Beyond Epistaxis: A Rare Case of Ectopic Sinonasal Adamantinomatous Craniopharyngioma.

Adamantinomatous craniopharyngioma (ACP) is one of the two types of craniopharyngioma recognized by the World Health Organization (WHO), the other being papillary craniopharyngioma (PCP). These rare, benign tumours of the pituitary region are classified as Grade 1 central nervous system (CNS) tumours. ACP predominantly affects adolescents aged 5-15 years and adults over 50 years. It is usually located in the sellar and suprasellar regions. We present the case of an 18-year-old Malaysian female with a six-year history of persistent epistaxis and progressive nasal obstruction, an atypical presentation of ACP. This report highlights an entirely ectopic location of ACP in the sinonasal region. The tumour encompassed the left nasal cavity, the left anterior and posterior ethmoid sinuses, and the bilateral frontal sinuses. The unusual presentation of this tumour was detected with the aid of CT and MRI and confirmed by histopathological examination. In this case report, we discuss a rare presentation, an unusual location, and the strategies employed to overcome these challenges.

Supraorbital Ethmoid Air Cell - Its Role in Sinonasal Pathologies.

The supraorbital ethmoid air cell (SOEC) is an anatomical variation of the ethmoid air cell system that pneumatizes the orbital plate of the frontal bone. It affects the frontal recess configuration by opening posterior and lateral to the frontal sinus ostium. This cross-sectional observational study includes 100 patients with Supra orbital ethmoid air cells including various pathologies. We picked up the first 100 patients who had SOEC in all the CT PNS done for various sinonasal pathologies. The incidence of the cell was about 43%. The most common type was the cell extending up to the medial wall of the orbit which was noted in 37% of the cases. Cribriform plate was low-lying in patients with SOEC and the most common type was Keros 3 in about 49% of the study group. 83 patients had anterior ethmoid artery (AEA) lying away from the skull base hanging freely in the mesentery. The most common pathologies observed in patients with supraorbital ethmoid cells were chronic rhinosinusitis followed by mucoceles. The recurrence rate of sinusitis is high in patients with SOEC. The recurrences were mostly because of mistaking the SOEC to be frontal sinus or incomplete removal of partition between them. study stresses the importance of SOEC and its orientation preoperatively to avoid complications during and after the surgery. Detailed preoperative evaluation with the CT helps the surgeon to identify the cells, their extent and associated anatomical variations thereby preventing damage to AEA, cribriform plate and lateral lamella and can get good results.

Frontal Sinus Adenocarcinoma: A Rare Case of Diagnostic Re-evaluation From Inverted Papilloma.

Adenocarcinoma of the frontal sinus is extremely rare. We present a primary frontal sinus adenocarcinoma masquerading as an inverted papilloma (IP). Here, we reviewed various clinical presentations, investigations, and management of frontal sinus adenocarcinoma. A 48-year-old male presented with nasal bridge swelling one month following endoscopic sinus surgery for frontal sinus inverted papilloma. Progressively enlarging swelling with persistent pressure symptoms drew doubts regarding previously proven diagnosis. Imaging studies put us at the management crossroads of malignancy versus infection (osteomyelitis). The complexity of this case prompted a multidisciplinary team approach, eventually leading to a revision surgery for re-evaluation. Re-excision of the frontal sinus tumor was later proven to be adenocarcinoma of the frontal sinus. This case underscores the importance of thorough follow-up and investigation in patients presenting with recurrent or persistent symptoms following sinus surgery. This case highlighted the need for a high index of suspicion and comprehensive diagnostic workup.

Cancer of the Nasal Cavity, Middle Ear and Accessory Sinuses - 15 Year Comparative Survival and Mortality Analysis by Age, Sex, Race, Stage, Grade, Cohort Entry Time-Period, Disease Duration and Topographic Primary Sites: A Systematic Review of 13,404 Cases for Diagnosis Years 2000-2017: (NCI SEER*Stat 8.3.8).

BACKGROUND: .-Sinonasal malignancies are rare, aggressive, deadly and challenging tumors to diagnose and treat. Since 2000, age-adjusted incidence rates average less than 1 case per 100,000 per year, male and female combined, in the United States. For the entire cohort, 2000-2017, overall median age-onset was 62.6 years. Carcinoma constitutes over 90% of these upper respiratory cancers and most cases are advanced, more than 72% (regional or distant stage) when the diagnosis is made. Composite mortality at 5 years was 108 excess deaths/1000/year with a mortality ratio of 558%, and 41% of deaths occurred in this time frame. As a consequence, observed median survival was approximately 6 years with 5-year cumulative observed survival (P) and relative survival rates (SR) 53% and 60%. This mortality and survival update study follows the World Health Organization International Classification of Diseases for Oncology-3rd Edition (ICD-O-3)1 topographical identification, coding, labeling and listing of 13,404 patient-cases accessible for analysis in the United States National Cancer Institute's Surveillance, Epidemiology and End Results program (NCI SEER Research Data, 18 Registries), 2000-2017 located in 8 primary anatomical sites: C30.0-Nasal cavity, C30.1-Middle ear, C31.0-Maxillary sinus, C31.1-Ethmoid sinus, C31.2-Frontal sinus, C31.3-Sphenoid sinus, C31.8-Overlapping lesion of accessory sinuses, C31.9-Accessory sinus, NOS. OBJECTIVES: .-1) Utilize national population-based SEER registry data for 2000-2017 to update cancer survival and mortality outcomes for 8 ICD-O-3 topographically coded sinonasal primary sites. 2) Discern similarities and contrasts in NCI-SEER case characteristics. 3) Identify current risk pattern outcomes and shifts in United States citizens, 2000-2017. METHODS: .-SEER Research Data, 18 Registries, Nov 2019 Sub (2000-2017)2,3 are used to examine the risk consequences of 13,404 patients diagnosed with sinonasal malignancies, 2000-2017, in this retrospective population-based study employing prognostic data stratified by topography, age, sex, race, stage, grade, 2 cohort entry time-periods (2000-06 & 2007-17), and disease-duration to 15 years. General methods and standard double decrement life table methodologies for displaying and converting SEER site-specific annual survival and mortality data to aggregate average annual data units in durational intervals of 0-1, 0-2, 1-2, 2-5, 0-5, 5-10, and 10-15 years are employed. The reader is referred to the "Registrar Staging Assistant (SEER*RSA)" for local-regional-distant Extent of Disease (EOD) sources used in the development of staging descriptions for the Nasal Cavity and Paranasal Sinuses (maxillary and ethmoid sinuses only) and Summary Stage 2018 Coding Manual v2.0 released September 1, 2020. Cancer staging & grading procedural explanations, statistical significance & 95% confidence levels4 are described in previous Journal of Insurance Medicine articles5,6 and other publications.7,8 Poisson confidence intervals at the 95% level based on the number of observed deaths are used in this study but not displayed here to conserve space on the mortality tables. Excluded were all death certificate only and those alive with no survival time. RESULTS: .-In the SEER 18 registries, a total of 13,404 patient cases (2000-2017) were available for analysis with an incidence of less than one patient per 100,000 people. From this group, analysis for survival and mortality totaled 10,624 patients. Males comprised 59.3% of cases and females 40.7%. Whites represented 80.3% of cases and black, others & unknown patients comprised 19.7%. The most common anatomic site of malignancy was the nasal cavity (49.7%); least common was the frontal sinus (1.2%). From diagnosis, across the span of 8 primary sites, first-year mortality rates q ranged from 14.3% (C30.0-nasal cavity) to 30.2% (C31.8-overlapping sinus) with corresponding excess death rates (EDR) of 118/1000/year and 279/1000/year. For single sites, the 5-year cumulative survival ratio (SR) was highest for the nasal cavity (69.5%) and lowest for overlapping lesions of the accessory sinuses (47.2%) with EDRs of 76 and 169 per 1000 per year respectively Overall, 5-year relative survival (SR) for all sinonasal tract malignancies combined was 60.3%, excess mortality (EDR) 108 per 1000 per year and mortality ratio 558%. CONCLUSIONS: .-The 8 sinonasal cancer primary sites are characterized by a low percentage of cases in the localized stage (28%). Since excess mortality is high even in the localized stage, overall prognosis is very poor for all patients. Excess mortality persists in cancer of the sinonasal tract as long as 10-15 years after diagnosis and treatment. EDR in the 15-year durational-interval, all sinonasal sites combined remained significant at 27.6 per 1000 per year with continuing decrease in cumulative survival ratio (SR) to 43.9%.

Clinical features, operative management and surgical results of first Draf III procedure, revision Draf III approach and the use of mucosal flaps and stents: a systematic review.

OBJECTIVES: Draf III procedure is a challenging endoscopic technique, which has gradually gained an increasing popularity in treating frontal sinus pathologies. The main aim of this systematic review is to offer a comprehensive overview on clinical indications, pre-operative evaluation, surgical techniques, post-operative management and complications of the Draf III procedure. As a step forward, such issues have been comparatively evaluated as referred to patients who underwent primary Draf III procedure and revision DRAF III one). Finally, surgical outcomes related to mucosal flaps and stents to prevent re-stenosis are analyzed. METHODS: A systematic literature review has been performed following PRISMA 2020 checklist statement. An automated search has been carried out by applying an extensive set of queries on the Embase/PubMed, Scopus and Cochrane databases, relating to papers published from 2000 to 2021. RESULTS: Frontal chronic refractory sinusitis is the most frequent indication to Draf III procedure (72%), followed by mucoceles (11%) and skull base or paranasal tumors (10%). The success rate of primary and revision Draf III are 83.5% and 71%, respectively. The re-stenosis phenomenon seems to depend on allergic mechanism and polyposis). The use of mucosal flaps could improve the Draf III efficacy, better than the use of stents (87 vs 72% of neo-ostium patency). CONCLUSION: Draf III is a safe and highly effective surgical technique. However, some limited clinical conditions require some careful technical features, such as the use of mucosal flap, in order to prevent re-stenosis.

Management of frontal sinus and frontal recess inverted papilloma: our experience and systematic review.

Objective: For frontal sinus inverted papilloma (FSIP) management, an endoscopic endonasal approach (EEA) can be combined (or not) with an external approach by an osteoplastic flap (OPF) or with a more conservative open approach. The present study aims to describe our experience in the management of FSIP, focusing on disease-related and anatomical features influencing outcomes and recurrence. Methods: This case series of FSIP investigated anatomical and disease-related predictors of recurrence associated with EEA or a combined EEA-OPF approach. A systematic review was also performed, selecting publications on IP with the insertion point in the frontal sinus or frontal recess. Results: Among 30 patients included, 18 underwent EEA, while 12 received a combined EEA-OPF approach. During a median follow-up of 37 months, the frontal sinus was cleared of IP in all cases except 2 in the EEA group, who presented a complex posterior wall shape of the frontal sinus. From the systematic review, a combined EEA-OPF approach was associated with a lower risk of recurrence. Conclusions: A correct indication for a combined EEA-OPF approach is paramount and should integrate all disease-related and anatomical features, including posterior wall shape.

Contemporary Trends in Frontal Sinus Balloon Sinuplasty: A Pilot Study.

Introduction: Balloon sinuplasty (BSP) is a common treatment modality used in the management of chronic rhinosinusitis (CRS). Although it has gained popularity, minimal self-reported data on its utilization and complications have been reported. The goal of this study was to describe current practices and complications experienced during frontal sinus BSP. Methods: An anonymous 20-question online survey was distributed to members of the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery from August 1, 2022, to August 30, 2022. The questions were listed as multiple choice or percentage sliding bars, and data were collected using a commercial online survey service site. Results were reported as frequencies, means, and percentages. Results: Forty-two respondents participated in the survey, with the majority practicing in the following hospital settings: community (34, 80.95%), hybrid (5, 11.90%), and academic (3, 7.14%). The southeast had the largest proportion of respondents (13, 30.95%), versus the midwest (12, 28.57%), southwest (10, 23.81%), northeast (5, 11.90%), and northwest (2, 4.76%). On average, 50.52% of cases were performed in the hospital setting, 48.50% in-office, and 42.40% in surgery centers. Respondents who primarily used BSP, reported a yearly average of 35.72 cases, a median of 12 cases, and a range of 0-361 cases. Respondents who used BSP with functional endoscopic sinus surgery (FESS), reported a yearly average of 48.62 cases, a median of 31 cases, and a range of 0-189 cases. Nasal packing was utilized both intraoperatively (11.72%) and postoperatively (3.62%). Early complications included postoperative headaches (9.86%), acute bacterial sinusitis (ABRS) (3.52%), and tooth/facial numbness (0.86%). Reported long-term complications included postoperative synechiae (5.10%), orbital complications (0.14%), and skull base complications (0.10%). A previously unreported complication was identified through this study, accidental sphenopalatine fossa dilation. Conclusions: This study contributes to the growing body of literature on frontal sinus BSP by characterizing utilization and complications from a large otolaryngologic academy.

In house 3-D printed surgical guide for frontal sinus osteotomy in traumatology: A technical note.

Frontal sinus surgery and particularly frontal sinus osteotomy represent historically a procedure demanding precision and careful planning. Achieving optimal results while minimizing complications requires meticulous preoperative planning and execution. Cutting guides are crucial tools in surgical procedures, particularly in complex osteotomies like could be those involving the frontal sinus. The aim of the study is to show the worflow for the in-house custom made cutting guide for secure and accurated frontal sinus approach. Given the simplicity, efficacy, rapidity, and safety of the procedure, the workflow for programming the cutting guide can be considered valid for all surgical procedures that contemplate performing an osteotomy on the anterior wall of the frontal sinus, such as trauma pathology, inflammatory naso-sinus pathology, benign or malignant neoplastic pathology, and craniofacial malformation pathology.

[Drafâ ¢ approach to unilateral frontal sinus for contralateral drainage].

Objective:Anatomical variation or scar atresia of the drainage channel of the frontal sinus on the affected side, and opening the frontal sinus through the drainage channel of the frontal sinus on the affected side may lead to surgical failure. The purpose of this study is to explore a modified Draf Ⅲ operation to complete the drainage of the affected frontal sinus by removing the floor wall and septum of the frontal sinus and connecting the bilateral frontal sinus through the healthy side of the frontal sinus. Methods:Through the anatomical study of 2 skull bone specimens and 2 fresh frozen specimens, the surgical landmark and surgical approach were explored. Four patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery in Eye & ENT Hospital of Fudan University were retrospectively analyzed. Descriptive method was used to analyze the data. Results:The bottom wall of bilateral frontal sinus was removed, and the bilateral frontal sinus was enlarged above the nasal septum to form a large common cavity. The uncinate process and ethmoid bubble were retained, and the midline drainage of the affected frontal sinus in the healthy side of the nasal cavity was completed. From August 2022 to April 2023, 4 patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery for unilateral frontal sinus papilloma in Eye & ENT Hospital of Fudan University were treated with surgery. The headache symptoms disappeared after surgery, and the drainage of frontal sinus was spacious, the mucosa healed well and the drainage was unobstructed under endoscopy. There were no other postoperative complications. Conclusion:DrafⅢ approach to unilateral frontal sinus for contralateral drainage can drain the affected frontal sinus adequately. The essence of this operation is to drain the bilateral frontal sinus in the unilateral nasal cavity, and this operation has short path, less trauma, and a broader prospect, which is suitable for promotion.

Intraosseous venous malformation of the frontal bone with extension into the frontal sinus and orbit.

We present a novel case of intraosseous venous malformation of the frontal bone with dehiscence of the inner table of the frontal calvarium and extension into the frontal sinus and orbit. This case report discusses the surgical management of this intraosseous lesion achieved with a multidisciplinary approach involving otolaryngology and neurosurgical teams. We also present a review of the literature of the pathophysiology of venous malformations, the imaging modalities that aid in diagnosis of these lesions and the management options.

Multicompartmental Paranasal Sinus Osteoma Complicated by Frontal Bone Hyperostosis, Intracranial Mucocele, and Inflammatory Pseudotumor.

Parasinusal osteoma complicated by intracranial and orbit extension, cranial vault hyperostosis, intracranial mucocele, and inflammatory pseudotumor is exceptional. A 68-year-old man presented with a long history of progressive proptosis and recurrent episodes of keratoconjunctivitis in the left eye, with restriction in upward gaze. Contrast-enhanced magnetic resonance imaging revealed a frontal sinus lesion extending to the left anterior fossa and orbit, featuring an intracranial cystic component and heterogeneous contrast enhancement. Head computed tomography confirmed the double calcific-cystic nature of the lesion. A left supraorbital-pterional approach allowed complete resection of mucocele and drilling of intracranial and orbital osteoma, including the intrasinusal component. The frontal sinus was cranialized, and a flap of pericranium, reinforced by Gelfoam sponge, was reflected on the anterior cranial base/orbital roof. The postoperative course was uneventful; magnetic resonance imaging depicted resolution of proptosis. Histological examination favored parasinusal osteoma associated with intracranial mucocele, frontal bone hyperostosis, and inflammatory pseudotumor.

Necessary Factors for Efficient Frontal Sinus Irrigation After Endoscopic Sinus Surgery: A Systematic Review.

OBJECTIVE: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS). METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS. RESULTS: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered. CONCLUSION: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes. LEVEL OF EVIDENCE: NA.

Computed Tomographic Study of Frontal Sinus Cells and Opacification as Per the International Frontal Sinus Anatomy Classification.

INTRODUCTION: International frontal sinus anatomy classification (IFAC) was introduced in 2016 to standardize the nomenclature of the cells in the frontal recess region, facilitate better communication between surgeons and precision in surgical planning, and improve surgical teaching. This study aims to estimate the radiological prevalence of the different frontal recess cells according to the IFAC and to evaluate the relationship of these cells with the frontal sinus opacification in patients with chronic rhinosinusitis. METHODS: In this study, 90 participants diagnosed with chronic rhinosinusitis (CRS) who underwent computed tomogram (CT) of the para nasal sinuses were enrolled consecutively. The CT images were were studied in detail using RadiAnt DICOM viewer. The frontal recess cells were grouped as per the IFAC guidelines and their respective prevalence was calculated. The frontal recess cells were grouped as per the Opacification or mucosal thickening within these cells and the frontal sinuses were noted. A multivariate logistic regression analysis was done to evaluate the association between frontal sinus opacification and presence of various IFAC cells. RESULTS: A total of 640 IFAC cells were documented in 180 sides, of which 326 were anterior cells, 263 were posterior cells and 51 were medial cells. The most prevalent cell was the agger nasi cells(ANC), present in 91.7% of 180 sides, the supra agger nasi cells(SANC), Supra agger nasi frontal cells(SAFC), supra bulla cells(SBC), supra bulla frontal cells(SBFC), supra orbital ethmoidal cells(SOEC) and frontal septal cells(FSC) were present in 47.8%,37.8%, 65.6%,28.9%, 51.1% and 28.3% respectively. There was no significant association of presence of IFAC cells and frontal sinus opacification except for SBFC(p = 0.038). A significantly higher number of diseased frontal recess cells were seen with involved frontal sinuses when compared with non-involved frontal sinuses across all types of IFAC cells. CONCLUSION: The ANC were the most prevalent among all the IFAC cells and the FSC were the least prevalent. There was no significant association with the presence of different types of IFAC cells and frontal sinus opacification except for SBFC. However, there was a significantly higher number of diseased IFAC cells associated with frontal sinus opacification than in those without frontal sinus opacification.

Patient satisfaction after conservative treatment of anterior wall frontal sinus fractures.

This study aims to determine patient forehead aesthetics satisfaction after conservative treatment of non-dislocated and dislocated anterior wall frontal sinus fractures. Prospectively, patients older than 15 years of age with a frontal sinus fracture, treated conservatively between the period of 2010-2020, were analysed. The Face-Q questionnaire was used to assess patient satisfaction, and the fracture dimensional properties were measured using computed tomography. The results were compared with a matched non-fractured control group. The mean total Face-Q questionnaire score was 114.77 (SD = 17.38) versus 114.23 (SD = 15.23) (research-versus control group, respectively), with a mean difference of 0.55 (SD = 4.85), which was not significant (p = 0.91). The size of impression area did not appear to have a linear relationship with patient satisfaction within the entire population (p = 0.87; r = 0.00). Presence of a scar in the fracture site was a significant predictor of patient satisfaction, contributing to 31% of the entire population's overall score (p = 0.01) and 57% in the dislocated fracture population (p = 0.003). The conservatively treated patients' satisfaction score was comparable to the control group. A higher satisfaction score after a conservative treatment is associated with the absence of a scar on the fracture site, even with dislocations up to 6 mm at the deepest impression point.

Fractura de seno frontal: reporte de caso clínico / Fratura do seio frontal: relato de caso clínico / Frontal sinus fracture: clinical case report

Introducción: Las fracturas del seno frontal, representando del 5% al 15% de las lesiones faciales traumáticas. La tomografía computarizada sin contraste es esencial para el diagnóstico. Clasificadas en cinco tipos según su trayectoria, la elección del tratamiento quirúrgico se basa en factores como ubicación, desplazamiento, integridad del tracto de salida del seno frontal y lesiones asociadas. Los objetivos de la intervención quirúrgica incluyen tratar fugas de líquido cefalorraquídeo, proteger estructuras intracraneales y prevenir complicaciones tardías como meningitis y osteomielitis frontal. Descripción del caso clínico: Paciente masculino de 26 años de edad, remitido al Hospital Vicente Corral Moscoso para valoración y manejo de trauma facial. A los 7 días de su ingreso bajo anestesia general balanceada se realizó el procedimiento quirúrgico que consistió en reducción más fijación con malla frontal más cinco tornillos de la fractura de la pared anterior del seno frontal derecho. Conclusiones: Se sugiere un enfoque multidisciplinario con neurocirujano y cirujano maxilofacial para tratar fracturas faciales superiores. El tratamiento actual considera la afectación de la tabla posterior, la permeabilidad del tracto de salida del seno frontal y el desplazamiento de la tabla anterior. Se prioriza el manejo temprano para proteger estructuras intracraneales, restaurar la función del seno frontal y prevenir complicaciones... (AU)

Introdução: Fraturas do seio frontal, representando 5% a 15% das lesões faciais traumáticas. A TC sem contraste é essencial para o diagnóstico. Classificada em cinco tipos de acordo com sua trajetória, a escolha do tratamento cirúrgico baseia-se em fatores como localização, deslocamento, integridade da via de saída do seio frontal e lesões associadas. Os objetivos da intervenção cirúrgica incluem o tratamento de fístulas liquóricas, proteção de estruturas intracranianas e prevenção de complicações tardias, como meningite e osteomielite frontal. Relato de caso clínico: Paciente do sexo masculino, 26 anos, encaminhado ao Hospital Vicente Corral Moscoso para avaliação e manejo de trauma facial. Sete dias após a internação, sob anestesia geral balanceada, foi realizado o procedimento cirúrgico que consistiu na redução mais fixação com tela frontal mais cinco parafusos da fratura da parede anterior do seio frontal direito. Conclusões: Sugere-se uma abordagem multidisciplinar com neurocirurgião e cirurgião maxilofacial para tratar fraturas faciais superiores. O tratamento atual considera o envolvimento da mesa posterior, a patência da via de saída do seio frontal e o deslocamento anterior da mesa. O manejo precoce é priorizado para proteger as estruturas intracranianas, restaurar a função do seio frontal e prevenir complicações... (AU)

Introduction: Fractures of the frontal sinus, representing 5% to 15% of traumatic facial injuries. Non-contrast CT is essential for diagnosis. Classified into five types according to their trajectory, the choice of surgical treatment is based on factors such as location, displacement, integrity of the frontal sinus outflow tract and associated injuries. The goals of surgical intervention include treating cerebrospinal fluid leaks, protecting intracranial structures, and preventing late complications such as meningitis and frontal osteomyelitis. Clinical case report: 26-year-old male patient, referred to the Vicente Corral Moscoso Hospital for evaluation and management of facial trauma. Seven days after admission, under balanced general anesthesia, the surgical procedure was performed, which consisted of reduction plus fixation with frontal mesh plus five screws of the fracture of the anterior wall of the right frontal sinus. Conclusions: A multidisciplinary approach with neurosurgeon and maxillofacial surgeon is suggested to treat upper facial fractures. Current treatment considers posterior table involvement, frontal sinus outflow tract patency, and anterior table displacement. Early management is prioritized to protect intracranial structures, restore frontal sinus function, and prevent complications... (AU)

Penicillin concentrations in oropharyngeal and frontal sinus tissue following enteral and intravenous administration measured by microdialysis in a porcine model.

BACKGROUND: Penicillin may be administered enterally or intravenously for the treatment of bacterial infections within the oropharynx and the frontal sinuses. We aimed to assess and compare penicillin concentrations in oropharyngeal and frontal sinus tissues following enteral and intravenous administration in a porcine model. METHOD: Twelve pigs were randomized to receive either enteral (0.8 g Penicillin V) or intravenous (1.2 g Penicillin G) penicillin. Microdialysis was used for sampling in oropharyngeal and frontal sinus tissues during a six-hour dosing interval. In addition, plasma samples were collected. The primary endpoints were time with drug concentration above the minimal inhibitory concentration (T>MIC) for two MIC targets: 0.125 (low target) and 0.5 (high target) µg/mL (covering Group A Streptococci, Fusobactarium necrophorum, Streptococcus pneumoniae and Hemophilus influenza) and attainment of these treatment targets for ≥50 % T>MIC. RESULTS: For both the low and high MIC targets, intravenous administration resulted in higher T>MIC in oropharyngeal and frontal sinus tissues compared to enteral administration. In oropharyngeal tissue, the treatment target (≥50 % T>MIC) was achieved for both the low target (96 %) and high target (68 %) when penicillin was administrated intravenously. In frontal sinus tissue, the treatment target was reached for the low target (70 %), but not the high target (35 %) when administered intravenously. None of the two tissues reached the treatment targets when penicillin was administered enterally. CONCLUSION: Intravenous administrated penicillin in standard dosage is superior to enteral administration of penicillin in standard dosage in achieving clinically important T>MIC as the majority of targets were achieved following intravenously administration, while none of the targets were achieved following enteral administration. These results support the general notion of higher tissue concentrations following intravenous compared to enteral administration.

The relationship of anterior occlusion and skeletal variables with the frontal sinus index: An analytical cross-sectional study.

OBJECTIVE: To determine the relationship of anterior occlusion and skeletal variables with the frontal sinus index. METHODS: The retrospective, analytical, cross-sectional, study was conducted from July to November 2020 at Dr Ishratul- Ebad Khan Institute of Oral Health Sciences and Dow Dental College, Dow University of Health Sciences, Karachi, and comprised data from 2015 to 2018 related to pre-treatment lateral cephalograms for determining frontal sinus index and other cephalometric variables. The dental casts were observed for incisor classification. Patients with Class I incisors formed the comparison group, while the rest comprised 5 malocclusion groups. The frontal sinus was traced, and the sinus index was calculated. Data was analysed using STATA 15 and R 3.5.1. RESULTS: Of the 240 subjects, there were 40(16.66%) in each of the 6 groups; 155(64.6%) females and 85(35.4%) males. The mean age of the sample was 21.33±3.52 years (range: 16-29 years). The mean sinus index was higher in all malocclusion groups than the comparison group, but it was significantly higher only in Class II division 2 and anterior open bite groups (p<0.05). The only exception to the trend was Class II division 1 with and without contact in which the value was lower (p>0.05). The anterior cranial base length, sella-nasion mandibular plane angle, and upper incisor palatal plane angle significantly affected the frontal sinus index (p<0.05). CONCLUSIONS: The frontal sinus index could be considered an indicator of harmonious anterior occlusion.

[Trauma of the midface : Symptoms, diagnostics and treatment]. / Trauma des Mittelgesichts : Symptomatik, Diagnostik und Therapie.

Midface fractures present a clinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides a radiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires a multidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.

[Based on CT imaging, surgical approach selection for frontal and ethmoid sinus osteoma].

Objective:To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Methods:Using sagittal and coronal CT images, the following lines were delineated: the F-line（a horizontal line passing nasofrontal beak）, the M-line（a vertical line passing paries medialis orbitae）, and the P-line（a vertical line passing the center of the pupil）. Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Results:Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. Conclusion:For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.

Validation of Gender Identification From Frontal Sinuses Using Yoshino's Classification: A Morphometric Radiographic Study.

INTRODUCTION: Gender determination of deceased individuals may become necessary in scenarios involving sudden and unforeseen fatalities like explosions, fires, transportation accidents, or instances of mutilation or decomposition, which frequently require medicolegal expertise. Forensic radiology is instrumental in identifying gender. The shape of the frontal sinus is considered distinct for every person, differing even among identical twins, much like individual fingerprints and establishing personal identity. AIMS AND OBJECTIVES: This study was designed to validate and determine gender identification by evaluating frontal sinus measurements using digital posteroanterior cephalograms with reference to Yoshino's classification and to determine gender based on measurements of frontal sinus size, bilateral asymmetry, the outline of the upper border of the frontal sinus, partial septa, and supraorbital cells of the frontal sinus. MATERIALS AND METHODS: A total of 300 digital posteroanterior cephalograms (150 males and 150 females) of age groups ranging from 18 to 30 years were collected from the records of the Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences & Research Centre, Hyderabad. The parameters that were assessed in a digital radiograph are Yoshino's frontal sinus pattern of the individual, which includes frontal sinus size, bilateral asymmetry, superiority of the side, outline of the upper border, partial septa, and supraorbital cells. The measurements were taken, tabulated, and compared with the standard values of the gender measurement. The values were subjected to statistical analysis. RESULTS: Results showed a statistically significant difference in the mean height (p=0.000), width (p=0.000), area (p=0.000), partial septa (p=0.002), and outline of the upper border on the right side (p=0.011) of the frontal sinus for both males and females. The mean values for length, width, and area of the frontal sinus were higher in males than females. No statistical difference is found on the outline of the upper border on the left side, superiority of the side, and supraorbital cells. The application of discriminative analysis to the data accurately identified gender in 65.3% of the cases. CONCLUSION: Thus, from the above study, the forensic application of frontal sinus morphology can be recommended as an adjunctive tool for gender determination.