Frontal Sinus Region Research Articles

Initial Frontal Sinus and Orbit Tumor Signaling Late Distant Metastasis in Kidney Cancer.

Although metastases to the paranasal sinuses are exceedingly rare, when they do occur, renal clear cell carcinoma is the most frequent primary tumor involved. The aim of this work was to present a case of metastatic clear cell renal carcinoma in the frontal sinus and orbit region, 7 years after the initial diagnosis and treatment. The patient was referred to our clinic due to drooping of the left eyelid and displacement of the left eyeball. Computed tomography revealed an expansive lesion in the left frontal sinus and orbit, causing destruction of its anterior, lateral, and roof walls. Profuse bleeding from the tumor and left orbit hindered a comprehensive assessment of tumor extension into the orbit and residual tumor size. Therefore, complete tumor removal was not possible; instead, reduction was achieved. Subsequent histopathologic and immunohistochemical analysis confirmed the lesion as a metastasis of renal cell carcinoma in the sinonasal tract. Unfortunately, 10 weeks later, the patient passed away. Treatment of metastatic clear cell renal carcinoma depends on the localization of the disease as well as the overall condition of the patient. If there is a solitary metastatic lesion, as in the case of the sinonasal region, surgical treatment is recommended. Metastasis of clear cell renal carcinoma to the sinonasal region is a rare occurrence; however, it is essential to consider it in cases of rapidly growing tumor masses, typically presenting with symptoms such as epistaxis and nasal obstruction.

Rare complex fistulations of frontal sinus, occulo‐nasal and oro‐nasal passages due to nasal form of canine transmissible venereal tumour

AbstractUnusual manifestations in commonly occurring diseases often mislead the diagnostic approaches of general veterinary practitioners. A 2.5‐year‐old male Spitz dog was evaluated for frequent episodes of nasal discharges. With no resolution of signs with treatments, the dog was brought to the Teaching Veterinary Hospital. On presentation, the dog had purulent nasal discharge from the right nostrils, right eye and from an opening in the right frontal sinus region along with mild swelling on the right nasal region and stertor. Anterior rhinoscopy confirmed the concurrent presence of frontal sinus, oculo‐nasal and oro‐nasal fistula. Endoscopic aspirations and washing confirmed an extra genital form of canine transmissible venereal tumour. Interestingly no genital lesions were seen. Treatment with vincristine resulted in complete remission with no further relapses over the last 8 years. Chronic nasal signs should be taken as warning signs and nasal washings should be evaluated for possible tumour cells, as observed in this study.

Anterior ethmoid and frontal sinus drainage pathways: five patterns formed and defined by their bony walls

PurposeTo perform endoscopic sinus surgery safely and effectively, surgeons need to visualize the complex anatomy of the anterior ethmoid and frontal sinus region. Because this anatomy is so variable and individualized, the foundation of understanding lies in identifying, following, and visualizing the drainage pathway patterns and anticipating possible variations.MethodsWe studied 100 sides (50 cases: 22 male, 28 female, aged 12–86, average age 46.5 years, ± 19.5) using computed tomography (CT) and multiplanar reconstruction (MPR) to identify and classify the drainage pathways leading to the frontal sinus and anterior ethmoidal cells.ResultsAnalysis revealed five patterns of drainage pathways defined by their bony walls: between the uncinate process and the lamina papyracea [UP–LP]; between the uncinate process and the middle turbinate [UP–MT]; between the uncinate process and the accessory uncinate process [UP–UPa]; between the uncinate process and the basal lamella of the ethmoidal bulla [UP–BLEB]; and between the basal lamella of the ethmoidal bulla and the basal lamella of the middle turbinate [BLEB–BLMT]. In most cases, BLEB formed the posterior wall of the drainage pathway of the frontal sinus, indicating BLEB could be one of the most important landmarks for approaching the frontal sinus.ConclusionsAs endoscopic sinus surgery depends on an understanding of this anatomy, this study may help surgeons to identify and follow the drainage pathways more accurately and safely through the anterior ethmoid to the frontal sinus.

Дифференцированный подход при пластике ликворных фистул в лобной пазухе на основе анализа компьютерных томограмм

The choice of the method of plasty of cerebrospinal fluid fistulas in the area of the frontal sinus is an important issue in neurosurgery, since there are a large number of anatomical variations in the structure of the naso-frontal canal and the sinus itself. Endoscopic, combined and transcranial approaches are described in the literature. However, there is no clear algorithm for choosing a surgical approach for nasal liquorrhea based on anatomical features. The objective of this article is to study various anatomical variants of the structure of the frontal sinus and nasolabial pocket in relation to defects of the base of the skull of a given localization and, based on the data obtained, to establish the patterns of the influence of certain indicators on surgical tactics and the quality of plastic to complement the proposed classification. This article include a retrospective analysis of case histories and computed tomograms of 38 patients who underwent surgical treatment for skull base defects in the frontal sinus region from 2010 to 2020. The patients were divided into three groups depending on the approach used, the features of intraoperative visualization of the defect, and relapses. In a series of 38 cases, the endoscopic approach was used in 26 (68.4 %) cases, combined in 12 (31.6 %) cases. The defect was completely visualized using angled optics during surgery in 32 (84.2 %) cases, and in 6 (15.8 %) cases the defect was not visualized or partially visualized (up to 50 %) using angled optics. Relapses were observed in 6 (15.8 %) cases. The main craniometric indicators affecting the choice of surgical tactics and the quality of plastics are the distance from the center of the defect to the nasal septum, the value of the angle between the nasal septum and the line drawn through the edges of the defect, and the size of the defect. The recurrence rate is directly related to the visualization of the defect during surgery. The distance from the defect to the nasal septum can serve as an objective indicator for choosing access to intermediate defects of the frontal sinus: at a distance of more than 0.95 cm, it is advisable to perform a combined approach; at a distance of less than 0.95 cm, it is possible to achieve full visualization of the defect and perform high-quality plastic surgery with an endoscopic approach. English version of the article on pp. 244-253 is available at URL: https://panor.ru/articles/differentiated-approach-in-frontal-sinus-csf-fistula-plasty-based-on-computed-tomogram-analysis/63924.html

CT FINDINGS OF AN ENDO-ORBITAL OSTEOMA PRODUCING PROPTOSIS AND THE OPTIC NERVE’S COMPRESSION

Osteoma is a benign bone tumour, with an incidence of 2% of all orbital tumours. Osteomas located in orbit remain asymptomatic until they reach a size that originates mass effect signs such as exophthalmos, diplopia, and unilateral blindness. Materials and methods. In this case, a male patient presented to the emergency room with progressive proptosis, worsening headaches, and swelling of the left anterior periorbital and frontal sinus region one year after the beginning of the symptoms. Results. Imaging studies revealed a hyperdense mass in the left orbital floor displacing the left globe superiorly and anteriorly with the optic nerve’s compression. Conclusion. Osteoma may represent an emergency in the long term when left untreated; it may destruct the eye due to direct pressure on the optic nerve and disturbance of the ocular blood supply.

Analysis of frontal sinus in various malocclusions

Aims: The study aims to investigate the normal dimensions of the frontal sinus and determine the role of the frontal sinus in various skeletal malocclusions and also to analyze the relationship between the length of the mandible and frontal sinus dimension. Materials and Methods: A total of 120 lateral cephalograms were selected according to the criteria and were grouped mainly into three groups: Group 1 – Class I (N = 40), Group 2 – Class II (n = 40), and Group 3 – Class III (n = 40). These were traced and analyzed by recording the linear measurements such as maximum width, maximum height, area of frontal sinus region, and the length of the mandible. To compare the difference between the skeletal classes, one-way ANOVA test was performed followed by post hoc with Sidak and Bonferroni statistical tests. Results: There was no such significant difference in the measurements of maximum width, height, and area of frontal sinus region of classes I, II, and III. Conclusions: After analyzing the linear dimensions, we found out that there is a significant difference in height, width, and area of the frontal sinus region with respect to classes I, II, and III. Therefore, we can say that the frontal sinus plays a significant role in depicting skeletal malocclusions.

Solitary Plasmacytoma of Frontal Bone: A Case Report.

A 42years old male presenting with complaints of swelling on the left supraorbital region since-5months. Swelling was gradual in onset and progressive in nature. On examination it was a single swelling 5 × 6cm, with diffuse margins, skin over the swelling was red and stretched, swelling is firm in consistency, fixed, tender on touch, non pulsatile with diffuse irregular margin. FNAC. Smears are positive for malignancy. Bone marrow examination was normal. Excision of the mass from the left frontal sinus, orbit and supraorbital region under GA and sent for HPR. Definitive treatment of choice is: radiotherary 45-50Gy/4-5weeks, chemotherapy and surgery. Prognosis is good with local recurrence (< 10%).

Long-Term Safety of Topical Bacteriophage Application to the Frontal Sinus Region.

Background: Staphylococcus aureus biofilms contribute negatively to a number of chronic conditions, including chronic rhinosinusitis (CRS). With the inherent tolerance of biofilm-bound bacteria to antibiotics and the global problem of bacterial antibiotic resistance, the need to develop novel therapeutics is paramount. Phage therapy has previously shown promise in treating sinonasal S. aureus biofilms.Methods: This study investigates the long term (20 days) safety of topical sinonasal flushes with bacteriophage suspensions. The bacteriophage cocktail NOV012 against S. aureus selected for this work contains two highly characterized and different phages, P68 and K710. Host range was assessed against S. aureus strains isolated from CRS patients using agar spot tests. NOV012 was applied topically to the frontal sinus region of sheep, twice daily for 20 days. General sheep wellbeing, mucosal structural changes and inflammatory load were assessed to determine safety of NOV012 application.Results: NOV012 could lyse 52/61 (85%) of a panel of locally derived CRS clinical isolates. Application of NOV012 to the frontal sinuses of sheep for 20 days was found to be safe, with no observed inflammatory infiltration or tissue damage within the sinus mucosa.Conclusion: NOV012 cocktail appears safe to apply for extended periods to sheep sinuses and it could infect and lyse a wide range of S. aureus CRS clinical isolates. This indicates that phage therapy has strong potential as a treatment for chronic bacterial rhinosinusitis.

Human identification study by means of frontal sinus imaginological aspects

The objective of this study was to evaluate the applicability of human identification parameters, established by Tatlisumak et al. (2007), by means of cone-beam computed tomography and extraoral radiographs of the frontal sinus region. From a total of 58 dry skulls, 26 were selected. Posteroanterior, profile cephalometric radiographs and cone-beam computed tomography images were acquired, adopting a specific method for reproducibility purposes. The images were evaluated by two examiners, previously calibrated, in a darkened environment and at two distinct sessions, with a minimum of 15 days between them. The characteristics of the frontal sinus were analyzed using the Cohen's kappa test, for categorical variables, and Lin's concordance correlation coefficient (CCC) for continuous variables. Acceptable values of inter method variability for the categorical variables were found, while same cannot be told for continuous variables. The parameters evaluated for the frontal sinus on extraoral radiographs and cone-beam computed tomographs were mostly concordant, with the exception of three. Categorical and discrete variables showed an intra- and interexaminer concordance ranging from good to perfect, and the quantitative continuous variables showed concordance ranging from moderate to excellent. The parameters examined are applicable and reproducible using multiplanar reconstructions of cone-beam computed tomography and extraoral radiographs of the frontal sinus.

Characteristics of paranasal sinus osteoma and treatment outcomes

Conclusion: The incidence of paranasal sinus (PNS) osteoma was 6.4%. The most common site of PNS osteoma was the ethmoid sinus. All surgically treated patients underwent endoscopic surgery, and there was no recurrence in any patient. Technical improvements, including an image guidance system, extended the indications for endoscopic surgery for PNS osteomas, especially in the frontal sinus region. Objective: The purpose of this study was to investigate the incidence and location of PNS osteomas detected by computed tomography (CT) scan at our hospital, and to describe our experience in the surgical treatment of PNS osteomas. Methods: This study was performed on 1724 patients undergoing CT scans because of suspected sinus disease between 2004 and 2013. Endoscopic surgery was performed in 34 symptomatic patients. Medical records of the patients were reviewed, and clinical findings and treatment outcomes were investigated. Results: PNS osteomas were detected in 110 patients (6.4%). Triple osteomas were detected in two patients. Double osteomas were detected in seven patients. In total, 121 lesions were identified as PNS osteomas. The ethmoid sinus was the most commonly affected site (57.0%), followed by the frontal sinus (25.6%), frontal recess (9.1%), maxillary sinus (5.0%), olfactory fissure (1.7%), and sphenoid sinus (1.7%) in descending order of frequency. Thirty-three patients were surgically treated for PNS osteomas through a purely endoscopic approach, and one patient with a frontal sinus osteoma underwent combined endoscopic surgery and frontal trephination. Image-guided surgery was performed in nine patients with involvement of the orbit and skull base, including the frontal sinus/recess. There were no major surgical complications and there was no tumor recurrence.

前篩骨洞，前頭洞への内視鏡下鼻内手術

前篩骨洞，前頭洞への内視鏡下鼻内手術

Endoscopic Sinus Surgery for Anterior Ethmoid and Frontal Sinus Region – Concept and Basic Technique of Takahashi—Moriyama Method—

Endoscopic Sinus Surgery for Anterior Ethmoid and Frontal Sinus Region – Concept and Basic Technique of Takahashi—Moriyama Method—

Preoperative Planning Using 3D Reconstructions and Virtual Endoscopy for Location of the Frontal Sinus

Objective: Demonstrate the production of 3D reconstructions from CTs of patients and compare them to the surgery’s actual endoscopic images. Method: Prospective study. The CTs files of 10 patients were reconstructed with a specific program. The reconstructions were performed before the surgeries, and a virtual endoscopy was made. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images. Results: The 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images. Conclusion: With relatively simple tools and a personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies.

A von Hippel-Lindau Disease–Associated Microcystic Adenoma of the Ethmoid Sinus: Case Report

We present a unique case of an anterior cranial base von Hippel-Lindau disease (VHL)-associated microcystic neoplasm. To determine the lesion's relationship with VHL and its appropriate management, we discuss its salient clinical, pathological, and molecular features. A 36-year-old woman with VHL presented with a 3-month history of phantosmia. Serial magnetic resonance imaging studies revealed a lesion within the ethmoid and frontal sinus region that was first evident 18 months before symptom development and demonstrated progressive growth over the interval period. The lesion was resected via a transbasal approach. Histopathological and immunohistochemical analysis revealed a microcystic lesion composed of bland clear cells and underlying endothelial cells consistent with a VHL-associated microcystic neoplasm that are not known to metastasize. Molecular testing demonstrated loss of heterozygosity of the VHL locus, verifying the tumor as a VHL-related neoplasm. Because primary VHL-associated microcystic tumors in the anterior cranial base have not been described previously, the natural history of these tumors remains unclear. Based on the benign features of these lesions, they can be managed conservatively with close observation and surgical intervention reserved for those that produce symptoms.

Planejamento pré-operatório utilizando reconstruções 3D e endoscopia virtual para a localização do seio frontal

INTRODUCTION: Computed tomography (TC) generated tridimensional (3D) reconstructions allow the observation of cavities and anatomic structures of our body with detail. In our specialty there have been attempts to carry out virtual endoscopies and laryngoscopies. However, such application has been practically abandoned due to its complexity and need for computers with high power of graphic processing. OBJECTIVE: To demonstrate the production of 3D reconstructions from CTs of patients in personal computers, with a free specific program and compare them to the surgery actual endoscopic images. METHOD: Prospective study in which the CTs proper files of 10 patients were reconstructed with the program Intage Realia, version 2009, 0, 0, 702 (KGT Inc., Japan). The reconstructions were carried out before the surgeries and a virtual endoscopy was made to assess the recess and frontal sinus region. After this study, the surgery was digitally performed and stored. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images. RESULTS: The 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images. CONCLUSION: With relatively simple tools and personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies. The preoperative knowledge of the frontal sinus natural draining path location may generate benefits during the performance of surgeries. However, more studies must be developed for the evaluation of the real roles of such 3D reconstructions and virtual endoscopies.

Study of the cells of frontal recess region with multi-detector CT multiplanar reconstruction and clinicaI significance

Objective To observe the cells of frontal recess region with multi-detector CT muhiplanar reconstruction(MPR).Methods One hundred patients without the disease of frontal sinus and frontal recess region underwent axial multi-detector CT scan with axial,coronal and sagittal multiplanar reconstruction.Results In 100 cases(200 sides),the agger nasi cell is present in 186 sides(93.0%),the frontal cells were identified in 88 sides(44.0%),the prevalence of type Ⅰ,type Ⅱ,type Ⅲ and type Ⅳ cells were 51 sides(58.0%),23 sides(26.1%),14 sides(15.9%)and 0 sides,respectively. The suprabullar cells,the frontal bullar cells and the supraorbital ethmoid cells were identified in 130 sides (65.0%),23 sides(11.5%)and 11 sides(5.5%),respectively.The interfrontal septal cells were identified in 36 sides(18.0%).There was no significant difference between males and females,as well as between left and right side(P＞0.05).Conclusion With MPR imaging,doctors could better understand the frontal recess region,which is helpful to the endoscopic frontal sinus surgery. Key words: Frontal sinus; Tomography; X-ray computed

Sinonasal poorly differentiated carcinoma presenting clinically as esthesioneuroblastoma

5605 Background: Sinonasal undifferentiated carcinoma presenting clinically as esthesioneuroblastoma is a rare finding. Method: A 54 year old white male presented with progressive double vision, left nasal congestion, proptosis of left eye and intermittent pain in left eye and frontal sinus region of 7–8 months duration. Examination revealed a large deforming mass involving the left proximal nasal cavity extending into the mid forehead protruding through the frontal bone. Intranasal cavity revealed edematous mucosa with soft tissue mass filling mid aspect of nasal cavity on the left. Neurological examination was non focal. CT scan revealed a large destructive mass involving the left nasal cavity and ethmoid sinus extending into the left orbit with displacement of the globe and destruction of the anterior cranial fossa including the frontal bone. MRI revealed a large sinonasal tumor (5.2x7x7.5cm) extending through the cribriform plate, anteromedial floor of the middle cranial fossa and through the inner and outer table of the frontal bones, more to the left than to the right of midline. A mass effect on the brain was noted but primarily appeared to be displacing rather than invading the brain. Result: Biopsy revealed poorly differentiated carcinoma. IHC stains showed cytokeratin positivity and were negative for CD99, NSE and synaptophysin. He is currently being treated with combined radiation therapy and chemotherapy (carboplatin/paclitaxel). Conclusion: Here we describe a patient who initially presented with signs and symptoms clinically and radiologically highly suspicious for esthesioneuroblastoma(ONB) but found to have carcinoma as per histology, which is a rare presentation. ONB is a rare tumor located in the roof of the nasal cavity and paranasal sinuses. Immunohistochemically, it typically exhibit positive staining for NSE, synaptophysin and chromogranin. These are negative for a variety of other markers, including CD99. Sinonasal undifferentiated carcinoma(SUC) cells are reactive for cytokeratin (90%) and EMA (65%). SUC behaves aggressively. Most patients have locally extensive disease and often, distant metastases at diagnosis. Multimodality approaches (eg, sequential chemotherapy, radiation therapy and craniofacial resection) can cure some patients with localized disease. No significant financial relationships to disclose.

Massive tumour arising from the hard palate after excision of a pleomorphic adenoma

A 60-year-old Japanese woman presented to the Department of Oral and Maxillofacial Surgery at Dokkyo University Hospital in 1982 with episodes of bleeding in the mouth. Clinical examination showed a 20 × 12 × 10 mm tumour in the right hard palate and no regional lymphadenopathy. It was excised under general anaesthesia and shown to be a pleomorphic adenoma. Follow-up was continued for six months but the patient was lost to follow-up until April 1994 when she presented to our hospital with a remarkable swelling of the face and repeated bleeding in the mouth. She was poorly nourished, her weight was 31 kg, and she could not walk by herself. She had a huge swelling of the right face roughly 170 × 200 × 140 mm in size, producing a severe form of hemifacial macrosomia with protrusion of the right buccal region and deviation of the nasal and lip regions to the left (Fig. 1). Conventional radiographs showed extensive resorption of the right maxillary bone and radio-opacities which indicated that the tumour was partially calcified. Magnetic resonance imaging (MRI) showed a tumour arising from the maxilla, almost entirely occupying the alveolar process and compressing the right maxillary sinus and the anterior aspect of the nasal cavity. The orbital floor seemed to be free of the lesion. The margins were relatively smooth and well-defined (Fig. 2). Incisional biopsy confirmed the diagnosis of carcinoma ex pleomorphic adenoma. In 1994 under general anaesthesia, through Webers and intraoral incisions, a flap was raised and the lesion was exposed. The mass extended to both maxillary bones, right maxillary sinus, right ethmoid sinus, right nasal fossa, right orbital floor, and right intratemporal fossa. There was no invasion in the right frontal sinus or cerebral region. The mass was almost surrounded by a capsule and was easily separated from the surrounding tissue. The tumour was completely Fig. 1 Photographs of the tumour: frontal view (left top), inferior view (right top), right lateral view (left bottom), and left lateral view (right bottom).

The perimeter marking technique for rigid fixation of frontal sinus fractures: Procedure and report of cases

Purpose : Fractures of the frontal sinus region frequently need operative intervention in the form of reconstruction and obliteration. This requires removing the anterior table of the frontal sinus to gain access to the floor as well as the entire lateral extent of the sinus. Prior techniques to obtain this access have involved fabrication of preoperative radiographic templates. This article describes a technique of perimeter marking for delineating the precise location of the frontal sinus perimeter without the use of a radiographic template. Methods: A 7-cm bayonet forceps is used for the perimeter marking. One prong is placed inside the sinus to the maximum peripheral extent and the corresponding prong then reflects its position on the external surface of the outer table. A no. 701 bur in a high-speed drill marks the perimeter adjacent to the bayonet forceps. After sinus marking is complete, the osteotomy is accomplished using either a drill or oscillating saw. Results: Because the exact perimeter of the proposed osteoplastic flap is known prior to the osteotomy, bone plates can be preinserted, removed, and then replaced at the end of the procedure to anatomically reconstruct the frontal contour. Additionally, it is possible to remove a large region of the anterior table during the osteoplasty in one segment. Conclusion: This technique creates an unobstructed view of the lateral recesses of the frontal sinus and makes esthetic reconstruction of the frontal bar region possible.

Evaluation in cats of a new material for cranioplasty: a composite of plaster of Paris and hydroxylapatite.

The materials ordinarily used to reconstruct bone defects in the calvaria and facial bones either are difficult to shape, are partially resorbed by the body, or are likely to become infected if used near a contaminated area such as the frontal sinus. Calcium sulfate hemihydrate (plaster of Paris) has been known for years to have excellent reparative qualities in bone defects, but ordinarily it is quickly resorbed. Consequently, a new material, a composite of a dense form of plaster of Paris and hydroxylapatite, was devised to provide nonabsorbable hydroxylapatite particles for bone to form around and within during the phase of plaster absorption. Two types of this material were evaluated in cranial defects in cats. Each of the plaster of Paris/hydroxylapatite mixtures was placed into a surgically unroofed frontal sinus and into a contralateral parietal trephine hole in a group of 32 cats. Two cats in each group succumbed to anesthesia, leaving two sets of 30 cats. During the entire follow-up period there was only one other death, with no evidence of wound infection, wound dehiscence, implant rejection, or cerebral dysfunction among the survivors. The cats in each group were sacrificed at 1, 2, 3, 5, 7, 8, 9, 10, or 12 months after operation. Following sacrifice, both the frontal and parietal defects were exposed and examined visually, histologically, and with histomorphometric analysis for new bone formation. New bone formation was present as early as 1 month after operation and continued to increase during the 12 months of the study. Based upon these osteogenic qualities, the ease of shaping the composite, and the lack of infection in the frontal sinus region, it is concluded that this substance could be a valuable new material for human cranioplasty.