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.

• Asymptomatic

  At follow-up, all patients were asymptomatic and had patent frontal sinus ostia. Follow-up ranged from 8 months to 38 months with a median of 25 months. Three patients required a revision of their frontal ostium. [ncbi.nlm.nih.gov]

  MR may be of limited utility in distinguishing symptomatic patients with recurrent disease from asymptomatic patients with imaging findings related to scar tissues. Imaging is useful for early detection of postoperative mucocele formation. [asnr.org]

  CB alone is usually asymptomatic. However, in the formation of a mucocele, CB may become expanded and occupy the surrounding structures with local bone destruction. [bmcresnotes.biomedcentral.com]

  The patients may be asymptomatic or present with a range of clinical signs, most of times depending on the mass effect resulting from the paranasal cavity enlargement. [scielo.br]

  Around 4% of the asymptomatic population may present bilateral frontal sinus agenesis (1). Gaafar e col.2 reported that the average diameter of the frontal sinus ostium has been 5.6 mm, varying from 4 to 7 mm. [arquivosdeorl.org.br]

• Mucosal Edema

  The front nasal duct is tortuous and easily obstructed by mucosal edema after a viral URTI. Early diagnosis and management of acute frontal sinusitis will go a long way in preventing development of complications. [drpaulose.com]

  An evaluation of 289 frontal recesses at the time of revision surgery found that 193 (66.8 %) had mucosal edema or polyposis obstructing the frontal recess [ 11 ]. [journalotohns.biomedcentral.com]

  Physical Findings Typical physical signs include bilateral nasal mucosal edema, purulent nasal secretions, and sinus tenderness (however, this is not a sensitive or specific finding). The location of sinus pain depends on which sinus is affected. [clevelandclinicmeded.com]

  It is important to keep pressure to the minimum necessary because of subsequent mucosal edema. [emedicine.medscape.com]

• Soft Tissue Mass

  MRI can discern secretions and mucosa from masses. When you understand the signal characteristics, you are readily able to distinguish soft tissues masses from inspissated secretions. [radiologyassistant.nl]

  In this study, orbit CT image showed a prominent soft tissue mass well circumscribed by a bony framework of the CB. This is important differential diagnosis between CB and ethmoidal mucocele [ 5 ]. [bmcresnotes.biomedcentral.com]

• 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]

• Nasal Discharge

  Purulent nasal discharge may be noted on physical examination. Roentgenographic studies will show opacification or an air-fluid level within the sinus. We present 4 cases of intracranial complications of frontal sinusitis seen in male adolescents. [ncbi.nlm.nih.gov]

  Warm air also helps mucus drain. runny nose, running nose, sinus, sinusitis, sinus inflammation, acute sinusitis, chronic sinusitis, blocked nose, sound while breathing, blood from nose, frontal sinus, loss of smell, pain behind the eye, nasal discharge [mtatva.com]

  The classic symptoms of chronic sinusitis are: nasal stuffiness increased nasal discharge face pain or pressure Chronic cough and loss of smell may occur. In children, symptoms are slightly different. [medicineonline.com]

  Aside from feeling of pressure, tenderness, stuffiness and headache, the symptoms usually include nasal discharge, fever and impairment or loss of the sense of smell. [ic.steadyhealth.com]

• Frontal Sinus Pain

  It is characteristic of acute frontal sinus pain to show definite periods of occurrence each day. [jamanetwork.com]

  Maxillary sinus pain is typically felt in the cheeks and may be mistaken for pain in the upper molars. Frontal sinus pain is felt above the eyes and is often confused with tension headache. [allergic.net]

• Fracture

  Balloon dilation enlarges the sinus ostium by effecting tiny fractures of the surrounding bone and compressing soft tissue such that no mucosa is removed. [ncbi.nlm.nih.gov]

  The hallmarks of a frontal sinus fracture is a frontal depression in the anterior table of the bone. [en.wikipedia.org]

  IMPORTANT POINTS Because of the forces required to fracture the bones of the frontal sinuses, these fractures rarely are isolated injuries; in 80% to 95% of cases, they are associated with other facial (80%) and skull fractures (55%). [pedsinreview.aappublications.org]

  To the Editor: Frontal sinus fractures represent 2% to 12% of facial trauma, 1 and most frontal sinus fractures are sustained by young male adults involved in vehicle accidents. 2 Devastating complications of frontal sinus fractures such as meningitis [journals.lww.com]

• Suggestibility

  Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. [ncbi.nlm.nih.gov]

  […] users Home remedy for allergic sneezing suggested by Varadarajan on Saturday, February 23, 2008 sinus infection suggested by vicki on Sunday, December 16, 2007 Fresh lemon juice suggested by Sash on Monday, June 18, 2007 Tea Tree Oil suggested by [unspecified [home-remedies-for-you.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]

  Treatment for these true “sinus headaches” may be medical, including antibiotics and/or steroids, or surgical, depending on the individual presentation. Tension Headache Cluster Headache Headache due to Rhinosinusitis A. [care.american-rhinologic.org]

  To reduce the headache prescribed ibuprophen, amidopyrine. Apply calcium gluconate. [minclinic.ru]

• 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]

  In our case, the patients had exophthalmos and frontal headache which are considered to be caused by extension of CB mucocele into the orbital space and acute frontal sinusitis secondary to the obstruction of osteomeatal complex by CB mucocele. [bmcresnotes.biomedcentral.com]

• Confusion

  One reason confusion arises in the diagnosis of this condition is that tests are often normal. [mhni.com]

  The ethmoidal cells above the level of frontal recess may confuse the surgeon who can mistake it for frontal sinus opening. Hence careful evaluation of this area using CT scan images is advisable before endoscopic sinus surgery. [drtbalu.co.in]

  However, the fact that its ostium may be easily confused with the FS ostium may be the most important one. It is not incommon to confuse a big supra-orbitary cell with the FS. [arquivosdeorl.org.br]

  With millions of Americans suffering from each of these problems, there is bound to be some overlap and confusion on the part of the patient as to what their diagnosis truly is. [care.american-rhinologic.org]

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].

• 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]

• Polyps

  Frontal Sinusitis Caused Due to Nasal Polyps: Polyps are abnormal growths that can occur anywhere in the body and the Frontal Sinus is no exception. [epainassist.com]

  Nasal polyps Polyps are abnormal growths in your body. Polyps in the frontal sinuses may block the sinuses from filtering air and increase the amount of mucus buildup. [healthline.com]

  One inflammatory sign associated with symptoms: - Discolored mucous, polyp, inflammatory swelling of nasal mucosa - Oedema / erythema of middle meatus 2. [drtbalu.co.in]

  From allergies and chronic nosebleeds to nasal polyps and skull base tumors, our fellowship-trained rhinologists (ear, nose, and throat doctors specializing in the nose and sinuses) treat patients with surgical and nonsurgical therapies. [nyee.edu]

treatment and endoscopic approaches, at least in the minds of many prominent surgeons. [ncbi.nlm.nih.gov]

OF ACUTE FRONTAL SINUSITIS. ( 14179757 ) Glasscock M.E. 1964 26 Acute frontal sinusitis; complications and treatment. ( 13393906 ) KRATZ R.C....THORNELL W.C. 1957 27 The treatment of acute frontal sinusitis. ( 14362339 ) Brown J.M....GOODHILL V. 1955 [malacards.org]

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]

Treatment and prognosis In general, drainage and marsupialisation of an affected sinus are sufficient. If large bony defects are present, reconstructive surgery may be necessary (e.g. of the orbital floor). [radiopaedia.org]

Sinusitis may be classified according to the duration of symptoms (acute, subacute, chronic, or recurrent) and the etiology (bacterial, viral, or fungal). [symptoma.com]

Although anatomic variations in the frontal recess are likely to play a role in frontal sinusitis, mucosal inflammatory processes are likely to be a much more important etiologic factor. [ncbi.nlm.nih.gov]

Etiology and pathogenesis INFLAMMATION OF THE FRONTAL SINUS (SINUSITIS FRONTALIS ACUTA ET CHRONICA) Infection. [lecheniebolezni.com]

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 and burden of nasal congestion. Stewart M, Ferguson B, Fromer L. Int J Gen Med. 2010 Apr 8;3:37-45. 28. De la rhinite allergique aux pathologies sinusiennes (sinusite/polypose) : les liens épidémiologiques et expérimentaux. P. Demoly. [passeportsante.net]

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]

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]

[…] 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]

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]

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4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011
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6. Jones NS. Sinus headaches: avoiding over- and mis-diagnosis. Expert Rev Neurother. 2009;9(4):439-444.
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