Frontal Sinuses Research Articles

Computed Tomography Evaluation of Frontal Sinus Volume in Migraine Patients.

This study aimed to assess the frontal sinus volume (FSV) on computed tomography (CT) scans in migraine patients. Cranial and paranasal CT images from 75 migraine patients (mean age: 39.14±13.63y) and 23 control cases (mean age: 38.78±13.32y) were analyzed retrospectively. Three-dimensionally reconstructed images of frontal sinuses were generated. Total FSV, anterolateral, and transverse diameters of the head were measured. The presence/absence and nature of supraorbital foramen and notches were evaluated. The total FSV was 8.02±5.97cm 3 in the migraine group and 8.38±4.83cm 3 in the control group, with no significant differences between them. Mean FSV values showed no statistically significant difference between females (7.79±5.85cm 3 ) and males (9.12±6.66cm 3 ) within and between the groups. Single notch was the most observed structure in both groups, with bilateral presence being the most common. Double foramen and notch were observed only in the migraine group, and the coexistence of both structures was higher in the migraine patients than in controls. There was no statistical difference in FSV between migraine and control groups, nor based on sex. Overall, the frontal region anatomy, particularly the exit locations of the supraorbital or supratrochlear foramen/notches, may be influenced by hyperplasia/hypoplasia of FSV. Therefore, assessing FSV using CT may be crucial for surgical planning in migraine patients undergoing open or endoscopic approaches to the frontal region.

Validation of Gender Identification From Frontal Sinuses Using Yoshino's Classification: A Morphometric Radiographic Study

Validation of Gender Identification From Frontal Sinuses Using Yoshino's Classification: A Morphometric Radiographic Study

Computed Tomographic Study of Frontal Sinus Cells and Opacification as Per the International Frontal Sinus Anatomy Classification.

International frontal sinus anatomy classification (IFAC) was introduced in 2016 to standardize the nomenclature of the cells in the frontal recess region, facilitate better communication between surgeons and precision in surgical planning, and improve surgical teaching. This study aims to estimate the radiological prevalence of the different frontal recess cells according to the IFAC and to evaluate the relationship of these cells with the frontal sinus opacification in patients with chronic rhinosinusitis. In this study, 90 participants diagnosed with chronic rhinosinusitis (CRS) who underwent computed tomogram (CT) of the para nasal sinuses were enrolled consecutively. The CT images were were studied in detail using RadiAnt DICOM viewer. The frontal recess cells were grouped as per the IFAC guidelines and their respective prevalence was calculated. The frontal recess cells were grouped as per the Opacification or mucosal thickening within these cells and the frontal sinuses were noted. A multivariate logistic regression analysis was done to evaluate the association between frontal sinus opacification and presence of various IFAC cells. A total of 640 IFAC cells were documented in 180 sides, of which 326 were anterior cells, 263 were posterior cells and 51 were medial cells. The most prevalent cell was the agger nasi cells(ANC), present in 91.7% of 180 sides, the supra agger nasi cells(SANC), Supra agger nasi frontal cells(SAFC), supra bulla cells(SBC), supra bulla frontal cells(SBFC), supra orbital ethmoidal cells(SOEC) and frontal septal cells(FSC) were present in 47.8%,37.8%, 65.6%,28.9%, 51.1% and 28.3% respectively. There was no significant association of presence of IFAC cells and frontal sinus opacification except for SBFC(p = 0.038). A significantly higher number of diseased frontal recess cells were seen with involved frontal sinuses when compared with non-involved frontal sinuses across all types of IFAC cells. The ANC were the most prevalent among all the IFAC cells and the FSC were the least prevalent. There was no significant association with the presence of different types of IFAC cells and frontal sinus opacification except for SBFC. However, there was a significantly higher number of diseased IFAC cells associated with frontal sinus opacification than in those without frontal sinus opacification.

A radiological study on anatomical variations of frontal sinus and its’ drainage pathway in a Nepalese adult population

Background: This study aims to assess anatomical variations in the frontal sinus and its drainage pathway within the Nepalese population. Methodology: This cross-sectional analytical study was conducted at the Department of ENT-HNS and Radiology, Maharajgunj Medical Campus in Nepal. Digital Imaging and Communications in Medicine (DICOM) computed tomography files of patients were analyzed over a year to assess pneumatization variations, frontal sinus size, presence of intersinus septa, olfactory fossa depth, frontal recess cells, and anterior ethmoidal artery position. Imaging files with obscuring disease processes or obtained in different positions, hindering frontal sinus or recess visibility, were excluded. Data analysis employed SPSS version 25, using descriptive statistics (median, range, interquartile range), Chi-squared tests, and Cramer’s V. Results: Among total sinuses analyzed, 7% exhibited unpneumatized frontal sinuses (3.3% bilaterally, 6.7% unilaterally). Median dimensions for right and left frontal sinuses were 10.2 x 11.15 x 11.7 mm and 10.2 x 11.1 x 11.6 mm, respectively. Predominant fin- dings included mixed upper uncinate process attachments, Type II olfactory fossa, agger nasi as the commonest anteriorly based cells, and supra bulla cells as the prevalent posteriorly based cells. Conclusion: Investigation of frontal sinus anatomy in the Nepalese population revealed distinct features. While generally well- developed, these sinuses exhibited relatively smaller dimensions compared to other ethnic groups. Consistent with prior studies, agger nasi and supra bulla cells were the most prevalent anteriorly and posteriorly based cells, respectively.

Dyke–Davidoff–Masson Syndrome – A Case Series

Abstract Dyke–Davidoff–Masson syndrome (DDMS) refers to variable degrees of atrophy of one cerebral hemisphere, resulting from brain injury in intrauterine or early years of life. Clinical features of this rare syndrome include varying degrees of contralateral hemiplegia, facial asymmetry, seizures, and mental retardation. Specific neuroimaging findings include unilateral brain volume loss, ventriculomegaly, and compensatory bone hypertrophy. In addition to this, calvarial thickening and hyperpneumatization of frontal sinuses may occur. We hereby report three cases of this syndrome, with varied clinical and radiographic features, to highlight the wide spectrum of this syndrome.

CHRONIC RHINITS WITH BRONCHITIS IN DOMESTIC CAT

Chronic rhinitis in cats is a syndrome associated with inflammation of the nasal cavity; it is often associated with secondary infection of the frontal sinuses, and usually lasts more than 1 month. This case study aims to determine the conclusion of several supporting examinations performed to diagnose chronic rhinitis in cats and its treatment. Examination was made on a 3-year-old female local cat with a body weight of 2.65 kg with a history of nasal discharge since approximately 2 years ago, sneezing, and occasionally followed by coughing with harsh-sounding breath. Physical examination showed a rough sound or stridor when the cat breathed, mucopurulent discharge in both nostrils, sneezing with high frequency and occasionally followed by coughing. Cytologic examination of nasal swab revealed rod-shaped bacteria, degenerate and non-degenerate infiltration of neutrophils, lymphocytes, monocytes and plasma cells. Mild interstitial pattern in the lung, and increased opacity or ring-like opacities ("donuts") at some bronchial ends were observed on radiographic examination. Bacterial growth and identification tests were positive for Proteus sp. bacteria. The cat was diagnosed with chronic rhinitis with bronchitis and treated with Cefixime antibiotic (12 mg/kg BW; q12 h; PO), anti-inflammatory corticosteroid Methylprednisolone (2 mg/kg BW; q24 h; PO) with tappering off dose, mucolytic decongestant Bromhexin HCL (1 mg/kg BW; q24 hours; PO), and immunomodulator Caviplex (2 ml; q24 hours; PO). Treatment for 14 days showed an improvement in the cat's condition where nasal discharge that was previously mucopurulent became serous and at certain times no discharge was found, the frequency of sneezing and coughing decreased, and the cat could eat and drink comfortably. The decision to select an antibacterial agent to treat rhinitis should be made based on the results of pharyngeal and nasal discharge swab cultures.

Sex estimation of frontal sinus volume from computed tomography scans in a Western Australian adult population.

With the increasing use of radiological three-dimensional imaging, different metric and morphological aspects of the frontal sinuses (FS) have been examined relative to their potential to aid human identification, including sex estimation. The aim of this study is to assess the validity of the metric analysis of the FS volume for estimating sex in a Western Australian (WA) adult population, following the Michel et al. (2015) method. The right, left and total frontal sinus volume (TFSV) from 99 computed tomography scans (47 males and 52 females) of WA individuals aged 18-40 years were three-dimensionally reconstructed using OsiriX® and their volumes acquired in mm3. Sexual dimorphism in the TFSV was tested, and the accuracy of the Michel et al. (2015) formulae was calculated. Population-specific regression equations were also produced. There was a significant difference between the mean TFSV in males and females. The classification accuracy derived from the Michel et al. (2015) formulae was 59.6%. The WA-specific logistic regression analysis yielded an accuracy of 57.2%. The low accuracy rates preclude the use of the sex estimation method in the WA population, but the volume analysis confirmed the individual variability of the frontal sinuses, which may be useful for personal identification.

The effect of nasal septal deviation on the volumes of the paranasal sinuses

Objectives: This study aims to determine the effect of nasal septal deviation (NSD) on the volumes of the paranasal sinuses, also considering the sex of the patients. Patients and Methods: One hundred and eighty-four patients (95 females, 89 males; mean age: 32.4±12 years; range, 17 to 69 years) with NSD were included in the retrospective study between January 2018 and March 2020. Patients were grouped according to the radiologically measured NSD angle: Group 1, <90° (mild deviation); Group 2, 90-150° (moderate deviation); Group 3, >150° (severe deviation). The volumes of the frontal, maxillary, and sphenoid sinuses on the deviated and opposite sides were calculated and compared. Results: There was no statistically significant difference between the deviated- and opposite-side volumes of the frontal, maxillary, and sphenoid sinuses of the female patients in all three groups and male patients in Groups 1 and 3 (p>0.05). Maxillary sinus volume on the deviated side was smaller than the opposite side in male patients in Group 2 (p=0.028). The frontal sinus volume on the deviated side and maxillary sinus volume on the opposite side of the male patients in Group 2 were higher than Groups 1 and 3 (p=0.046, p=0.017). Conclusion: Nasal septal deviation does not affect the volumes of the paranasal sinuses in females. Moderate NSD in males may affect the volumes of frontal and maxillary sinuses.

GADNN: a revolutionary hybrid deep learning neural network for age and sex determination utilizing cone beam computed tomography images of maxillary and frontal sinuses

IntroductionThe determination of identity factors such as age and sex has gained significance in both criminal and civil cases. Paranasal sinuses like frontal and maxillary sinuses, are resistant to trauma and can aid profiling. We developed a deep learning (DL) model optimized by an evolutionary algorithm (genetic algorithm/GA) to determine sex and age using paranasal sinus parameters based on cone-beam computed tomography (CBCT).MethodsTwo hundred and forty CBCT images (including 129 females and 111 males, aged 18–52) were included in this study. CBCT images were captured using the Newtom3G device with specific exposure parameters. These images were then analyzed in ITK-SNAP 3.6.0 beta software to extract four paranasal sinus parameters: height, width, length, and volume for both the frontal and maxillary sinuses. A hybrid model, Genetic Algorithm-Deep Neural Network (GADNN), was proposed for feature selection and classification. Traditional statistical methods and machine learning models, including logistic regression (LR), random forest (RF), multilayer perceptron neural network (MLP), and deep learning (DL) were evaluated for their performance. The synthetic minority oversampling technique was used to deal with the unbalanced data.ResultsGADNN showed superior accuracy in both sex determination (accuracy of 86%) and age determination (accuracy of 68%), outperforming other models. Also, DL and RF were the second and third superior methods in sex determination (accuracy of 78% and 71% respectively) and age determination (accuracy of 92% and 57%).ConclusionsThe study introduces a novel approach combining DL and GA to enhance sex determination and age determination accuracy. The potential of DL in forensic dentistry is highlighted, demonstrating its efficiency in improving accuracy for sex determination and age determination. The study contributes to the burgeoning field of DL in dentistry and forensic sciences.

Endoscopic surgical management of the fronto-ethmoido-orbital mucopyocele: a case report and literature review

Abstract Frontal sinus mucocele are benign, pseudocystic lesions that derive from the destruction of the sinus ostium, resulting in a continuous accumulation of mucus. The process of mucocele growth leads to a progressive enlargement of the sinus cavity, thickening and erosion of its bone walls until the invasion of surrounding tissues. Mucoceles are more common in the frontal sinuses, while involvement in the sphenoid, ethmoid and maxillary sinus is rare. The frontal sinus floor is divided by the upper orbital wall; thus, an early displacement of the orbit occurs in the growth of the frontal mucocele. This paper presents one of our experiences in endoscopic surgical management of frontal sinus mucopyocele with secondary orbital complications.

Analysis of anatomical variations in the frontal and maxillary sinuses and their relevance in dentistry

Introduction: Paranasal sinuses can be defined as air-filled cavities lined with mucosa. Although there is a limited number of previous studies that have addressed the relationship between anatomical variations in these sinuses and dentistry, it is essential to emphasize the significance of morphofunctional knowledge of the maxillary sinus (MS) and frontal sinus (FS) for various dental specialties. Objectives: To investigate and analyze anatomical variations in selected paranasal sinuses (MS and FS) from the embryonic period to advanced age, and to correlate them with their diverse applications in dental practice. Methods: Electronic databases PubMed, Lilacs (via Bvsalud), and Scielo were consulted using the descriptors: "anatomical variation," "maxillary sinus," "frontal sinus," "dentistry," and their English counterparts. Initially, a total of 334 published articles were found, and after reading the abstracts and applying inclusion and exclusion criteria, 19 articles were analyzed. Results: The main morphological variations found included changes in dimension, number, characteristics of septations, and physiological pneumatization, which vary with age, sex, and facial sides. Among the dental implications, notable aspects include associated pathologies, techniques for maxillary sinus elevation in implantology, craniofacial profile relationships, connections with orthodontics and forensic dentistry, imaging techniques, and general surgical treatments. Conclusion: The literature reviewed suggests that the morphology of the sinuses analyzed directly influences dental practice, contributing to the improvement of clinical, forensic, surgical, and other procedures. However, studies involving the subject matter are still scarce, thus requiring further investigations.

Evaluation of Dimensional Changes in Maxillary and Frontal Sinus in Adult Patients With Anterior Open Bite and Normal Overbite: A Retrospective Cone Beam Computed Tomography (CBCT) Study.

An anterior open bite is a form of vertical discrepancy that presents as a lack of contact between maxillary and mandibular segments. The treatment modalities usually involve either intrusion of posterior teeth or extrusion of anterior or a combination of both. The anatomical relationship between the apex of the maxillary molar roots to the inferior wall of the maxillary sinus floor is crucial in planning posterior intrusion. The paranasal sinuses influence the growth of the facial structures that eventually get altered in various malocclusions. Studies have proven that theheight of the sinusgets modified in anterior open bite owing to pneumatization. This study aims to evaluate the distance from the root apex of maxillary first molars (mesiobuccal, distobuccal, and palatal roots) to the maxillary sinus floor to evaluate the significance of the vertical pneumatization of the sinus on planning for true intrusion in anterior open bite and to assess the correlation between frontal and maxillary sinuses in an anterior open bite. This retrospective study evaluated 30 pre-treatment cone beam computed tomographies (CBCTs) of patients out of which 15 were with anterior open bite and 15 with ideal overbite. Linear measurements were carried out using care stream software in CBCTs. There was a significant correlation between the distance of the palatal root and the distobuccal root of the maxillary first molar to the maxillary sinus floor bilaterally in the anterior open bite (p<0.04). A significant moderate positive correlation of the maxillary and frontal sinus height in anterior open bite (p<0.006). A significant moderate negative correlation between the distance from the palatal root to the maxillary sinus floor and maxillary sinus height in anterior open bite (p<0.001). Vertical pneumatisation of the maxillary sinus has caused a significant negative correlation between the apex of the palatal root of the maxillary first molar tooth and the maxillary sinus floor in the anterior open bite. The palatal root being the closest to the sinus floor, and the distobuccal root being second nearest. There is a significant correlation between the height of the sinuses in the anterior open bite.

The Variants of Frontal Recess and Its Effect in the Development and Prevalence of Frontal Sinusitis in Patients in a Tertiary Care Hospital: A Retrospective Observational Study.

According to medical literature, the frontal recess' intricate physical structure resembles an inverted funnel. The anatomical structure is not distant from the frontal ostium. Surgery requires a good understanding of the frontal recess architecture because of the intricate anatomy of this relatively small area. The pathophysiological characteristics of frontal sinusitis and the process of sinus ventilation through the sinus ostium have been linked, according to medical literature. Medical studies show that one of the most important factors affecting the amount of drainage in the frontal sinuses is the size of the frontal sinus ostium. Inflammation brought on by frontal recess cells can frequently affect the airflow in the frontal sinuses. The drainage channel of the frontal sinus is stated as narrowing in the current investigation as an observed phenomenon. The aim of this study was to examine the frontal recess changes and how they might affect the emergence of frontal sinusitis. The classification of frontal recesses according to their various categories was the study's principal finding. The investigation of the causal elements that resulted in the development of frontal sinusitis was the study's secondary goal. In a hospital setting, a cohort of 200 patients with sinonasal disorders underwent a retrospective observational research. Over the course of a year, from July 2021 to June 2022, the study participants had evaluations at a tertiary care center. 200 CT PNS images of individuals who fit certain inclusion and exclusion criteria were examined in this study. Using the chi-square test, the study looked into the relationships between several risk factors, including age, gender, and the type of frontal recess. The presence of frontal sinusitis served as the main outcome indicator. This study included a total of 200 participants with a mean age was 43.38years (± 10.69). There was 146 (73%) male and 54 (27%) female were in the study. Type I frontal recess in 50 (25%), type II in 82 (41%), type III in 24 (12%) and type IV in 18 (9%) patients. The association of age (P = 0.141) and gender (P = 0.345) with frontal sinusitis was not significant. The statistical association between type of frontal recess and frontal sinusitis was statistically not significant. The association between age and the type of frontal recess was found to be statistically significant by Fischer's exact test with P value of 0.012 (< 0.05), whereas gender was not associated with the type of frontal recess by the same test. It is difficult to overstate the significance of the terms frontal recess, frontal sinusitis, and sinus ostium in this particular medical context. This article was a retrospective observational study that investigates the connection between frontal sinusitis and changes in the frontal recess in patients receiving care at tertiary medical facilities.

A cross-sectional study: correlation of forehead morphology and dentoskeletal malocclusion in Chinese people

BackgroundThe lateral profile is an important indicator of facial attractiveness. This study explored the general characteristics of the forehead profile and protrusion, and their relationship with related factors in structure and development.MethodsFour hundred fourteen Chinese participants in the Yangtze River Delta region were involved. Including 206 males (17.15 ± 7.68 years old) and 208 females (18.35 ± 8.06 years old); 94 children (8.54 ± 2.21 years old, ranging from 4 to 12 years old), 166 adolescents (14.83 ± 1.50 years old, ranging from 13 to 17 years old), and 154 adults (25.52 ± 4.89, 18 years or older). The frontal section of the forehead was used to explore its shape. The straight distance between the vertical line of the FH plane through the nasal root point and its parallel line, which is tangential to the forehead, indicates the forehead prominence. Frontal sinus width was measured using the method described by Mahmood.ResultsThe general shape of the forehead was straight and slightly bulged near the eyebrow arch in males but rounder in females. The average forehead protrusion in males was higher than that in females in adults. Significant differences in forehead protrusion between the dentoskeletal classifications and growth phases were notable. Frontal protrusion significantly correlated with frontal sinus depth, especially in males, adults, Class I, and those whose convex points were located in the lower section of the forehead.ConclusionsAge, race, and sex affect the forehead protrusion and frontal sinus width. Forehead protrusion may be an indicator of dentoskeletal deformities in the early stage. And dentoskeletal deformities may impair the correlation between the frontal sinuses and forehead protrusion during development.Trial registrationThis retrospective, cross-sectional study was reviewed and approved by the Research Ethical Committee (T2020008), and registered at ClinicalTrial.gov with an identified number (ChiCTR2100041913).

Quantitative analysis of the skull in the Japanese wolf (Canis lupus hodophilax) using CT.

In this study using computed tomography (CT), the volumes of the internal cranial cavities, such as the braincase, frontal sinus and tympanic cavity, and the ratio of the volume of each cavity to the skull volume in Japanese wolves were quantified, and CT images of the frontal sinus were observed. The results were then compared with those of other wolf subspecies, including Akita, a dog breed, to clarify the characteristics of the internal cranial cavities in Japanese wolves. The present study revealed that the Japanese wolf had a relatively larger braincase volume and a relatively smaller frontal sinus volume than the wolf ssp. (a group of wild wolf subspecies except the Japanese wolf) and Akita. Moreover, the relative and absolute tympanic cavity volumes of the Japanese wolf and Akita were significantly smaller than those of the wolf ssp. In the CT image or macroscopic observations, the frontal sinuses of the wolf ssp. and Akita were relatively well developed to the caudal and dorsal directions, respectively, compared with that of the Japanese wolf, and the tympanic cavity of the wolf ssp. was more largely swelled ventrally and medially than that of other groups.

Endoscopic-Assisted Excision of an Extensive Inverted Papilloma (Krouse Stage IV) through Lateral Rhinotomy Approach: A Case Report

Inverted papilloma is a benign epithelial growth arising from the Schneiderian mucosa with a tendency to grow into the underlying stroma. The etiology remains obscure but its tendency for an association with malignancy makes it an important entity important for the surgeon. We present a case report of an extensive inverted papilloma (Krouse stage IV). The tumour involved entire right side nasal cavity extending to the vestibule, extended to the orbit and also intracranially (though extradural) through the frontal and ethmoid sinuses. This extensive tumour was removed by a combined (lateral rhinotomy plus endoscopic) approach and obviated the need for external approach to frontal sinus as well as extended lateral rhinotomy. Thus, even for extensive tumours using the endoscope as an adjunct aids in complete tumour removal and prevents additional morbidity to the patient.

Not Every Anosmia is COVID, a Case of Nasal Mass

Smell and test problems especially anosmia is a frequent symptom for COVID infection. Anosmia was experienced by almost 53% of those affected, in some cases persisting for longer periods after resolution of respiratory symptoms. Nasal blockage is another common symptom for emergency department patients and frequently associated with allergic rhinitis. A 25-year-old male patient presented with persistent bilateral nasal blockage, blood-stained nasal discharge, anosmia, and headache since last 1 year. During the peak of the pandemic, he was diagnosed with COVID. He was complaining of anosmia and nasal blockage and was treated with antihistaminic medicine for allergic rhinitis, but his symptoms persisted. He had breathing, bleeding and smelling problems in the last 2 years and started complaining of left sided proptosis for 3-4 weeks before being admitted to our department and had computerized tomography (CT) imaging at another facility. He was referred by an ophthalmologist to our hospital for advanced imaging with magnetic resonance (MRI) with contrast. He was investigated for exophthalmos in his left eye. He denied any other prior disease or medication. On examination he has nasal voice, left side exophthalmos, no diplopia or vision problem. The right tympanic membrane (TM) was intact, left sided dull TM with effusion. Other system evaluations were unremarkable. The patient was referred to Ear Nose and Throat consultant for further examination. Nasal endoscopy revealed fungating mass with covered blood clots and engorged vessels filling both the nasal cavities. MRI report described soft tissue mass, infiltrating the nasal cavity, paranasal sinuses and clivus with intracranial extension, to involve the left sub frontal region. Also noted associated destruction of the left lamina papyracea, showing orbital extension, compressing the orbital muscle cone, and compressing the medial rectus, with consequent left sided unilateral proptosis. In addition, there was nasopharyngeal extension. The epicenter of the mass was likely to be the ethmoid sinuses. His MRI revealed complete obstruction of the osteomeatal complexes, complete obliteration of the maxillary, ethmoids and frontal sinuses, due to retention of secretions and mass infiltration. Biopsy was taken and patient was followed up for surgical intervention. The differential diagnosis included vascular tumor, meningothelial tumor, undifferentiated carcinoma, and neuroendocrine carcinoma. Smell and taste disorders emerge during COVID infection, seem to be more common than other upper respiratory tract infections. Allergic rhinitis is also common amongst emergency department patients and frequently associated with nasal blockage. Rhinitis can be differentiated from sinus problems by the increased response of nasal obstruction to treatment, clear nasal discharge, and absence of pain or fever. Rhinitis does not lead to ostial obstruction, and patients do not complain of facial pain or headache. For suspected rhinitis or acute sinusitis, routine radiographic examination is not recommended and should be limited to the diagnosis of chronic or recurrent admissions, cases of questionable diagnoses, patients with unresponsive disease, or investigation of complications. Axial and coronal CT is the imaging modality of choice. In this case the patient was investigated for sinusitis complications and additional further imaging was necessary like MRI with contrast for proper diagnosis and management of the patient. Nasal blockage and upper respiratory system findings may be overseen by the patients or even the healthcare workers. Especially repeated admissions and persistence of these symptoms should be suspicious for the emergency physicians. Additional imaging and thorough examination are crucial for differential diagnosis and proper management of these patients. Emergency physicians should be careful on their diagnoses for common symptoms like nasal blockage especially for the patient

Evolution of understanding.

From the time of Hippocrates to the early 19th century, knowledge advanced but that was an uneven process. Anatomy was basically defined by Galen and remained cast in stone until the early 16th century. Neuroanatomy was described by Galen but had little practical value, as brain surgery was not possible. The anatomy of the cranium was known and was largely correct. Care was taken to avoid the frontal air sinuses and the venous sinuses and the temporal region. The role of the brain in consciousness was not understood. It was considered the seat of the soul but there was a lack of understanding that damage to it could induce clinical symptoms such as stupor or paralysis. These were variously attributed to injuries to the meninges or the bone. This error was finally corrected in the 18th century when the brain was identified as responsible for much of the clinical disturbance following cranial trauma. All awareness that post traumatic neurological deficit was contralateral was ignored until the late 18th century, although several authors noted it. Likewise, the presence of CSF had to wait until the 18th century until it was recognized. Fissures were treated with trepanation, because of a perceived risk of infection developing between the bone and the dura. Depressed fracture fragments were elevated, replaced, or removed according to the details of the injury. Finally, for centuries surgeons blocked patients ears to reduce the sound of drilling, despite the fact that such a blocking would amplify the noise.

The prevalence of frontal sinus agenesis (aplasia) among Kurdish populations of Erbil city.

Background and objective: The frontal bone contains a pair of air-filled hollow cavities called frontal sinuses, the size, shape and anatomic measurements and dimensions of the frontal sinuses are determined by the degree of its pneumatization. Any disturbance to the sinus during its early development stages could results whether in hypoplasia (underdevelopment) or aplasia (total lack) of the sinus either unilaterally or bilaterally. This study aims to investigate the prevalence of aplasia of the frontal sinus among Kurdish populations of Erbil city, in addition to assessment of the type of aplasia and gender impact on the condition if there is any. Methods: This retrospective/radiological study was conducted on randomly selected PA (Caldwell view or occipito-frontal) plain radiographic images of 512 Kurdish individuals of mixed genders, ages ranging between 18 to 64 years and images were taken from the periods between April 2020 to May 2022. Results: Careful examination of 512 assessed PA radiographs (with patient’s ages ranging between 18 to 65 years) showed agenesis of the frontal sinus in 26 cases (5.16 %), 17 females and 9 male cases), the type and location of the agenesis varied greatly as it was bilateral agenesis type only in 7 cases, and unilateral in remaining 19 cases, among the unilateral sinus agenesis cases 2 were observed to be agenesis of the left and 17 of the right frontal sinuses respectively. Keywords: Prevalence, Frontal bone, Frontal sinus, Aplasia, Kurdish peoples, Anatomical variations

Frontal Sinus Mucopyocele Presenting as Purulent Discharge in the Frontal Region Following a Neglected Frontal Fracture: A Case Report and Literature Review

Mucoceles are progressive growths of encapsulated mucus capable of eroding and destroying adjacent bone structures and compressing neighboring organs. They are caused by the presence of mucous cells from the sinus membrane in an undrained space. These mucoceles can become infected, leading to the formation of a mucopyocele. They may manifest many years after the initial trauma to the facial bones, especially those involving the frontal sinuses. The discovery is either fortuitous or secondary to imaging: Computed tomography (CT), magnetic resonance imaging, carried out during an etiological assessment of symptoms such as frontal pain, proptosis, diplopia, nasal obstruction, rhinorrhea. Rarely, purulent discharge through a frontal cutaneous fistula may be the initial sign of a frontal sinus mucocele or mucopyocele. We report a case of mucopyocele of the frontal sinus presenting in the form of purulent discharge at the frontal level following a neglected frontal fracture and present our therapeutic approach.