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Management of frontal sinus fractures.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the radiographic and clinical diagnosis of frontal sinus fractures. 2. Identify various management approaches to the frontal sinus fracture and the indications for each. 3. Understand the rationale behind the decision of sinus obliteration when needed. 4. Recognize the most common complications arising from frontal sinus fracture treatment and the methods of avoiding or managing these complications. SUMMARY: Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. There is no single algorithm for the choice of management, but appropriate treatment depends on an accurate diagnosis using physical examination, computed tomography data, and the findings of intraoperative exploration. The amount and location of fixation and the need for frontonasal duct and sinus obliteration or elimination of the entire sinus depend on the anatomy of the fracture in general and the extent of involvement of the anterior wall of the sinus, the frontonasal duct, and the posterior wall in particular. This article discusses an algorithm for frontal sinus fractures that was obtained from the literature and modified according to the authors' experience. The decision-making process presented by the authors has withstood the test of time over a period of more than 20 years in their practice and has been proven to be safe and efficacious in treating frontal sinus fractures of all types.

Accidents, Traffic↗

Sounding airflow enhances aerosol delivery into the paranasal sinuses.

BACKGROUND: The use of aerosol therapy is commonly suggested in the treatment of paranasal disorders but it is difficult to achieve an effective penetration of drugs into the sinuses. The authors have recently shown that an oscillating airflow produced by phonation (nasal humming) causes a large increase in the gas exchange between the nose and the paranasal sinuses. This is reflected by a high peak in nasally exhaled nitric oxide (NO) levels because NO accumulated in the sinuses is rapidly washed-out via the sinus ostia. OBJECTIVE: This study was designed to test whether the increase in sinus gas exchange caused by an oscillating airflow could be used to enhance penetration of a drug into the sinuses. MATERIALS AND METHODS: In six healthy subjects a nitric oxide-synthase inhibitor L-NAME was administrated into the nostrils by a jet nebulizer connected to a duck call, which could be modified to generate either a sounding airflow or a non-sounding airflow. The degree of L-NAME penetration into the sinuses was judged from the reduction in nasal NO during humming exhalations. Sinus drug deposition was also studied in a model of the nose and sinus. RESULTS: In humans the delivery of L-NAME with the non-sounding airflow had no effect on the NO levels achieved during humming, whereas L-NAME administration with sound caused a significant 22-35% reduction in nasal NO. In the model the aerosol delivery with the sounding airflow caused a fourfold increase in sinus drug deposition as compared with an aerosol without sound. CONCLUSION: A sounding airflow increases the delivery of an aerosolized drug into the paranasal sinuses.

Administration, Intranasal↗

Benefits of dual chamber pacing in sick sinus syndrome.

The effects of DDD (fully automatic) and VVI (ventricular demand) pacing modes on exercise tolerance, symptom diary cards, and Holter monitoring were investigated in a randomised double blind crossover study of 16 patients who had had DDD pacemakers implanted because of frequent syncope. Eight patients presented with sick sinus syndrome and, with one exception, retrograde atrioventricular conduction and eight age and sex matched patients presented with 2:1 or complete atrioventricular block. Maximal symptom limited exercise in those with atrioventricular block was significantly higher after one month of DDD pacing than after VVI pacing. In those with sick sinus syndrome, however, maximal effort tolerance was not significantly different for the two pacing modes. In all but one patient with sick sinus syndrome sinus rhythm developed during exercise in VVI pacing. For both VVI and DDD modes maximal atrial rates were significantly lower in those with sick sinus syndrome. Palpitation and general wellbeing were significantly improved during DDD pacing in the eight patients with sick sinus syndrome. Shortness of breath was improved by DDD pacing in the eight patients with atrioventricular block but not in those with sick sinus syndrome. Holter monitoring showed that sick sinus syndrome patients remained in paced rhythm, either DDD or VVI, for most of the 24 hour period. DDD pacing was better than VVI pacing in sick sinus syndrome with retrograde atrioventricular conduction. Despite their ability to show sinus rhythm and inhibit their pacemakers on exercise patients with sick sinus syndrome are just as likely to have symptomatic benefit from DDD pacing as patients with atrioventricular block.

Adult↗

Different distribution of abnormal endocardial electrograms within the right atrium in patients with sick sinus syndrome.

BACKGROUND: Prolonged and fractionated right atrial endocardial electrograms are characteristic of paroxysmal atrial fibrillation (idiopathic or associated with sick sinus syndrome). The distribution of these abnormal atrial electrograms within the right atrium and the way it is related to the likelihood that patients with sick sinus syndrome will develop paroxysmal atrial fibrillation was studied. METHODS: Endocardial catheter mapping of the right atrium during sinus rhythm was performed in 41 control patients with normal sinus node function and without paroxysmal atrial fibrillation, in 33 patients with sick sinus syndrome but without tachycardia, and in 27 patients with sick sinus syndrome and paroxysmal atrial fibrillation (group 3). The bipolar electrograms were recorded at 12 sites in the right atrium and an abnormal atrial electrogram was defined as lasting > or = 100 ms and/or showing eight or more fragmented deflections. RESULTS: 1195 atrial endocardial electrograms were assessed and quantitatively measured. In patients with sick sinus syndrome and paroxysmal atrial fibrillation 54% of the abnormal atrial electrograms were recorded from the high right atrium, 28% from the mild right atrium, and 18% from the low right atrium. However, in patients with sick sinus syndrome without tachycardia 78% of the abnormal atrial electrograms were recorded from the high right atrium and 22% from the mid right atrium. No abnormal electrograms were recorded from the low right atrium. CONCLUSIONS: In patients with sick sinus syndrome without tachycardia abnormal atrial electrograms generally came from the high right atrium but in patients with sick sinus syndrome and paroxysmal atrial fibrillation abnormal atrial electrograms were more widely distributed in the right atrium. In patients with sick sinus syndrome the greater the extent of the compromised atrial muscle, the greater the likelihood that paroxysmal atrial fibrillation will develop.

Adult↗

Development of sinus node disease in patients with AV block: implications for single lead VDD pacing.

OBJECTIVE: To investigate the incidence of sinus node disease after pacemaker implantation for exclusive atrioventricular (AV) block. DESIGN: 441 patients were followed after VDD (n = 219) or DDD pacemaker (n = 222) implantation for AV block over a mean period of 37 months. Sinus node disease and atrial arrhythmias had been excluded by Holter monitoring and treadmill exercise preoperatively in 286 patients (group A). In 155 patients with complete AV block, a sinus rate above 70 beats/min was required for inclusion in the study (group B). Holter monitoring and treadmill exercise were performed two weeks, three months, and every six months after implantation. Sinus bradycardia below 40 beats/min, sinoatrial block, sinus arrest, or subnormal increase of heart rate during treadmill exercise were defined as sinus node dysfunction. RESULTS: Cumulative incidence of sinus node disease was 0.65% per year without differences between groups. Clinical indicators of sinus node dysfunction were sinus bradycardia below 40 beats/min in six patients (1.4%), intermittent sinoatrial block in two (0.5%), and chronotropic incompetence in five patients (1.1%). Only one of these patients (0.2%) was symptomatic. Cumulative incidence of atrial fibrillation was 2.0% per year, independent of the method used for the assessment of sinus node function and of the implanted device. CONCLUSIONS: In patients undergoing pacemaker implantation for isolated AV block, sinus node syndrome rarely occurs during follow up. Thus single lead VDD pacing can safely be performed in these patients.

Aged↗

Echocontrast-enhanced transcranial color-coded sonography for the diagnosis of transverse sinus venous thrombosis.

BACKGROUND AND PURPOSE: Early diagnosis of cerebral transverse sinus venous thrombosis (TSVT) is difficult because of nonspecific and variable clinical presentations. Therefore, we evaluated the diagnostic value of transcranial color-coded duplex sonography (TCCS) after administration of an echocontrast-enhancing agent (cTCCS) in clinically suspected TSVT. METHODS: We examined 14 patients (6 men, 8 women; mean age, 48 years; range, 18 to 70 years) with signs and symptoms suggestive of cerebral TSVT. Color-coded signals from the contralateral transverse sinus were displayed transtemporally before and after injections of an echocontrast agent by TCCS. Sonographic findings were correlated with MRI and MR venography (MRV). RESULTS: Before echocontrast enhancement, TCCS displayed color Doppler signals in 7 of 28 transverse sinus. Echocontrast TCCS obtained sufficient color signals in 27 of 28 transverse sinus. Thus, diagnostic confidence was achieved in all but 1 patient. In 13 patients, cTCCS identified 3 cases with symmetrical blood flow in the transverse sinus, which was confirmed by MRV. Accordingly, asymmetry of venous blood flow was correctly assessed by cTCCS in the other 10 patients. In 6 of these 10 patients, cTCCS demonstrated residual color flow signals, which on MRI/MRV corresponded to partial TSVT (4 cases) and to hypoplasia (1 case) of the transverse sinus. One case of complete thrombotic occlusion of the transverse sinus was missed by cTCCS because of color Doppler signals originating from an adjacent dural fistula. Echocontrast TCCS diagnosis of occlusion of a transverse sinus was confirmed by MRI/MRV in all cases (aplasia of transverse sinus, n = 1; complete TSVT, n = 3). Systolic peak flow velocities were significantly decreased in hypoplastic or partially occluded transverse sinus (9.4 +/- 4.0 cm/s) and significantly increased contralaterally (28.4 +/- 6.5 cm/s) with respect to patients with symmetrical appearance of the transverse sinus (17.5 +/- 1.9 cm/s) (P < .05). CONCLUSIONS: TCCS examination of the cerebral venous system is difficult without contrast media application and almost useless for the study of TSVT. However, cTCCS is of practical value in the initial workup of patients with clinically suspected TSVT and may provide further insight for follow-up studies in view of monitoring the recanalization.

Adolescent↗

Immunopathologic study of chronic sinusitis: a proposal for atopic and non-atopic IgE-activated mast cell allergic inflammation.

Paranasal sinus mucosa was examined in this study for mast cell membrane-bound IgE. The study material was from 54 patients identified in hospital records as having one of the following diagnoses: chronic sinusitis, chronic sinusitis with asthma, or chronic sinusitis with associated nasal polyps. Formalin-fixed tissue samples taken during endoscopic sinus surgery were routinely processed and examined with hematoxylin and eosin stains. Additional sectioned tissue was analyzed by fluorescence microscopy for mast cells after the use of anti-IgE and anti-tryptase antisera; 45% of the cases of chronic sinusitis, 50% of the cases of chronic sinusitis with polyposis, and 69% of the cases of chronic sinusitis with asthma exhibited 10 or more IgE-positive mast cells in the sinus mucosa. Significant numbers of individuals with chronic sinusitis have coexistent allergic disorders. Some individuals in this study who were not allergic by hospital record review also manifested IgE-positive mast cells in the sinus mucosa; a basis for this finding is proposed.

Adolescent↗

Experimental model of fungal sinusitis: a pilot study in rabbits.

We have established an experimental model of fungal sinusitis in rabbits to analyze the chronology and the pathogenesis of the development of noninvasive fungal sinusitis due to Aspergillus fumigatus. Thirty-four Pasteurella-free New Zealand white rabbits divided into three groups were included in this study. In the first group (10 rabbits), A fumigatus was inoculated into the maxillary sinus. In the second group (10 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a wound in the mucosa. In the third group (14 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a blocked ostium. On days 15 and 30, endoscopic, histopathologic, bacterial, and mycological examinations of both maxillary cavities and mucous membrane were performed. The rabbits were painlessly sacrificed 30 days after inoculation; mucosal and bone biopsies of the maxillary sinus cavities were performed for histopathologic studies. We found that noninvasive fungal sinusitis had been induced in 2 rabbits of the second group and 8 rabbits of the third group. We conclude that introduction of fungi into a sinus with a blocked ostium induces fungal sinusitis. The present model of experimental fungal sinusitis seems to be reproducible and suitable for further studies of the development of fungal sinusitis.

Animals↗

Clinical characteristics of nosocomial sinusitis.

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 +/- 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.

Adult↗

Endoscopic surgical treatment of nasal and paranasal sinus inverted papilloma.

Most of the papers written in the past regarding surgical treatment of nasal and sinus inverted papilloma recommend aggressive surgical treatment-usually a medical maxillectomy with external or transantral ethmoidectomy. However, since the introduction of endoscopic diagnostic and surgical techniques for the treatment of nasal and sinus disease, the treatment of inverted papilloma requires review. In Europe, Waitz and Wigand1 and Draf* routinely treat inverted papilloma endoscopically, reserving extensive surgery for papilloma involving the maxillary sinus or for recurrent disease. Fifteen cases of inverted papilloma of the nose and paranasal sinuses are discussed in this article. Ten cases represent inverted papilloma treated primarily with endoscopic sinus surgery; five were endoscopically treated for secondary or recurrent disease. All primarily treated patients had disease limited to the nose, nasal cavity, ethmoid, sphenoid, or medial wall of the maxillary sinus. The one patient in whom a recurrence in the maxillary sinus developed laterally underwent a medial maxillectomy for control. All patients treated endoscopically have had their disease followed for a minimum of 1 year, with an average of 3 years. Four patients in this study had traditional surgery involving medial maxillectomy and ethmoidectomy for an initial diagnosis of inverted papilloma. These patients manifested recurrent papilloma into the sphenoid sinus bilaterally in one case, frontal sinus in another, and the maxillary sinuses in two other cases, and all patients have papilloma controlled endoscopically. Endoscopic nasal and sinus diagnosis and surgery is appropriate for diagnosis, followup, and treatment of both limited and recurrent inverted papilloma, provided all patients are made aware of the possibility of recurrent and need for more extensive surgery as a result.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Bone reformation and implant integration following maxillary sinus membrane elevation: an experimental study in primates.

BACKGROUND: Recent clinical studies have described maxillary sinus floor augmentation by simply elevating the maxillary sinus membrane without the use of adjunctive grafting materials. PURPOSE: This experimental study aimed at comparing the histologic outcomes of sinus membrane elevation and simultaneous placement of implants with and without adjunctive autogenous bone grafts. The purpose was also to investigate the role played by the implant surface in osseointegration under such circumstances. MATERIALS AND METHODS: Four tufted capuchin primates had all upper premolars and the first molar extracted bilaterally. Four months later, the animals underwent maxillary sinus membrane elevation surgery using a replaceable bone window technique. The schneiderian membrane was kept elevated by insertion of two implants (turned and oxidized, Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in both sinuses. The right sinus was left with no additional treatment, whereas the left sinus was filled with autogenous bone graft. Implant stability was assessed through resonance frequency analysis (Osstell, Integration Diagnostics AB, Göteborg, Sweden) at installation and at sacrifice. The pattern of bone formation in the experimental sites and related to the different implant surfaces was investigated using fluorochromes. The animals were sacrificed 6 months after the maxillary sinus floor augmentation procedure for histology and histomorphometry (bone-implant contact, bone area in threads, and bone area in rectangle). RESULTS: The results showed no differences between membrane-elevated and grafted sites regarding implant stability, bone-implant contacts, and bone area within and outside implant threads. The oxidized implants exhibited improved integration compared with turned ones as higher values of bone-implant contact and bone area within threads were observed. CONCLUSIONS: The amount of augmented bone tissue in the maxillary sinus after sinus membrane elevation with or without adjunctive autogenous bone grafts does not differ after 6 months of healing. New bone is frequently deposited in contact with the schneiderian membrane in coagulum-alone sites, indicating the osteoinductive potential of the membrane. Oxidized implants show a stronger bone tissue response than turned implants in sinus floor augmentation procedures.

Animals↗

Occlusion of the sigmoid sinus after surgery via the presigmoidal-transpetrosal approach.

OBJECT: In this paper the authors report on sigmoid sinus occlusion as a surgical complication in seven of 143 operations in which a presigmoidal-transpetrosal approach was used. METHODS: Five patients (Cases 1-5) developed occlusion within 40 days after surgery, and in the remaining two (Cases 6 and 7) occlusion was detected 5.4 and 6.4 years postsurgery by means of cerebral venography, which was performed in 40 of the remaining 138 patients. Of the two patients with occlusion of the hypoplastic transverse sinus, one (Case 1) did not develop symptoms and the other (Case 2) developed brain edema with transient aphasia. Of the three patients suffering from occlusion of the dominant sigmoid sinus, one (Case 3) developed severe intracerebral hemorrhages and had a poor prognosis; one (Case 4) developed profuse supra- and infratentorial brain edema with consciousness disturbance; and the other (Case 5) developed hemorrhagic infarction in the temporal lobe accompanied by aphasia. Two patients whose sinus occlusion was detected later (Cases 6 and 7) did not develop symptoms and displayed well-communicated transverse sinuses. In Case 7, a dural arteriovenous malformation formed at the site of the sinus occlusion. Laceration of the sigmoid sinus was suspected as the cause of occlusion in Cases 2, 3, and 7; compression of the sinus in Cases 5 and 6, sinus laceration and postoperative dehydration in Case 4; and laceration and compression of the sinus in Case 1. CONCLUSIONS: Differences in the clinical course among these patients were attributed to anatomical variations in the venous system. Occlusion of the sigmoid sinus should be weighed as a potential complication when selecting candidates for the presigmoidal-transpetrosal approach.

Adolescent↗

Superficial surgical landmarks for the frontal sinus.

OBJECT: There is a lack of reports in the literature that contain descriptions of superficial anatomical landmarks for the identification of the internally located frontal sinus. Neurosurgeons must often enter the cranium through the frontal bone and knowledge of the frontal sinus is essential to minimize complications. METHODS: Seventy adult cadaveric frontal sinuses were evaluated. Measurements included both the lateral and superior extent of the frontal sinus in reference to a midpupillary line, and the superior extent of the frontal sinus from the nasion. Frontal sinuses were found bilaterally in all specimens. The mean height of the frontal sinus superior to the nasion was 2.8 cm. In 71.4% and 74.3% of specimens the lateral extent of the frontal sinus was found to be medial to the left and right midpupillary line, respectively. Distances superior to a plane drawn through the supraorbital ridges at a midpupillary line included a mean of 2.5 mm for the left side and 1.8 mm for the right side. CONCLUSIONS: Of 70 sinuses, none extended more than 5 mm lateral to a midpupillary line. At this same midpupillary line and at a plane drawn through the supraorbital ridges, the frontal sinus was never higher than 12 mm. Finally, in the midline the frontal sinus never reached more than 4 cm above the nasion. These measurements will assist surgeons who must manipulate the frontal bone.

Adult↗

The marginal sinus.

OBJECT: Descriptions of the marginal venous sinus are lacking in the extant medical literature. The aim of this study was to characterize the anatomy of this intracranial venous sinus. METHODS: The authors examined the marginal sinuses in 15 adult cadavers following the injection of latex into the intracranial venous system. The maximal vertical height of the sinuses, which ranged from 7 to 15 mm (mean 10 mm), was located at the lateral aspect of the foramen magnum at or near the region at which the spinal accessory nerve crossed en route to the jugular foramen. In all specimens the sinus tapered as it traveled both anteriorly and posteriorly. Ninety-three percent of the specimens demonstrated significant drainage into the veins of the hypoglossal canal. The hypoglossal nerve rootlets pierced the sinus and its tributaries in 11 (73%) of 15 specimens. The marginal sinus communicated with the basilar venous plexus in 12 (80%) of 15 specimens and with the occipital sinus in all specimens (100%). There was venous communication with the sigmoid sinus in all specimens. The vertebral artery coursed through the marginal sinus as it pierced the posterior atlantooccipital membrane in all left sides and in 87% of the right sides. CONCLUSIONS: These quantitative data will be useful to the neurosurgeon who operates in the region of the marginal sinus.

Aged↗

[Conventional X-ray versus CT in diagnosis of chronic sinusitis in children].

The interpretation of conventional radiographic views for sinusitis in children has given rise to considerable controversy. Thirty-three children (66 sides of sinuses) aged from 4 to 15 years who were suspected of having chronic sinusitis were studied to determine the accuracy of conventional X-ray examination, comparing the results with those of CT. Coronal CT was taken after conventional X-ray examination (Waters and occipito-frontal views), and the time interval between these two examinations was 0 to 14 days (average 5.1 days). The rate of correspondence in diagnosis of sinus pathology between conventional X-ray views and CT was 74.3% in the maxillary sinus and 40.9% in the ethmoid. The rate of overestimation with conventional X-ray views was 24.2% in the maxillary sinus and 56.1% in the ethmoid, while that of underestimation was 1.5% and 3.0% in the maxillary and the ethmoid sinus respectively. The incidence of false positives according to conventional X-ray views was 8.0% in the maxillary sinus and 33.3% in the ethmoid. Our results indicate that Waters view is sufficient to diagnose maxillary sinus pathology in children. However, additional radiologic examinations, such as CT, are necessary in investigating the pathologic conditions of the ethmoid sinus, since diagnostic significance of occipito-frontal view for ethmoid pathology is doubtful in children. A routine preoperative CT is recommended, which allows a detailed evaluation of pathologic changes and anatomical relations of the ethmoid before embarking a surgical intervention for the ethmoid sinus in children.

Adolescent↗

[Olfactory disturbance caused by chronic sinusitis].

Sinusitis has been reported to be one of the major causative etiologies of olfactory disorder. According to our data during last 3 years, 47.5% of all cases of olfactory disorder were attributed to sinusitis. Persistent olfactory disturbance was often critical even after resection of the pathological sinus mucosa by surgery for chronic sinusitis. Accordingly, olfactory epithelial inflammation involved in sinusitis may be considered another important causative factor disturbing the restoration of olfactory acuity. To elucidate this hypothesis, the following experimental and clinical studies were carried out. (1) A morphological study was done with specimens taken from the olfactory cleft of rabbits with experimentally induced sinusitis to analyze the inflammatory effects, and the degree of inflammatory damage was compared, histopathologically between olfactory and respiratory epithelium. SEM observation in the morphological study showed delayed healing in the olfactory portion in comparison with the respiratory portion (p < 0.01). Cell proliferation activity as determined by immunohistochemical study with bromodeoxyuridine (BrdU) was significantly greater in the respiratory area of the cases with sinusitis than in the control (p < 0.01). Cell proliferation status may play a significant role in this delay. (2) Olfaction tests were performed in patients with sinusitis accompanied with olfactory disturbance. In addition to both T&T olfactometry and intravenous olfactometry using fursultiamine (Alinamin Test), Smell Identification Test (SIT) and Threshold Test by graded Phenyl Ethyl Alchol (PEA) were applied to estimate the olfactory acuity of the patients with sinusitis. The results of SIT and PEA tended to parallel not the Alinamin Test but T&T olfactometry. Results showed that the olfactory disorder caused by sinusitis tended to be severe. The results showed that the epithelial factor is important in explaining olfactory disorder etiologically in cases of sinusitis. In particular, olfactory disturbance tended to persist.

Animals↗

[Hydrodynamic of the C.S.E. under experimental occlusion of superior sagittal sinus (author's transl)].

It is recognized that absorption of C.S.F. occurs mainly at the superior sagittal sinus through arachnoid villi after study of the Retzius (1875) and Weed (1914). We are interested in C.S.F. circulation and pathway on the obstructed superior sagittal sinus. At the border of middle one third and posterior one third of the superior sagittal sinus was obstructed experimentally. 1. When evans blue 0.5 to 1.0 ml was injected into lateral ventricle or cisterna magna, the evans blue was recognized on basal surface in either normal and obstructed dog of the superior sagittal sinus. Evans blue stained the convexity of normal dog, however, did not stain the convexity in the dog of obstructed superior sagittal sinus contrally. This was caused by the disturbance of C.S.F. circulation toward superior sagittal sinus. On the intraventricular injection of evans blue, it infiltrated into parenchym from ventripcle due to C.S.F. circulatory disturbance. 2. Study of radioactivity in the peripheral blood after intracisternal or intraventricular injection of RISA 100 muCi revealed that the radioactivity in the blood lowered with day after obstruction of superior sagittal sinus comparing with normal dogs. 3. Macroautoradiography after intracisternal or intraventricular injection of P 2mCi showed lower RI activity at the convexity, but increased activity at the basal brain in the obstructed dogs of superior sagittal sinus. These results showed that C.S.F. in normal dog was absorbed through the brain surface, expecially the basal surface of brain, other than through the superior sagittal sinus. Absorption of C.S.F. through the convexity of brain was disturbed significantly in the obstructed dogs of superior sagittal sinus. C.S.F. absorption into peripheral blood decreased in chronic stage after occlusion of surperior sagittal sinus and it suggested that the absorptive function of C.S.F. through the basal surface of brain was restricted.

Absorption↗

[The maxillary sinus: evolution and function in aging].

The maxillary sinus, or Highmore's antrum, is located in the maxillary bone. The maxillary, above the buccal cavity, below the orbital cavity and outside the nasal fossa, is going to take a part in the formation of the three cavities which surround it. Although voluminous, it is consists of a light bone. This distinctive feature is essentially due to the fact that the maxillary has a cavity. The maxillary sinus occupies the upper 2/3s of this maxillary bone. It is the largest of the facial structure's cavities. Its volume is very variable, depending on the individual, the condition of their edentulousness and their age. We find small, average or large sinuses. This sinus communicates with the corresponding nasal fossa by a canal. It opens at the level of the nasofrontalis duct by a meatic ostium, an ostium located at the top of the meatus nasi medius, i.e. under the floor of the sinus. This highly positioned drainage location easily explains the problems that sinus pathologies can come up against. The sinus is lined with a mucous membrane and we can point out that in the normal condition this mucous membrane adheres weakly to the bone. It is more or less thick as a function of the pathologies to which the sinus has been subjected, or even as a function of the geographical location where the individual lives. The imaging of this sinus as a function of age is not obvious due to the fact that it is invisible throughout embryonic and foetal development, and that it only becomes visible to X-rays relatively late, at about 6 years old. Its role is important at the level of the growth of the facial structure because it is always easier to have growth around cavities. It also has a mechanical role concerning the transmission of shockwaves during traumas. In old individuals, due to the condition of the edentulousness, the volume of the sinus is larger; in fact one can note the resorption of the alveolar bone. The maxillary sinus is a cavity which plays a very important role throughout an individual's existence because of the previously mentioned reasons, and which could be used during surgical reconstructions, by the partial filling of this space, to increase the quantity of usable bone (grafts...).

Adolescent↗