Frontal Sinusitis Research Articles

Oestrus ovis sinusitis in a dog

AbstractA 2‐year‐old, female Cane Corso was presented for chronic epistaxis, reverse sneezing and purulent nasal discharge. Clinical examination was unremarkable. Bloodwork revealed a mild anaemia. Computed tomography of the nasal cavity was consistent with right frontal sinusitis with suspected foreign bodies. Surgical approach of the right sinus by frontal osteotomy allowed to perform an endoscopically guided extraction of a 15‐mm white ringed worm and multiple black worm‐like structures. The evaluation by an EVPC diplomate confirmed an Oestrus ovis infestation. After endoscopic lavage of the frontal sinus, the dog went home with an ivermectin‐based treatment. It was presented 7 months later for a recurrence of the clinical signs. Tomography and surgical approach to the right frontal sinus revealed persistent presence of the O. ovis infestation. After surgical removal of the parasite and oral isoxazoline treatment, the dog had no signs of clinical recurrence. Follow‐up computed tomography scan confirmed complete resolution of the sinusitis.

Pott’s Puffy Tumour in Mucormycosis: New Presentation of an Old Disease

Introduction: Pott’s puffy tumour (PPT) is a rare but grave complication of frontal sinusitis. During the second wave of Covid-19, there was rise in rhino-orbito-cerebral mucormycosis (ROCM) cases in India. There is a paucity of literature reporting association of frontal osteomyelitis with rhino-orbital cerebral mucormycosis. This study elucidates the clinico-epidemiological profile and clinical outcomes of management of frontal osteomyelitis in patients with ROCM. Materials & Methods: A retrospective, observational study was conducted at a tertiary hospital from May 2021 to May 2022. 350 patients with covid-19 associated ROCM had reported to the hospital. 12 patients presenting either pre- or post-operatively with doughy swelling over the forehead, with/without oedema of the upper eyelid were clinically diagnosed to have frontal osteomyelitis. Minimal localised defects in the frontal bone were subjected to local excision of granulation tissue, evacuation of pus and biopsy. Cases involving extensive erosions of anterior table of frontal sinus underwent osteoplastic flap with obliteration. Results: 12 patients presented with frontal osteomyelitis. All received systemic antifungals and broad-spectrum antibiotics. It sufficed in only 1 case. 2 required additional local debridement. In 4, endoscopic sinus surgery achieved adequate disease control. 5 with extensive disease required osteoplastic flap with obliteration via either eyebrow or bicoronal incision. Conclusion: A high index of suspicion is warranted in patients with covid-19 associated mucormycosis who present with a forehead swelling because even though PPT is a rare clinical entity it is associated with potentially life-threatening complications.

Pott's Puffy Tumor: A Rare, Life-Threatening Presentation ofPeriorbital Edema.

Pott's puffy tumor (PPT) describes forehead swelling with associated frontal bone osteomyelitis and a subperiosteal abscess (SPA) requiring a high suspicion index for optimal outcomes. PPT is a life-threatening complication of frontal sinusitis typically found in adolescents. Our case is one of the youngest in the literature. This report describes a 3-year-old patient who developed multifocal abscesses in the epidural space with frontal and orbital SPA, requiring surgical intervention. Additionally, her course was complicated by a superior sagittal venous thrombosis, a complication commonly associated with PPT. We present an unusual case of orbital SPA and aim to highlight a life-threatening pediatric condition that is often underrecognized.

Pott's Puffy Tumor in Pediatric Patients: Case Series and Literature Review.

Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence. We report a series of 10 pediatric patients (9-17 years of age) who presented with PPT in 2 tertiary care pediatric hospitals in central Israel between January 2018 and August 2022 and review the published literature on pediatric PPT. The most common clinical presentations included headache (10 cases), frontal swelling (6 cases) and fever (5 cases). Symptom duration before admission was between 1 and 28 days (median 10 days). The diagnosis of PPT was made by imaging studies at a median of 1 day after admission. All 10 patients underwent computed tomography studies, and 6 patients also underwent magnetic resonance imaging. The overall rate of intracranial complications was 70%. All 10 children were treated with systemic antibiotics and surgical interventions. Streptococcus constellatus group was the most common causal bacteria. All 10 patients recovered uneventfully. Our findings show that a high index of suspicion for PPT should be applied to adolescents presenting with prolonged headache and frontal swelling. Contrast-enhanced computed tomography is an appropriate first tool for the evaluation; however, an magnetic resonance imaging should be performed to determine the necessity of intracranial interventional treatments if there is any suspicion of intracranial involvement. Complete recovery can be expected with appropriate antibiotic treatment and surgical intervention in most of the cases.

A 9-year-old boy with a nonmalignant forehead tumor – a rare case of pediatric Pott’s puffy tumor

BackgroundPott’s puffy tumor (PPT) is a rare and potentially deadly complication of frontal sinusitis consisting of subperiosteal abscess and osteomyelitis of the frontal bone.Case presentationWe report the case of a 9-year-old boy who presented with fever and soft tissue swelling of the forehead. Magnetic resonance imaging (MRI) depicted an abscess in the subcutaneous tissue frontally and an epidural empyema, while a cranial computed tomography (CT) scan revealed bone erosion as a sign of osteomyelitis. The patient was treated accordingly.ConclusionsThis rare condition is essential to keep in mind as it needs a multidisciplinary approach and relevant imaging to start proper treatment and thus decrease the risk of intracranial complications.

Intact Bulla Versus Trans-Axillary: Which is a Better Approach to Frontal Sinus?

Frontal sinus is one of the most difficult sinuses to approach endoscopically because of its anatomical location. Challenges and difference in opinions still exist in terms of its surgical management. Endoscopic approach to frontal sinus commonly involves either trans-axillary or intact bulla technique. Trans-axillary technique gives a direct access to the frontal sinus even with a 0° endoscope whereas Intact bulla technique warrants the use of 70° scope. Despite both the techniques now existing for quite some time; literature is still controversial regarding the superiority of one technique over the other. A randomised prospective study of 40 patients of frontal sinusitis. Patients were randomly allocated into two groups. In approaching frontal sinus, groupA patients underwent trans-axillary technique and group B patients underwent intact bulla technique. Both the groups were statistically compared in terms of time taken for surgery, post operative results and improvement in symptom score. The pre-operative endoscopic Lund -Kennedy score in group A was 7.1 ± 1.57 while in group B was 6.95 ± 1.1. The mean post -operative endoscopic Lund Kennedy score in group A was 1.25 ± 0.93. and in group B was 1.05 ± 0.89. The mean pre& SNOT-22 score in group A was 79.85 ± 19.1 and in group B was 80.55 ± 16.94. The mean postoperative SNOT-22 Score in Group A was 4.450 ± 2.136 and group B was 2.579 ± 1. 714.The average time taken in group A to reach frontal sinus was 21.1 ± 5.44min while in group B it was15.9 ± 3.6min. At 12 weeks follow up recurrence was seen in 4/20 cases in group A and 3/20 Cases in group B. Ostial Stenosis was seen in 3/20 cases in group A and 2/20 cases in group B. Nasal adhesions were seen in 7/20 cases in group A and 1/20 cases in group B. Middle turbinate lateralization was seen in 8/20 cases in group A and 1/19 cases in group B. Lamina Papyracea injury was seen in 1 case in group B but in 3 cases of group A. Both the techniques were highly efficacious in improving post-operative endoscopic as well as symptom scores. However, some post operative complications like middle turbinate lateralization were more with trans-axillary technique as compared to intact bulla technique.

Ecological evaluation of the development of Neanderthal niche exploitation

Understanding the ecological niche occupied by Neanderthals and their ancestors is at the forefront of many Palaeolithic investigations. In this study, a complex characterization of the environments once occupied by these hominins in Western Eurasia were performed. It included the determination of the biome and climatic zones occupied, the potential wind exposures, the classification of the karst regions where they lived, the direction of the entrance of caves inhabited and the average daily total solar irradiation values. In addition, the climatic suitability of the Mediterranean mosquito fauna, tick-borne encephalitis and four large mammal species as potential mammal hosts were also studied. It was found that Western Eurasian hominins occupied a wide ecological niche range from the semi-arid to the subarctic climates. Between the MIS20-MIS4 interval, the biomes occupied by Neanderthals and their ancestors shifted from the woodland-shrubland to the boreal biomes, indicating the increasing general biocultural adaptation to the more continental environments. These populations inhabited territories with weak to moderate wind exposure (Beaufort 2–5) and usually occupied caves with a south or southwest-oriented entrance. This habitat selection indicates the recognition of local microclimatic factors and a conscious choice of shelters. In the glacial periods, the increasing extension of temperate-subpolar karst regions at the expense of the more habitable subtropical karst areas might have adversely affected the overwintering chances of ancient western Eurasian populations in West, Central Europe, and Central Asia. The supraorbital area of ancient hominins with low receding foreheads and prominent supraorbital ridges may have been exposed to a greater risk of the development of frontal sinusitis and its complications than modern humans with more gracile skulls. Neanderthals and their predecessors were exposed to moderate average daily solar radiation values, although these values exhibit heterogenic picture in the comparison of Central and Southern Europe. While the southern European Neanderthal populations were dominantly exposed to the risk of mosquito-borne diseases, the northern and central populations could suffer from tick-borne diseases. However, both tick-borne encephalitis virus and its medium-large mammal hosts were present in most sites dwelled by Neanderthals and their ancestors.

Pott's Puffy Tumor, an Exceptional Complication of Frontal Sinusitis: About a Case Report

Pott's puffy tumor is a rare entity, characterized by the association of a subperiosteal abscess and osteomyelitis of the frontal bone. It is often secondary to frontal sinusitis. The diagnosis of Pott's puffy tumor is difficult and often confused with a tumor, infection or hematoma. Although this condition is frequently observed in children, rare cases in adults have been described. We report the case of a 23-year-old man who presented with right frontal inflammatory tumefaction, and in whom the scanner showed a Pott's puffy tumor following frontal sinusitis. He was successfully treated with antibiotic therapy and percutaneous drainage of the abscess under the frontal periosteum. We reviewed cases of Pott's puffy tumor in adults published in the literature and discussed the particularities of this condition.

Silent sinus syndrome with interfrontal sinus retraction: A 3-case series using CARE methodology

IntroductionSilent sinus syndrome (SSS) is a rare entity, almost exclusively involving the maxillary sinus, frontal location being very rarely reported. The aim of the present study was to describe clinical and radiological characteristics and surgical treatment using the CARE methodology. ResultsOne woman and 2 men were referred for chronic unilateral frontal pain with imagery showing silent sinus syndrome. All showed partial or complete liquid opacification of the affected sinus associated with a thin interfrontal sinus (IFS) retracted toward the affected sinus. Functional endoscopic sinus surgery was performed in all cases, with good functional results. DiscussionWe describe 3 cases of SSS with IFS involvement. The frontal sinus wall seemed most vulnerable, probably most liable to be weakened by atelectasis. The study suggests that frontal SSS can be an etiology in chronic frontal sinusitis. Preoperative findings of IFS retraction are useful for surgical restoration of frontal sinus ventilation, relieving chronic pain and preventing complications.

A case report: Diagnosis and treatment of idiopathic hypertrophic pachymeningitis

AbstractA 57‐year‐old man who suffered from a headache for 1 year, accompanied by blurred vision for 7 months and numbness in his left face for 1 week was admitted to the Affiliated Hospital of Zunyi Medical University on May 7, 2022. One year ago, the patient had no obvious precipitating factor of paroxysmal stabbing pain in the whole skull with dizziness, which could be relieved by oneself after lasting for 1–2 min each time, with about 20 episodes per day. The cranial magnetic resonance imaging revealed changes in bilateral frontal lobe ischemic foci, bilateral frontal, ethmoid, sphenoid and maxillary sinusitis, and retinal macular degeneration. After hormone shock treatment, the condition improved. He suffered from headaches again with blurred vision in the right eye 7 months ago and was initially diagnosed with multiple sclerosis. He then was discharged after improvement due to hormone shock therapy. Oral hormone therapy was continued outside the hospital, but he stopped it due to drug side effects (details remained unclear). After cutting off, he developed a headache and visited our hospital once more, the relevant tests were performed and the patient was diagnosed with idiopathic hypertrophic pachymeningitis (IHP). The symptoms were slightly abated after hormone therapy. We hope that through this case report, we can deepen the clinicians' understanding of IHP, and improve the diagnosis rate of the disease through relevant examinations in future clinical work, so that patients can receive timely treatment and the mental pressure and economic burden caused by the disease on patients are reduced.

A Case of Pott's Puffy Tumor Developing Secondary to Pansinusitis in an Obese Diabetic Adolescent

Pott's Puffy tumor is a rare osteomyelitis of the frontal bone presenting with swelling and headache in the frontal region that can be seen after frontal sinusitis. It is a complication that requires urgent surgical intervention. In this case study, a case of complicated Pott's Puffy tumor secondary to pansinusitis in a 16-year-old adolescent male with underlying obesity and uncontrolled type 2 diabetes is presented.

External Frontal Sinostomy to Drain Frontal Lobe Abscess

A case of frontal sinusitis with osteomyelitis of its posterior wall producing frontal lobe brain abscess is presented, whereby the posterior wall dehiscence was exposed by external sinostomy by an ENT surgeon and then, through the dehiscence, the abscess was drained by a neurosurgeon. This is an uncommon technique of draining a frontal lobe brain abscess where no frontal bone craniotomy was required. This approach yields the least damage to the cerebral tissue as the frontal abscess was very close to posterior wall of frontal sinus and drain has to travel through minimal intracerebral distance.

Surgical treatment of a patient with purulent frontal sinusitis and falcotentorial empyema

Background. Subdural empyemas are accumulation of pus between the dura mater and the arachnoid mater of the brain. They represent 12–25 % of all intracranial purulent‑inflammatory diseases. 70–80 % of them are located convexitaly and 10–20 % in the area of the falx cerebri. A spread of pus on the tentorium cerebellum occurs rare. Without timely treatment, that includes massive therapy with antibiotics and drainage of the subdural empyema, most of the patients die in the result of progression of the secondary purulent meningoencephalitis and dislocation of the brain.Аim. To report the case of subdural empyema of rare localization – in the left part of the interhemispheric fissure and supratentorial space, to demonstrate the effectiveness of prolonged continuous flow drainage in treatment of the subdural empyema in this particular case.Materials and methods. 16‑year‑old patient was admitted into the neurosurgical department of the 1‑st Republican clinical hospital of the Izhevsk city with pronounced general infectious and meningeal syndrome and paresis of the muscles of his right shin and foot. CT scans revealed frontal sinusitis and subdural empyema of the left part of the interhemispheric fissure and the supratentorial space. In addition to intravenous antibacterial therapy with vancomicyn and Meronem bifrontal cranioectomy, debridement of the frontal sinus, obliteration of it’s residual cavity with free muscle graft and external drainage of the subdural empyema with following continuous irrigation during 6 days after surgery had been performed. At the time of discharge from the neurosurgical department 16 days after the operation complete regress of the general infectious and meningeal syndrome was observed.Results. On control examination 44 days after the surgery the patient’s condition was normal and he had no neurolog ical deficit. On the series of MRI scans preformed 6 months latter, after the cranioplasty, no remnants of the subdural empyema were revealed.Conclusions. This clinical case demonstrates the effectiveness of the prolonged continuous flow drainage in combination with systemic antobioticotherapy and elimination of the primary source of infection within the frontal sinus in treatment of the large and deeply situated subdural empyema of rare falcotentorial localization.

Pott's puffy tumor on an exceptional clinical case: review of the literature

Pott's tumor or Pott's puffy tumor or osteomyelitis of the frontal bone is a rare clinical presentation. It usually occurs as a complication of trauma to the frontal region, frontal sinusitis or by blood-borne spread, the infection can also spread inwards leading to an intracranial abscess. This is a 04-month-old, 7 kg infant with left frontal swelling with ipsilateral orbital extension. This swelling had been evolving for approximately 1 month. The computed tomography showed a hypodensity of liquid in the left fronto-orbital subcutaneous topography with an intense annular parietal enhancement in the arterial and late stages. Treatment consisted of surgical drainage under general anesthesia. We made the incision via the left pterional approach and undermining up to the frontal bone. From the pus about 40 cc then we proceeded to the debridement of necrotic tissues and curettage of the frontal bone which was lysed in places. The germ found was Burkhoderia pseudomallei gram-negative bacillus sensitive to C3G. Pott's tumor is a rare complication most often from untreated or poorly treated frontal sinusitis. This lack of knowledge raises fears of an evolution towards intracranial complications that could be life-threatening for patients.

Potts puffy Tumor

Pott puffy tumor is a rare entity, characterized by the association of a subperiosteal abscess and osteomyelitis of the frontal bone. It is often secondary to frontal sinusitis or trauma. We report the case of a 14-year-old child who presented with a Pott’s tumor following frontal sinusitis, complicated by subdural empyema. He was successfully treated with antibiotic therapy and percutaneous drainage of the frontal abscess.

Pott's Puffy Tumor: A Rare Diagnosis

Pott’s puffy tumor consists of subperiosteal abscess of the frontal sinus wall associated with underlying osteomyelitis, which can appear as a rare complication of frontal sinusitis

The value of frontal sinusotomy in cases of sinonasal polyposis

BackgroundChronic frontal sinusitis is being treated with less invasive transnasal endoscopic treatments. Surgery relieves illness and prevents recurrence. Our study was conducted on 80 patients who suffer from frontal opacity with sinonasal polyposis and divided randomly into 2 groups: group A: 40 patients candidate for anterior ethmoidectomy without identification of frontal sinus ostium and group B: 40 patients candidate for anterior ethmoidectomy with identification of frontal sinus ostium. The study was conducted in the otolaryngology department faculty of medicine Cairo university.ResultsCT score and sinonasal endoscopy score were statistically significantly improved postoperatively compared to preoperative scores in both groups. There are no significant differences between the 2 groups regarding recurrence rate and complications.ConclusionEthmoidectomy without frontal sinusotomy is a potential substitute for frontal sinusotomy for the treatment of chronic frontal sinusitis with sinonasal polyposis, and it can achieve similar improvements in symptoms and radiological evidence of frontal sinusitis.

Do We Overdiagnose Migraine? A Prospective Study at Emergency Departments of Two Tertiary Care Hospitals

Objective: To assess pathologies in patients previously diagnosed with migraine for their recurrent headachecomplaints, with an aim to uncover the misdiagnosis of migraine.Study Design: Prospective cohort study.Place and Duration of Study: The study was carried out at Emergency Departments of Military Hospital andCombined Military Hospital, Rawalpindi Pakistan from April 2018 to February 2019.Materials and Methods: This study is a prospective cohort study. Raosoft was used for sample size calculation.Non-probability convenient sampling technique was used. All patients included in the study were diagnosed asa case of migraine by a Medical Specialist /Neurologist and were already on treatment protocols for migraine.All patients with additional CNS pathology were excluded from this study. The data analysis was done using IBMSPSS for Windows version 25. Categorical Data was presented as percentages and frequencies.Results: One hundred thirty one patients participated in the study. The subjects ranged from 19 to 51 years ofage with 32% males and 68% females. Seventy seven of those patients reported more than 4 acute attacks ofheadache per 6 months which compelled them to visit their nearest ER. The participants were dividedaccording to possible causes after reassessment. Other causes included Hypertrophied Nasal Turbinates, DNS,Frontal Sinusitis, Septal Spur, TMJ disorders, Maxillary Sinusitis, Pansinusitis and Post Herpetic Neuralgia. Aftermanaging their acute attack in the ER, the patients were referred to various departments for respectivetreatment protocols. After 6 months of follow-up, 54.7% of the patients reported a reduction in visits to the ERfor acute episodes of headache.Conclusion: There is an increased tendency to label and treat patients with any headache as migraine whichresults in the administration of unnecessary analgesia which may have serious effects on health.

A Review of a Selected Ayurvedic Herbal Formula in the Management of Suryavarta (Frontal Sinusitis): A Comprehensive Analysis

The most prevalent clinical ailment among patients who present to physicians with a headache as a cardinal symptom, closely linked to the position of the ‘sun’ in the sky, is Suryāvarta. Approximately 14% of the population suffers from frontal sinusitis, which primarily afflicts individuals between the ages of 20 and 30 and is less common in children. Piper longum (Pippali) and Glycyrrhiza glabra (Yashtimadhu) constitute the ingredients of a traditional paste formula. The objective of this review was to investigate the effectiveness of this herbal paste formula in the treatment of frontal sinusitis. Information regarding frontal sinusitis was gleaned from Ayurvedic scriptures, contemporary texts, and earlier research studies from primary and secondary sources. Subsequently, a comprehensive survey of the literature was conducted for these two herbs in the selected paste, which was then scrutinized for their Pancha Padārtha (five elements of the herb) and pharmacological qualities related to the management of frontal sinusitis. Ayurvedic Pancha Padārtha analysis has revealed that the selected herbal formula is efficacious in managing Suryāvarta. While the majority of studies have demonstrated the anti-inflammatory effects of the herbal formula, reviewed articles have also highlighted additional qualities that alleviate the symptoms of frontal sinusitis. Based on the literature review and Pancha Padārtha analysis, the selected herbal formula proves to be valuable in the management of frontal sinusitis.

Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis in Egyptians: A Computerized Tomography Study

Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis in Egyptians: A Computerized Tomography Study