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Results for “Frontal Sinusitis”

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At least 19 recordsLinked to original sources

PubMed1991

Hydroxyapatite cement. II. Obliteration and reconstruction of the cat frontal sinus.

Frontal sinus obliteration and reconstruction can be performed with autogenous grafts or synthetic implants, each of which has significant limitations. Hydroxyapatite cement, which can be shaped intraoperatively and sets to a microporous hydroxyapatite implant, was applied to this problem. Nine cats had the anterior table of their frontal sinus unilaterally removed and the sinus cavity stripped of its mucosa. Hydroxyapatite cement was used to obliterate the cavity and reconstruct the overlying anterior table defect. The unoperated side served as the control, and the animals were sacrificed up to 18 months postoperatively. There were no adverse reactions, infections, mucoceles, or implant extrusions. The normal anatomic contour of the forehead region overlying the hydroxyapatite cement implants was maintained in all animals. Histologic examination of undecalcified whole sinus sections revealed progressive replacement of the implants with woven bone without a loss of volume. Replacement of the hydroxyapatite cement by woven bone is postulated to occur through a combination of implant resorption coupled with osteoconduction. The use of hydroxyapatite cement proved successful for the reconstruction and obliteration of cat frontal sinuses, and may be appropriate for the same application in humans.

Animals↗

PubMedDate not supplied

Fibrous xanthoma of the frontal sinus.

Frontal sinus mucocele was our preoperative diagnosis in a patient who had frontal swelling and downward displacement of the eye. Supporting this were typical roentgenogram changes, a long history of asthma, pansinusitis, and previous multiple-polypectomy surgery. Frontal sinus exploration revealed a locally eroding lesion. It was composed of spindled cells and lipid-laden histiocytes with a pattern of fibrous xanthoma and was treated conservatively. It should not be confused with true malignancies such as fibrous histiocytoma having a similar histopathologic appearance and requiring more aggressive surgical treatment.

Fibroma↗

PubMed1979

Anterior table frontal sinus fractures.

Frontal sinus fractures cover a spectrum of injury. A series of 52 primarily treated patients from the University of Cincinnati Medical Center is presented. Initial systematic management was applied to these patients and consisted of complete radiographic evaluation supplemented by wound care and cosmetic restoration when needed. All patients were followed on a long-term basis; both clinically and radiographically. Results to date are that 49 patients have had an uneventful post-traumatic course with re-establishment of normal sinus aeration. From the cosmetic standpoint no contour revisions have been needed and only two patients required elective scar revision. Three patients developed chronic suppurative sinus disease within the first post-traumatic year which was readily diagnosed and managed without complication by osteoplastic frontal sinusotomy and adipose obliteration.

Adolescent↗

PubMed1975

Frontal sinus cancer manifested as a frontal mucocele.

During the period 1972 to 1974, 12 frontal mucopyoceles were seen. Subsequently, three were shown to have an underlying neoplasm. Evaluation of the roentgenograms demonstrated minor differences between those with and those without a malignant basis. In previous reports of frontal sinus cancer, the descriptions of the roentgenograms suggest that it is possible that these features were also present. The difficulty in deciding the sinus of origin in such cancers has often been discussed, but the possibility that neoplasms of the orbital lobe of the lacrimal gland may occur in the frontal sinus is usually not considered. Anatomically, the intimate proximity of this lobe to the frontal sinus suggests that a neoplasm could develop in this manner. I believe that this was true in two of the patients reported herein.

Adenocarcinoma↗

PubMed1979

Frontal sinus mucocele.

Although not uncommon, and certainly not rare, frontal sinus mucocele was seen in 4 cases by the authors. Since one of the cases was rather unusual, we were prompted to evaluate the subject and prepare this manuscript. Gradual onset of unilateral proptosis should make one suspicious of a mucocele involving the paranasal sinuses, the frontal and ethmoid being the 2 most common locations. Diplopia, due to limited ocular motility on upward gaze, along with proptosis and epiphora are frequently the presenting symptoms which, in one particular case, paradoxically improved at first with topical anti-inflammatory therapy . A team approach (ophthalmologist, radiologist, otorhinolaryngologist, and neurosurgeon) are essential for an accurate diagnosis and therapeutic approach to this problem. The use of a precut template from the Caldwell projection is a very useful device to outline the contours of the frontal sinus during surgery. The not-so-frequent use of abdominal fat to fill the frontal sinus cavity is presented with no apparent postoperative fat necrosis. A 5-year follow-up has shown the patient to be free of recurrences.

Diplopia↗

PubMed1992

Anterior table free bone graft technique for frontal sinus obliteration.

The osteoplastic flap technique for exposure of the frontal sinus has been an accepted approach for cases in which obliteration or exploration of the frontal sinus has been necessary. Preservation of vascularized anterior pericranium is credited with reduction of the chances of anterior table bone resorption and subsequent cosmetic deformity. Disadvantages include the need for templates and unpredictable random fracturing in the supraorbital rim area, increasing the chance of potential injury to the periorbita and/or supraorbital neurovascular structures as well as limiting surgical exposure in some cases. Ten patients with chronic frontal sinusitis underwent frontal sinus obliteration using an anterior table free bone graft technique over a 3 year period. The superior orbital neurovascular pedicles were easily identified and protected within its pericranial sheath in all cases. All patients had precise delineation of the frontal sinus anterior bone flap margins with no need for templates. Bone graft viability was documented in all patients, along with excellent cosmetic results comparable to the osteoplastic flap technique. A review of the literature and description of the technique are presented.

Adolescent↗

PubMed1976

Experimental evaluation of a new implant material in frontal sinus obliteration: a preliminary report.

Frontal osteoplasty with exogenous material has been uniformly unsuccessful both experimentally and clinically. Our experiment was designed to test the long-term behavior of a new poly (tetrafluoroethylene)-carbon fiber implant material (Proplast) in a canine frontal sinus model. Varying conditions such as removal of the sinus mucoperiosteum, closure of the nasofrontal ducts, exposure of dura mater, and cerebrospinal fluid leaks were studied at intervals up to one year. Proplast was 100% successful in obliteration of the canine frontal sinus. The ultraporous nature allowed rapid vascularization, collagen ingrowth, and new bone formation, and led to stabilization rather than sequestration. Frontal obliteration with Proplast may be clinically superior to osteoplasty with any other presently available exogenous material or with osteoneogenesis alone, and may even obviate the few complications encountered with adipose implants. Only longer range experimental and clinical evaluation will provide the answer.

Animals↗

PubMed1992

Frontal sinus fractures in the pediatric population.

Full development of the frontal sinus is not achieved until approximately 19 years of age. An evaluation of frontal sinus injuries isolated to the subset of patients less than 20 years old has yet to be reported. In order to determine whether age was a factor in the clinical course of patients with frontal sinus fractures, 209 patients who sustained frontal sinus fractures from January 1985 to April 1990 were identified using the trauma registry from all six major trauma centers, one of which is a pediatric trauma center, in a county of 2.5 million people. Forty patients (19%) were between the ages of 6 and 19 years at the time of their injury. Computed tomography imaging of these pediatric patients identified associated head and neck fractures in 37 (93%) as well as significant central nervous system injury in 22 (55%). Seventeen pediatric patients were treated nonoperatively and 1 died prior to the planned surgery. A detailed analysis of extent of injury and treatment together with a comparison of the 169 adult and the 40 pediatric patients is presented.

Abbreviated Injury Scale↗

PubMed1992

Do abnormalities of the frontonasal duct cause frontal sinusitis? A CT study in 198 patients.

OBJECTIVE: The purpose of the study was to determine the correlation between frontonasal duct abnormalities (narrowing or obstruction caused by hypertrophic mucosa) and frontal sinusitis. This study was based on the hypothesis that abnormalities of the frontonasal duct cause frontal sinusitis by impairing normal drainage of the sinus. MATERIALS AND METHODS: CT studies of 198 consecutive patients with clinical diagnoses of chronic sinusitis were reviewed retrospectively. Criteria for inclusion were (1) no history of sinus surgery or facial trauma and (2) absence of polyps at rhinoscopy. As 37 frontal sinuses were undeveloped, a total of 359 sinuses were evaluated. CT scans were obtained in oblique axial and coronal planes. The following CT features were assessed: (1) the frequency of detection of the frontonasal duct, (2) the appearance of the frontonasal duct: normal vs abnormal (narrowed or obstructed), and (3) the correlations between abnormalities of the frontonasal duct and frontal sinusitis. RESULTS: The frontonasal duct was detected in all 359 cases, either in both CT planes (81%) or only in the axial oblique plane (19%). In 267 (74%) of 359 cases, the duct appeared normal; among these, isolated frontal sinusitis was detected in five cases (2%). In 92 (26%) of 359 cases, the duct was abnormal; it was narrowed in 18 cases (5%) and obstructed in 74 cases (21%). Frontal sinusitis was noted in 78 (85%) of the 92 cases of frontonasal duct abnormalities. The sensitivity and specificity of the correlations between frontonasal duct abnormalities and frontal sinusitis were 98% and 85%, respectively. CONCLUSION: Because our results show a strong correlation between abnormalities of the frontonasal duct and frontal sinusitis, it seems highly probable that abnormalities of the frontonasal duct cause frontal sinusitis.

Adolescent↗

PubMed1975

Frontal sinus disease. III. Experimental and clinical factors in failure of the frontal osteoplastic operation.

The surgical approach to frontal sinus disease has been subject to much variation. Experimental evidence for new treatment modalities is quite limited. Frontal osteoplasty, while probably the best procedure to date, has up to a 25 percent failure rate. Possible complications include recurrent disease, incomplete bony obliteration (Macbeth technique), infection of the adipose implant, frontal bossing or depression, and laceration of the dura. Four experimental groups were designed using the canine frontal sinus model. Results indicated that stripping the mucosa in a normal sinus with intact periosteum and a patent nasofrontal duct will not consistently lead to normal mucosal regeneration. Second, the additional factor of removing the periosteum (as in osteoplasty by osteoneogenesis), leads to partial fibrous obliteration complicated by mucocele formation. Third, sinus obliteration by osteoneogenesis was much more consistent with concurrent closure of the nasofrontal duct. Fourth, intentionally leaving a strip of mucosa leads to failure of obliteration by osteoneogenesis 100 percent of the time. Finally, bony-fibrous obliteration increases with time but is still incomplete after one year. In light of these results, fat obliteration with closure of the nasofrontal duct is probably more reliable than obliteration by osteoneogenesis.

Adipose Tissue↗

PubMed1992

Management of frontal sinus fractures. Changing concepts.

Since the turn of the century, surgeons have handled frontal sinus fractures with a variety of different procedures. The optimal management procedure remains controversial. We have presented a graduated anatomic algorithm for treatment of frontal sinus fractures based on the degree of fracture displacement and nasofrontal duct involvement and presence of CSF leak. Nondisplaced fractures are best handled conservatively, without operative intervention. However, the majority of frontal sinus fractures require operative correction. Uncomplicated anterior table displacement with an aesthetic deformity is treated by fragment reduction and stabilization with miniplates or microplates or wires. Nasofrontal duct obstruction is usually managed by sinus obliteration with spontaneous osteoneogenesis or autologous bone grafting. Finally, comminuted, displaced anterior and posterior table fractures, especially those with persistent CSF leakage and associated nasofrontal duct involvement, are best handled with frontal sinus cranialization. The presented algorithm is simply a treatment guideline. Frontal sinus fracture management must be individualized. However, this graduated anatomic approach provides a pragmatic framework for decision making and understanding this complex and controversial topic.

Bone Transplantation↗

PubMed1978

Compound frontal sinus injuries with intracranial penetration.

Extensive trauma to the forehead, resulting in large penetrating wounds of the frontal sinus that extend into the frontal lobes of the brain, has traditionally been treated by frontal sinus ablation. Although this operation eliminates dead space, it leaves the patient with a depressed area in the forehead with little protection for the brain. The success of Nadell and Kline in replacing skull fragments following compound depressed skull fractures yet avoiding infection has spurred us to attempt this technique in penetrating injuries of the frontal sinus. By preserving the anterior frontal sinus wall, we have not only afforded protection for the frontal lobes of the brain, but, at the same time, avoided the cosmetic defect that would be left by an ablation procedure. This procedure has been performed on two patients at our institution. After a two-year follow-up, excellent forehead profile preservation has been achieved and there has been no evidence of bone absorption or infection at any time since surgery.

Adolescent↗

PubMed1979