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Frontal Sinusitis

Inflammation and infection of the frontal sinus - frontal sinusitis, is distinguished by the presence of symptoms such as a headache and pain in the superior part of the orbits, in addition to rhinorrhea, discharge, and nasal obstruction. Frontal sinusitis poses the greatest risk for intracranial complications, which is why an early diagnosis is a must. A thorough clinical workup supported by imaging studies is sufficient to make the diagnosis.


Presentation

Sinusitis is considered to be a rather common entity in clinical practice, as studies show that up to 31 million diagnoses are made in the United States alone each year [1] [2]. Sinusitis may be classified according to the duration of symptoms (acute, subacute, chronic, or recurrent) and the etiology (bacterial, viral, or fungal) [1] [3] [4]. If symptoms last up to 4 weeks (or 30 days by some authors), the term acute sinusitis is used; when four or more episodes of acute sinusitis are seen during the year, the diagnosis of recurrent sinusitis can be made; and conversely, chronic sinusitis develops when symptoms last more than 90 days (or 12 weeks) [1] [3] [4] [5]. The clinical presentation of sinusitis (regardless of the exact sinus involved) is comprised of symptoms such as nasal obstruction, discharge, localized pain, and headaches [4] [5] [6] [7]. Some studies show that vomiting may be a common symptom as well [7]. However, the frontal sinusitis is suspected when a headache, described as constant and dull pain, is localized to the forehead or the superior aspects of the orbit [1] [4] [8]. Frontal sinusitis is known for causing intracranial complications, primarily because of its anatomical proximity to the meninges and the venous sinuses [1] [8] [9]. For this reason, an early diagnosis is mandatory.

Low Fever
  • Symptoms of a cold (runny nose and low fever) often give way to pain and pressure in the sinuses, which are usually the first signs of sinusitis.[humanillnesses.com]
Wound Infection
  • Three patients with redness and swelling around the wound were initially thought to have wound infection, but localized tenderness to percussion of the frontal sinus and air fluid levels on x-rays indicated acute frontal sinusitis.[ncbi.nlm.nih.gov]
Pseudotumor
  • In rare cases, the osteomyelitis of the frontal bone can be externally presented in the form of a subperiosteal abscess, which manifests itself clinically by infiltration and "pseudotumoral" bulging of the soft tissues in the anterior frontal region,[panafrican-med-journal.com]
Intravenous Administration
  • In the childs life threating event (accompanying with laryngeal edema, severe allergic reaction ) is used intravenous administration of prednisolone (up to 1-3 ml for 3 min).[minclinic.ru]
Frontal Sinus Pain
  • It is characteristic of acute frontal sinus pain to show definite periods of occurrence each day.[jamanetwork.com]
  • Frontal sinus pain is felt above the eyes and is often confused with tension headache. Ethmoid pain is felt between and behind the eyes and in the temples. Pain originating in the sphenoid sinus may be experienced as pain at the back of the head.[allergic.net]
Facial Mass
  • The study of the facial mass was carried out by series of T2, T1 and T1Fat Sat weights with IV injection of Gadolinium.[panafrican-med-journal.com]
Headache
  • The symptoms may be minimal and may be manifested only by a mild headache and occasional stuffy nose. A 16-year-old boy was studied one month after a head injury sustained while wrestling, complaining only of recurrent headaches and fever.[ncbi.nlm.nih.gov]
  • However, the frontal sinusitis is suspected when a headache, described as constant and dull pain, is localized to the forehead or the superior aspects of the orbit.[symptoma.com]
Frontal Headache
  • CASE REPORT: A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis.[ncbi.nlm.nih.gov]
  • Case presentation A 42-year-old Korean male presented with gradually progressive proptosis of right eye and right-sided frontal headache. He had previously undergone endoscopic sinus surgery (ESS) 15 and 9 years ago.[bmcresnotes.biomedcentral.com]
Cognitive Deficit
  • With this approach only two patients suffered long-term morbidity in our series, in the form of persistent neurological or cognitive deficit. No patient required a definitive sinus procedure.[ncbi.nlm.nih.gov]
Neglect
  • THORNELL W.C. 1957 27 The treatment of acute frontal sinusitis. ( 14362339 ) Brown J.M....GOODHILL V. 1955 28 Acute myeloid leukaemia presenting as acute frontal sinusitis. ( 13263776 ) 1955 29 Subdural empyema secondary to acute frontal sinusitis; a neglected[malacards.org]

Workup

The workup of frontal sinusitis should start with a complete patient history that will include the duration of symptoms and their progression [1]. A presumptive diagnosis in terms of etiology can be made based on the duration of complaints, as viral sinusitis (rhinovirus, influenza virus and parainfluenza virus) is more likely when the illness lasts < 10 days, whereas bacterial pathogens (staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis, etc.) should be considered with a prolonged clinical course [1] [6]. A thorough physical examination, comprised of cranial inspection, palpation of the sinuses (which reveals tenderness in the frontal area in the case of frontal sinusitis), and anterior rhinoscopy must follow in order to obtain sufficient evidence to make the diagnosis [1]. Imaging studies are recommended for solidifying clinical suspicion and plain radiography is the first-line study for sinusitis [1] [5]. The frontal view (known as Caldwell‐Luc view) is used to assess the frontal sinuses and can reveal opacification of the sinus or the presence of an air-fluid level [3] [5]. Computed tomography (CT), however, is a superior method that is able to provide a better view into the sinuses and their anatomical landmarks, which is why it is favored over X-rays [1] [3] [5]. In some patients, puncture of the frontal sinus might be indicated to obtain viable material for microbiological investigation, especially if fungal pathogens are suspected [3] [5].

Periostal Elevation
  • (A) Curved incision under eyebrow to periosteum, (B) underlying bone exposed by periosteal elevator, with burr holes created with small drill, (C) two small plastic tubes inserted for daily irrigation of the frontal sinus.[emedicine.medscape.com]
Sinus Opacification
  • New mucosal thickening of 1 mm was found in three patients in the MTsc group and eight patients in the MTsp group (p 0.21); the only patient with postoperative complete frontal sinus opacification was in the MTsp group.[ncbi.nlm.nih.gov]

Treatment

  • Results of treatment in the series support the opinion that combined aggressive surgical and antibiotic treatment is a preferred method in complicated sinusitis in children.[ncbi.nlm.nih.gov]

Prognosis

  • Our conclusion was that the prognosis of frontal sinusitis is difficult to predict with any single factor, but is affected by many of them.[ncbi.nlm.nih.gov]
  • Treatment and Prognosis The treatment may be either medical or surgical. The initial treatment involves administration of appropriate antibiotics along with an analgesic and an anti-histaminic.[webhealthcentre.com]
  • The prognosis is guarded. The best control method is to dehorn calves at a young age using a closed dehorning technique.[merckvetmanual.com]
  • Prognosis The prognosis for acute sinusitis is very good. Most cases will go away within one to two weeks, often without antibiotics.[drugs.com]
  • Prognosis All but the acute invasive form carry a good prognosis once the diagnosis is made and treatment completed. Fulminant fungal sinusitis is associated with a 50% mortality rate, even with aggressive surgical and medical treatment.[patient.info]

Etiology

  • Sinusitis may be classified according to the duration of symptoms (acute, subacute, chronic, or recurrent) and the etiology (bacterial, viral, or fungal).[symptoma.com]
  • Abstract A retrospective analysis of patients with acute frontal sinusitis treated at Kuopio University Hospital between 1981 and 1990 was performed to define etiological factors, clinical course and response to treatment.[ncbi.nlm.nih.gov]
  • Etiology and pathogenesis INFLAMMATION OF THE FRONTAL SINUS (SINUSITIS FRONTALIS ACUTA ET CHRONICA) Infection.[lecheniebolezni.com]

Epidemiology

  • Aim: The purpose of this study is to evaluate epidemiology, clinical features and management of the frontal sinusitis’s complications. Study Design: Retrospective study.[scitechnol.com]
  • Epidemiology Although this is less common than acute sinusitis, it remains a reasonably common entity in itself, accounting for about 25 cases per 10,000 person-years in an average UK GP practice [ 2 ].[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Contemporary medical management of frontal sinusitis requires recognition of the unique disease process with implementation of targeted therapies aimed at addressing the specific pathophysiology. Copyright 2016 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Thorough discussions of anatomy and pathophysiology of a variety of frontal sinus diseases provide a background for in-depth chapters on aspects of both medical and surgical management.[books.google.es]
  • In order to understand the pathophysiology of chronic frontal sinus infections it is imperative that we should understand the anatomy of frontal outflow tract. Complications are more common in chronic frontal sinusitis.[drtbalu.co.in]
  • The pathophysiology of frontal sinusitis is associated with ventilation of the sinus via the sinus ostium. The size of the frontal sinus ostium is key to frontal sinus drainage.[journalotohns.biomedcentral.com]
  • […] and chronic bronchitis, exacerbation of these diseases affects more than 90 million people—nearly one in three Americans. 5 The socioeconomic impact of this translates to more than 5.8 billion dollars spent on the treatment of sinusitis. 6 Back to Top Pathophysiology[clevelandclinicmeded.com]

Prevention

  • Surgical intervention is often required to prevent unacceptable mortality.[ncbi.nlm.nih.gov]
  • How Can Frontal Sinusitis be Prevented? Practicing good hygiene is the best way to prevent Frontal Sinusitis.[epainassist.com]

References

Article

  1. Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137(3 Suppl): S1-31.
  2. Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US adults: National Health Interview Survey, 2004. Vital Health Stat. 2006;10:19-22
  3. Osguthorpe JD. Adult rhinosinusitis: diagnosis and management. Am Fam Physician. 2001;63(1):69-76.
  4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011
  5. Masood A, Moumoulidis I, Panesar J. Acute rhinosinusitis in adults: an update on current management. Postgrad Med J. 2007;83(980):402-408.
  6. Jones NS. Sinus headaches: avoiding over- and mis-diagnosis. Expert Rev Neurother. 2009;9(4):439-444.
  7. Kombogiorgas D, Seth R, Athwal R, Modha J, Singh J. Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg. 2007;21(6):603-609.
  8. Reuler JB, Lucas LM, Kumar KL. Sinusitis. A review for generalists. West J Med. 1995;163(1):40-48.
  9. Hadley JA, Schaefer SD. Clinical evaluation of rhinosinusitis: history and physical examination. Otolaryngol Head Neck Surg 1997;117(Suppl): S8 –S11.

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Last updated: 2019-06-28 11:43