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.
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  . Sinusitis may be classified according to the duration of symptoms (acute, subacute, chronic, or recurrent) and the etiology (bacterial, viral, or fungal)   . 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)    . The clinical presentation of sinusitis (regardless of the exact sinus involved) is comprised of symptoms such as nasal obstruction, discharge, localized pain, and headaches    . Some studies show that vomiting may be a common symptom as well . 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   . Frontal sinusitis is known for causing intracranial complications, primarily because of its anatomical proximity to the meninges and the venous sinuses   . For this reason, an early diagnosis is mandatory.
Entire Body System
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]
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]
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]
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]
Face, Head & Neck
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]
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]
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]
The workup of frontal sinusitis should start with a complete patient history that will include the duration of symptoms and their progression . 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  . 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 . Imaging studies are recommended for solidifying clinical suspicion and plain radiography is the first-line study for sinusitis  . 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  . 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   . In some patients, puncture of the frontal sinus might be indicated to obtain viable material for microbiological investigation, especially if fungal pathogens are suspected  .
(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]
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]
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