontal sinusitis after middle turbinate resection occurs because of stenosis of the frontal ostium by soft tissue scarring or residual bony fragments (which are pulled to the medial orbital wall by scar contracture). Standard endoscopic techniques cannot address this problem; however, revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement (the frontal sinus rescue procedure) relieves this bony stenosis and incorporates a mucosal flap that minimizes postoperative stenosis.
Endoscopy↗
THE SURGICAL TREATMENT OF ACUTE FRONTAL SINUSITIS.
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Adolescent↗
[Fronto-orbital corrections and development of the frontal sinus].
The development of frontal sinuses following bilateral fronto-orbital advancement is a topic of controversial discussion in the literature. In a retrospective study on 33 patients (15 girls and 18 boys) the development of the frontal sinus was examined radiologically. Only patients with a minimum age of 6 years and with at least 1 year of postoperative follow-up were included. The radiological reference for the frontal sinus development consisted of pneumatisation at or above the level of the supraorbital rims, as projected din postero-anterior cephalograms. According to these criteria a frontal sinus development was seen in 72.7% of our patients. There was no statistically proven correlation between sinus development and the sex of the patient, age at surgery or the amount of advancement. With the exception of severe cases of Crouzon's disease we usually expect normal development of the frontal sinus following bilateral fronto-orbital correction.
Child↗
Treatment of frontal sinus osteoma using a craniofacial approach.
Osteoma is one of most common benign tumors of the nose and paranasal sinuses, with the frontal sinus being its most frequent location. It may be locally destructive and aggressive with possible intracranial complications. Osteoma of the frontal sinus comprises 57% of all osteomas in the paranasal sinuses. In 1939, Childrey reviewed 3,510 consecutive sinus radiographs taken for any reason and found an incidence of 0.43% of paranasal sinus osteomas. There are many operative approaches for frontal sinus osteomas, such as external frontoethmoidal approach and osteoplastic frontal sinusectomy, both with high recurrence rates. Those traditional operative methods cannot radically eradiate the osteoma grown in the posterior table of the frontal sinus. From July 1991 to June 1992, three patients with symptomatic frontal sinus osteomas were operated by a craniofacial approach. One patient is presented here in detail. A coronal incision is used and is found to be beneficial both in surgical exposure and in reconstruction with a calvarial bone graft. The patient has been followed for 3.5 years without osteoma recurrence.
Bone Neoplasms↗
Assessment of symptomatic patients after endoscopic sinus surgery with special reference to the frontal sinus: comparative radiologic analysis.
PURPOSE: To reveal the role of potential risk factors in frontal recess dissection (FRD), middle turbinate resection (MTR), sinonasal polyposis, and extension of disease in postoperative frontal sinus opacification by determining radiologic changes after endoscopic sinus surgery (ESS) in symptomatic cases using computed tomography (CT). STUDY DESIGN: Retrospective analysis of prospectively collected data from symptomatic patients after ESS. METHODS: Postoperative CT scans were taken in all symptomatic patients during their least symptomatic period or after maximal medical therapy. The radiologic findings of each sinus were compared, and the outcome of ESS was statistically evaluated. Furthermore, FRD, MTR, sinonasal polyposis, and extension of disease were analyzed for postoperative frontal sinus opacification. RESULTS: In our study, 101 sinuses of 61 symptomatic patients were examined. A significant improvement in opacification in all sinuses was detected postoperatively. Multivariate analysis of all potential risk factors revealed that postoperative frontal sinus opacification was affected only by sinonasal polyposis (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.04-10.58) and extension of disease (OR 16.93; 95% CI 4.33-66.23). CONCLUSIONS: Our study revealed that surgical procedures such as FRD and/or MTR may not directly affect postoperative frontal sinus opacification. On the contrary, sinonasal polyposis and extension of disease seemed to be the main risk factors of this issue.
Adolescent↗
[Transnasal endoscopic frontal surgery for chronic frontal sinusitis].
OBJECTIVE: The recurrence of chronic frontal sinusitis after endoscopic surgery is mainly due to the mismanagement of frontal recess and frontal sinus orifice. The aim of this study is to investigate the characteristics of chronic frontal sinusitis and to advance the clinical therapeutic efficacy. METHODS: Different methods were used to manage different local diseases in frontal sinus orifice or frontal recess in 58 cases (96 sides) with chronic frontal sinusitis by nasal endoscopic surgery. RESULTS: Different degree of middle meatal obstruction was seen in all cases at operation. The situation of frontal sinus ostium and frontal recess was as follows: 38 sides obstructed by swollen mucosa, polypoid mucosa or polyps, no cell obstruction at frontal sinus orifice; 34 cases constricted by over development of agger nasi cells, ethmoid bulla or terminal cell at frontal recess; 15 cases obstructed completely by over development cells at frontal recess; osteal stenosis at frontal sinus orifice in 9 cases. The situation in frontal sinus was as follows: pus accumulation in 18 sides, mucosal swollen in 21 sides, mucosal congestion in 49 sides, no obvious mucosal diseases in 8 cases. Follow-up for 6-20 months showed that 69 sides (71.9%) were cured, 17 sides (17.7%) better and 10 cases (10.4%) recurrent. CONCLUSION: Obstruction of osteomeatal complex and frontal recess is the main causes of chronic sinusitis. There are four pathologic states in obstruction of frontal recess and frontal ostium. Different operative methods should be taken according to different pathological changes. The operative effects is still needed to improve.
Adult↗
Surgery of the frontal recess and frontal sinus.
Surgery on the frontal recess and frontal sinus remains a challenge for endoscopic sinus surgeons. This paper examines the philosophy behind such surgery and presents a technqiue for 3-dimensional reconstruction of the anatomy of the frontal recess and frontal sinus. Utilizing this anatomical reconstruction the surgeon is encouraged to develop a pre-operative step-by-step surgical plan for each cell identified within the frontal recess and frontal sinus and thereby predict the anatomy of this region before surgery is undertaken. An increased understanding of the anatomy of this region should improve the surgeon's surgical confidence and ability to remove all the obstructing cells from the frontal sinus ostium.
Endoscopy↗