Treatment and prevention of frontal sinusitis after cerebral frontal sinus surgery / 中国医师进修杂志

Objective:To study the cause of frontal sinusitis and the prevention methods after opened frontal sinus in the trans-frontal approach surgery.Methods:Retrospectively analyze 18 cases of frontal sinusitis secondary to the trans-frontal approach surgery in Sanbo Brain Hospital, Capital Medical University from January 2016 to December 2020. The main symptoms include headache, stuffy nose, skin redness and skin abscess in frontal. The mean history was 3.2 years, all the patients were performed surgical treatment, including 5 patients undergone trans-nasal trans-sphenoid sinus operation, 14 patients undergone debridement surgery following the original surgical approach. The cause of frontal sinusitis were analyzed statistically.Results:All the patients were totally cured post operation, the standard included no frontal sinus inflammation symptoms, no imaging characters of frontal sinusitis.Conclusions:Proper management of opened frontal sinus in trans-frontal approach is very important for preventing the frontal sinusitis. Completely remove the frontal sinus mucosa, avoid using bone wax, chemical glue stuffing, which can effectively prevent the frontal sinusitis.

Encefalitis y abscesificación cerebral como complicación de una sinusitis frontal aguda en un niño

Resumen Las sinusitis son procesos infecciosos-inflamatorios de las cavidades neumáticas paranasales. Entre las complicaciones de las sinusitis agudas se encuentra la afectación intracraneal, con meningoencefalitis e incluso abscesos extra o subdurales. En este trabajo se describe un caso de meningoencefalitis y empiemas subdurales derivados de una sinusitis frontal aguda en un niño de 12 años, que acudió a urgencias presentando alteración del nivel de conciencia y hemiparesia derecha. Se realizan estudios de tomografía computada y resonancia magnética cerebral, evidenciándose ocupación de seno frontal izquierdo, acompañada de extensa afectación hipercaptante en cubiertas en hemisferio cerebral izquierdo, con formación de empiemas subdurales a nivel frontal izquierdo, parafalciano y en reborde tentorial. Ingresa para tratamiento antibiótico intravenoso y dado el nivel de afectación y la escasa respuesta a tratamiento médico, se decide realizar cirugía endoscópica DRAF IIa con drenaje del absceso frontal, etmoidectomía y meatotomía media izquierda, con sonda de drenaje a fosa nasal. Las complicaciones a nivel de sistema nervioso central son graves y han de tenerse siempre presentes, requiriendo en ocasiones drenaje quirúrgico con abordaje por vía endonasal o abierta.

Abstract Sinusitis are infectious-inflammatory processes of the pneumatic paranasal cavities. Among the complications of acute sinusitis, we can find intracranial involvement, with meningoencephalitis and even extra or subdural abscesses. In this article we describe a case of meningoencephalitis and subdural empyemas associated with acute frontal sinusitis in a 12-year-old child who presented to the emergency room referring altered level of consciousness and right hemiparesis. Computed tomography scan and brain magnetic resonance imaging studies were performed, evidencing left frontal sinus occupation, accompanied by extensive hypercaptant defects in the left cerebral hemisphere, with formation of subdural empyemas at the left frontal level, parafalcian and in the tentorial area. He was hospitalized for intravenous antibiotic treatment, and given the lack of response to medical treatment, a DRAF IIa sinus surgery and drainage of the frontal abscess, ethmoidectomy and left middle meatotomy with drainage tube to the nasal cavity were performed. Complications at the central nervous system are serious and must always be kept in mind, sometimes requiring surgical drainage with an endonasal or open approach.

Pseudotumor inflamatorio de Pott: una complicación olvidada y peligrosa de la sinusitis / Pott's puffy pseudotumor: a forgotten and dangerous complication of sinusitis

Resumen El pseudotumor inflamatorio de Pott es una de las posibles complicaciones de la sinusitis. En la literatura existen pocos casos reportados de esta entidad, pero el presente artículo expone cuatro casos con el propósito de concientizar al grupo médico sobre la existencia de esta enfermedad y cómo su manejo temprano puede prevenir complicaciones severas.

Abstract Pott's puffy pseudotumor is one of the possible complications of sinusitis. The literature reports few cases related to this entity; however, this article presents a series of four cases to raise awareness among the medical group of the existence of this disease, and how timely management can prevent severe complications.

Analysis on effect of vacuum sealing drainage combined with routine debridement in treatment of frontal sinusitis after craniotomy / 重庆医学

Objective To investigate the clinical effect of using uninterrupted vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis in treating frontal sinusitis after craniotomy.Methods The clinical data in 31 cases of frontal sinusitis after craniotomy in our hospital from January 2006 to December 2014 were retrospectively analyzed.Seventeen cases adopted simple debridement and drainage treatment and 14 cases were treated with continuous vacuum sealing drainage combined with routine debridement treatment.Postoperative follow up lasted over 1 year.Results In simple debridement and drainage,12 cases were cured,the other 5 cases recurred after operation,and the cure rate was 70.6 ％.But in the continuous vacuum sealing drainage combined with routine debridement treatment,14 cases were cured,no case recurred after operation,and the cure rate was 100％.Therefore,the cure rate of continuous vacuum sealing drainage treatment combined with routine debridement was higher than that of simple debridement and drainage treatment(P＜0.05).Conclusion Adopting vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis can promote the infection focus clearance and wound healing,and increases the cure rate.

Frontocutaneous Fistula Secondary to Frontal Sinusitis.

Frontocutaneous fistula is a rare complication of frontal sinusitis. This mostly occurs as a result of osteomyelitis of the frontal bone on account of sinusitis. These are managed by endoscopic closure or by external approach depending on the cause and extent of sinusitis. We report on the case of a 57 year old man who presented to our ENT Unit with a defect on the face medial to the right eye.

Empiema subdural secundario a sinusitis: reporte de caso / Subdural empyema secondary to sinusitis: case report

El empiema subdural es una complicación intracraneana secundaria a sinusitis bacteriana poco frecuente que ocurre generalmenteen varones entre la segunda y tercera década de la vida. Se presenta el caso de un paciente masculino, de 16 años, sinantecedentes, asintomático. Ingresa por cefalea frontoparietal izquierda intensa, compromiso cualitativo de conciencia, calofríos,fiebre y vómitos, sin focalidad neurológica ni signos meníngeos. Resonancia magnética de cerebro muestra colección líquida subduralinterhemisférica en región frontoparietal izquierda que desplaza línea media y sinusitis aguda frontoetmoidomaxilar ipsilateral.Se realiza craniectomía frontoparietal, drenaje quirúrgico y tratamiento antibiótico triasociado intravenoso. Paciente evolucionacon desaparición de síntomas y sin secuelas neurológicas. La clínica del empiema subdural es inespecífica, encontrándose másfrecuentemente cefalea, vómitos, fiebre y compromiso de conciencia. Las imágenes son esenciales para confirmar el diagnósticoy determinar la necesidad de cirugía. Es una patología, cuyo manejo debe ser médico y quirúrgico, comprendiendo drenaje dela colección y terapia antimicrobiana intravenosa. La duración del tratamiento se ha descrito de 3 a 6 semanas. Es necesario unabordaje multidisciplinario precoz para un buen resultado neurológico y funcional, ya que la morbimortalidad se describe hastaun 40%.

The subdural empyema secondary to sinusitis is a rare intracranial complication, which occurs mostly in males in the secondto third decade. We present a case of a 16 years old male patient, without medical history. He is hospitalized for a frontparietalprogressive headache, associated with decreased of consciousness, chills, fever and vomiting, without neurological deficit andmeningeal signs. The magnetic resonance imaging reveals a subdural interhemispheric liquid collection in the left frontparietal regionwith deviation of midline brain structures and left acute frontethmoidmaxilary sinusitis. Craniotomy and surgical drainage withintravenous antibiotic treatment was made. The symptoms dissapear after this and no neurological sequelae was found. The clinicalmanifestation of subdural empyema are inespecific. The more frecuent symptoms are headache, vomit, fever and decreasedof consciousness. The imaging study is essential to diagnose and evaluate the surgical need. The subdural empyema is pathologywith a medical and surgical management; wich involves collection drainage and intravenous antibiotic therapy. It is been describedthat the treatment duration will be prolonged for 3 to 6 weeks. A multidisciplinary approach is necessary for a better neurologicaland functional outcome, because the mortality rates are described up to 40%.

Frontoethmoidal Cells on Computed Tomographic Analysis: The Prevalence and Relationship to Frontal Sinus/Recess Mucosal Thickening

OBJECTIVES: To determine the prevalence of frontoethmoidal cells (FECs) in patients with and without frontal sinus/recess mucosal thickening and to establish the relationship between the FECs and the frontal sinus/recess mucosal thickening. MATERIALS AND METHODS: We retrospectively reviewed 245 consecutive ostiomeatal CT scans (490 sides). The normal and frontal sinus/recess mucosal thickening groups were categorized based on these images. The latter group was sub-categorized into the frontal sinus mucosal thickening group (FS group) and the frontal recess mucosal thickening group (FR group). RESULTS: Types 1, 2, 3 and 4 frontal cells were found in 17.5, 6.7, 8.3 and 0% of 326 normal sides, respectively. The prevalence of agger nasi, suprabullar, frontal bullar, supraorbital ethmoid and interfrontal sinus septal cells was 85.6, 43.3, 4.9, 4.3 and 17.2% of the same 326 normal sides, respectively. Type 3 frontal cells, frontal bullar cells and suprabullar cells were more prevalent in the FS and FR groups than in the normal group. All types of cells were more prevalent in the FS group, but only the suprabullar cells were more prevalent in the FR group than in the normal group. CONCLUSION: These findings suggest that type 3 frontal cells, frontal bullar cells and suprabullar cells may have a significant association with frontal sinus/recess mucosal thickening.

Tumoración de Pott: A propósito de un caso / Pott puffy tumor: Case report

Se analiza el caso de un niño con sinusitis frontal, con una forma de presentación poco habitual que, además, padecía una complicación intracraneal grave. Las complicaciones intracraneales de las sinusitis son raras en cerebrales y trombosis del seno cavernoso. Se hace hincapié en la importancia del diagnóstico precoz y de un tratamiento empírico inicial adecuado para evitar las posibles complicaciones. Asimismo, cabe enfatizar que una vez producidas estas, requieren un tratamiento médico-quirúrgico intensivo para su resolución.

We present the case of a child with frontal sinusitis, who also suffers from a severe intracranial disease. Although sinusitis intracranial issues are rare nowadays, they include a wide range of serious entities such as meningitis, brain abscesses and thrombosis of the cavernous sinus. We emphasize the importance of early diagnosis and an adequate initial empirical treatment to prevent possible complications. Once they are presented, an aggressive surgical medical treatment is required for its resolution.

Effects of Frontal Recess Cells on the Development of Frontal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Frontal recess anatomy can be very complex, with accessory cells extending to the frontal sinus and possibly contributing to the obstruction of the frontal sinus. However, there is still controversy on the effect of the frontal recess cells. We designed this study to assess the effect of frontal recess cells on frontal sinusitis. SUBJECTS AND METHOD: We retrospectively reviewed chart and collected data of those who visited the outpatient clinic between January and June, 2011. Parnasal sinus CT was taken with Brillance 64-slice computed tomography scanners. The image was reviewed by two or more otolaryngologists to identify the frontal recess cells. The nasofrontal isthmus diameter and the area of nasofrontal isthmus was reconstructed and measured with workstation. Then, we compared the radiological results of frontal recess cells with the frequency of frontal sinusitis. RESULTS: The presence of anterior group of frontal recess cells showed no influence on the frontal recess anatomy. The presence of frontal bullar cell was significantly associated with the development of frontal sinusitis by simple (p=0.001) and multiple (p=0.038) logistic regression models. It was shown that the narrower the area of frontal isthmus the more developed were the frontal sinusitis, showing statistically significance in the simple (p=0.013) and multiple (p=0.017) logistic regression models. CONCLUSION: Our results also showed that similar results compared to previous Asianreport. The narrowness of nasofrontal isthmus could be the cause of frontal sinusitis. The frontal bullar cell could be the cause of frontal sinusitis encroaching on the frontal recess and affect the nasofrontal pathway.

Endoscopic Endonasal Treatment of a Pott's Puffy Tumor

Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It has become rare due to the development of antibiotics and is usually seen as a complication of frontal sinusitis. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. Once the diagnosis is suspected, appropriate imaging should be performed to evaluate the possible complications. The treatment of Pott's puffy tumor combines medical and surgical approaches in order to prevent further complications. The goal of surgery is to drain the sinus and to excise the infected bone if necessary. The endoscopic endonasal approach is a safe and effective alternative to the external approach. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis.

A Case of Treatment of Traumatic Recurrent Frontal Sinusitis with T-tube / 대한이비인후과학회지

The most common disease process involving the frontal sinus is infection secondary to inadequate drainage through the frontal recess. Obstruction of the frontal recess may result from rhinosinusitis, allergic rhinitis, nasal polyposis, tumor and traumatic injury. The principle treatments are not only ventilation and drainage but also removal of predisposing factors. If there is no response to conservative treatment, surgical treatment is considered. To prevent closure of the frontal recess, external approach, endoscopic approach, grafts, indwelling tubes and mucoperiosteal flaps have been used. Insertion of silicone tube in frontal recess is a simple and easy method of drainage through frontal recess. We report a case of traumatic recurrent frontal sinusitis which was treated by endoscopic sinus surgery with silicone T-tube insertion.

Anatomic Variations of the Frontal Recess and Frontal Sinusitis: Computed Tomographic Analysis

BACKGROUND AND OBJECTIVES: The frontal recess (FR) cells, including the frontal cell (FC), agger nasi cell (ANC), supraorbital ethmoid cell (SOC) and inter-frontal sinus septal cell (IFSSC), can interfere with the drainage system of the frontal sinus. We evaluated the relationship between the FR cells and the frontal sinusitis. SUBJECTS AND METHODS: All paranasal sinus CT scans performed from July 2004 through June 2005 were reviewed. Of the 675 scans reviewed, 317 patients (634 sides) were selected for data collection. Exclusion criteria included a clinical history of neoplasms, bony deformities, and extensive disease responsible for obscuring the bony anatomy. Similarly, CT scans with severe artifacts were also excluded. RESULT: FCs were present in 21.9% of the patients. According to the Bent's classification, the prevalence of each FC type was as follows; type 1 FC (13.6%), type 2 FC (3.2%), type 3 FC (1.9%) and type 4 FC (3.1%). Of the four types of FR cells, type 4 had a significant association with frontal sinusitis. The incidence of hyperpneumatized frontal sinus, ANC, SOC, IFSSC were significantly higher among patients with the FC than those without the FC (p<0.05). Patients without the ANC or with type 1 uncinate process, according to Stammberger's classification, displayed a higher frequency of frontal sinusitis (p<0.05). There was a statistically significant decrease in the frequency of frontal sinusitis among patients with hypopneumatized frontal sinus (p<0.05). CONCLUSION: In our series, the frontal sinusitis was influenced by each types of FC, attachment sites of uncinate process and the degree of frontal sinus pneumatization. Therefore, these anatomic variations in the frontal recess should be appropriately addressed during the surgical management of the frontal sinusitis.

A Case of Pott's Puffy Tumor as a Complication of Contralateral Frontal Sinusitis / 대한이비인후과학회지

Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with the underlying frontal osteomyelitis. It has become a rare disease entity due to the development of antibiotics. Despite its rarity, it must be managed carefully because it is often associated with significant intracranial complications. We described a 12-year-old girl with Pott's puffy tumor accompanied with epidural abscess and subdural empyema, which was considered to be caused by the contralateral frontal sinusitis. To our knowledge, a Pott's puffy tumor caused by contralateral frontal sinusitis has not been reported in the literature. We discuss the clinical presentation and successful treatment of this unique case with brief review of the literature.

A Case of Isolated Frontal Fungal Sinusitis with Orbital Complication / 대한이비인후과학회지

The most commonly involved sinus of fungal infections is maxillary sinus, followed by sphenoid sinus and ethmoid sinus. On the other hand, the frontal sinus is only occasionally affected. Common pathogenic organisms related to fungal sinusitis are species of Aspergillus, dematiaceous fungi or zygomycetes; however, species of candida are rarely reported. In the invasive fungal sinusitis, orbital invasion, invasion and destruction of the skull base with a fungal meningitis, and fungal osteomyelitis with complete destruction of the maxilla have all been reported. Although these occurrences can not be explained, orbital complications have been reported in the noninvasive paranasal sinus mycosis. The treatment of paranasal fungus ball is primarily by surgical removal. In the past, fungus ball of frontal sinus was approached externally; however, this has been largely replaced with the endonasal endoscopic technique. We experienced a case of frontal fungal sinusitis with orbital complication, which was successfully treated by endonasal endoscopic frontal sinusotomy. In this paper, we report this case with a review of literature.

A Case of Recurrent Frontal Sinusitis due to Bone Wax

Frontal sinusitis can lead to severe and life-threatening disorders. Complications may involve intracranial structures, orbit and adjacent bone and soft tissue structures. Bone wax has been used since the turn of the century as a mechanical aid to hemostasis following surgical procedures. That it may produce a foreign body giant cell reaction in significant proportion of cases is well known. We experienced a woman who had recurrent frontal sinusitis due to bone wax. She was treated by endoscopic frontal sinusotomy with foreign body removal.

Endoscopic Frontal Sinus Surgery through the Agger Nasi Cell / 中国微创外科杂志

Objective To discuss the effectiveness of endoscopic frontal sinus surgery through the agger nasi cell. Methods Twenty-seven patients with chronic frontal sinusitis were treated with endoscopic frontal sinus surgery. The frontal sinus was opened by resecting the agger nasi cell. Results The frontal sinus were opened successfully in all the patients. No complications occurred except periorbital bruising in 3 eyes. Nasendoscopy showed that the frontal sinus drainage pathway was normal after the operation. During a 6-month follow-up, the symptoms of the frontal sinus disappeared in 18 of the patients, improved in 7, and were not changed in 2. Conclusions Endoscopic frontal sinus surgery through the agger nasi cell is effective for chronic frontal sinusitis.The method is worth being widely used.

Acute Frontal Osteomyelitis Managed by Endoscopic Sinus Surgery: A Case Report / 대한이비인후과학회지

Frontal osteomyelitis, frequently characterized by the classical sign of Pott's puffy tumor, is a serious life-threatening complication of frontal sinus infection. Anterior extension of the frontal sinus infection leads to osteomyelitis of the frontal bone and subperiosteal abscess. Surgical options are necessitated by the location and extent of infection, and include trephination, frontal sinus obliteration, and craniotomy. Recent advances in endoscopic sinus surgery have provided surgeons another access to the frontal recess. Examination of the frontal recess and removal of obstructive ethmoidal cells or diseased mucosa becomes feasible with nasal endoscopes. We report a recent encounter with a case of frontal osteomyelitis managed by endoscopic sinus surgery in a 22-year-old healthy male. We think that endoscopic sinus surgery is a good approach which can be carried out for the treatment of frontal sinus diseases and its complication.

Computed Tomographic Findings of Frontal Sinusitis / 대한이비인후과학회지

Functional endoscopic sinus surgery(FESS) is now the surgical procedure of choice for treating chronic and recurrent sinusitis in patients of all ages. But successful eradication of disease from an obstructed frontal sinus ostium and frontal recess area is one of the most difficult procedures of FESS. It is known that the frontal sinus drainage is influenced by frontal cells, agger nasi cell, uncinate process attachment, concha cell, supraorbital cell and enlarged ethmoid bulla. We analyzed the coronal computed tomography of 118 frontal sinusitis cases and two control groups to compare which anatomic or mucosal factors can influence the developmemt of frontal sinusitis. In chronic sinusitis with frontal sinusitis group, frontal cell was observed in 11 cases(9.4%), agger nasi cell in 108 cases(91.5%), concha bullosa in 26 case(22.0%), supraorbital cell in 53 cases(44.9%), uncinate attachment to lamina papyracea in 76 cases(64.4%) and ethmoid bulla occupy 80.6% in the ostiomeatal area. In two control groups(chronic sinusitis without frontal sinusitis group and normal group) frontal cell was observed in 7 cases(10.5%) and 4 cases(6.0%), agger nasi cell in 54 cases(80.6%) and 43(65.2%), concha bullosa in 16 cases(23.9%) and 15 cases(22.8%), supra-orbital cell in 29 cases(43.3%) and 29 cases(43.9%), uncinate attachment to lamina papyracea in 55 cases(82.1%) and 53 cases(80.3%) and ethmoid bulla occupy 74.6% and 75.6% in ostiomeatal area. Our study concluded that the agger nasi cell, enlarged ethmoid bulla and attachment site of uncinate process can influence the development of frontal sinusitis(p<0.05).

A Case of acute Exophthalmos due to Spreading of Chronic Frontal Sinusitis

It is not common that formation of retrobulbar abscess by inflammatory spreading of chronic frontal sinusitis and even rare that the abscess cause acute exophthalmos and ocular pain. But, if the acute exophthalmos with ocular pain arise from the patient associated with chronic rhinitis or paranasal sinusitis, it should be suspected that peri bulbar abscess was formed by spreading of these disease and otorhinologic examination should be taken. The authors experienced a case of acute exophthalmos with ocular pain in a 27-years old woman and founded that abscess arising from the chronic frontal sinusitis disrupted the superomedial wall of orbit and spread to the retrobulbar area by computed tomography and other radiologic evaluation. We had good result by performing incision and drainage and some otorhinologic therapy.