Left Frontal Sinus Research Articles

皮下膿ようを形成した前頭洞炎例 冠状切開法による根治例

A 27-year-old male complaining of anterior frontal swelling and pain was sent to our hospital for further examination and treatment. Examinations, including X-ray, CTscan, MRI, led to a diagnosis of frontal sinusitis with bone defect of the anterior wall and a fistula between the frontal sinus and the skin. After radical maxilloethmoidectomy, an extranasal frontal sinus operation employing a coronal incision was performed under general anesthesia. A bone defect was found in the medio-superior portion of the left frontal sinus. The defect connected with the fistula to the frontal skin as an extension of the frontal sinus lesion. After complete removal of the inner wall lesions in the frontal sinus and nasofrontal duct, the latter was plugged with autogenous iliac bone grafts. Then autogenous abdominal fat was implanted into the frontal sinus. The anterior wall of the frontal sinus was reconstructed with an iliac bone graft. During the 34 months since surgery, he has had no recurrent infection and no cosmetic or functional problem. In conclusion, frontal sinus surgery via a coronal incision approach is feasible when a wide surgical field with direct visualization of the frontal sinus is required, and it can produce satisfactory results.

Pneumatoencephalocele secondary to a fronto-orbital osteoma. (Case Report)

We present the case of an osteoma situated in the orbital portion of the left frontal sinus in a 22 year- old male, who also presented pulsatile exophtalmos, diplopia and headache. The neuro-radiological tests revealed also a large intracranial air cavity. Surgery demonstrated the relation between the osteoma and pneumatocele, where the tumor produced effacement of the orbitary roof; this placed the sinusal cavity in contact with the subdural space. A valve mechanism is suggested to explain the accumulation of intracranial air without liquorrhea. Finally, the rarity of the case in the literature is commented on.

Orbital multilobular tumour of bone in a dog

ABSTRACTA multilobular tumour of bone with left orbital involvement was diagnosed at post mortem examination in an eight‐year‐old German shepherd cross dog. The tumour resulted in progressive exophthalmos with lateral deviation of the left eye. Radiographs revealed that the mass was mineralised and originated from the left frontal bone with invasion of the left frontal sinus and destruction of the cribriform plate. This is the third reported case of this type of tumour involving the orbit of the dog and thus multilobular tumour of bone should be considered as a differentia] diagnosis of exophthalmos.

髄液漏を伴った前頭洞髄膜脳りゅう例

A 48-year-old man was referred to us complaining of a copious clear watery discharge from his left nostril, that had started 8 weeks earlier. Tomographic studies revealed a mass in the left frontal sinus. A radioisotope was introduced into the subarachnoid space by lumbar puncture, and 3 hours later the radioactivity of pledgets in the left nasal cavity was significantly greater than in the right nasal cavity. Cerebrospinal fluid rhinorrhea through the left frontal sinus was therefore diagnosed. An extranasal approach was selected for repairing the cerebrospinal fluid leakage. The polypoid tissue in the left frontal sinus was removed. There were two bony defects in the posterior wall of this sinus. These defects were successfully closed by fascia lata with the use of a fibrin sealant, and continuous spinal drainage was done pre- and post- operatively. The postoperative course was uneventful. Histological diagnosis of the tissue removed from the frontal sinus was menigoencephalocele.

顔面神経麻ひをきたした副鼻腔ムコール症例

A 60-year-old man with diabetes mellitus visited our clinic with complaints of lowgrade fever, headache, left cheek pain and left periorbital edema on September 13, 1988. Left paranasal sinusitis was found. Left peripheral facial palsy started on September 20. A left probe maxillotomy was performed on September 21. The specimen of maxillary mucosa was consistent with a diagnosis of mucormycosis. Sinusitis was temporarily improved by surgery and local irrigation with amphotericin B, but facial palsy persisted. Left mastoiditis was disclosed by high resolution CT on November 18. He received left frontal, ethmoidal and maxillary sinus debridement and left mastoidectomy on December 7. The vertical segment of the facial nerve was necrotic due to severe inflammation and was resected during the mastoidectomy. Hyphae of mucor were not found in the specimens of mastoid mucosa and facial nerve, but the severity of the inflammation seen in the operative and histological findings suggested that the mastoiditis and the facial neuritis might have been caused by mucormycosis. After the surgical debridement, left sinusitis and mastoiditis were controlled with 6 months of intravenous amphotericin B therapy combined with flucytosine. The authors discuss the management of peripheral facial palsy and em-phasize the importance of combined surgical treatment and antifungal chemotherapy.

Early invasive CNS aspergillosis

A 46-year-old woman with non-Hodgkin's lymphoma presented with a new onset of seizures. A cranial CT was interpreted as normal. Eight months later, she presented with changed mental status and leg weakness, and a repeat CT scan showed multiple ring-enhancing lesions close to the left frontal sinus, with mass effect. A review of the previous CT scan showed a very small area of sinusitis as well as a small ring-enhancing lesion contiguous to it. A short course of intravenous steroids markedly relieved her symptoms, and a stereotactic biopsy confirmed Aspergillus fumigatus to be the cause of the infection. She was successfully treated with Amphotericin B. Central nervous system (CNS) aspergillosis is a potentially fatal disease. The therapeutic success in this case was related to a high index of suspicion at her second presentation. As the early signs of infection might be subtle and easily missed, patients at high risk for opportunistic infection should be studied carefully when new onset of CNS symptoms occur. Early initiation of therapy should improve the prognosis in such cases.

Acute frontal sinus barotrauma

A 25-year-old man presented to the emergency department with an acute onset of frontal sinus pain during descent on a commercial airliner. There was no history of recent upper respiratory infection, sinus infection, or chronic allergic rhinitis. Sinus radiographs demonstrated a left frontal sinus submucosal hematoma. Symptoms improved within 24 hours with systemic and topical decongestants/vasoconstrictors and a nonsteroidal antiinflammatory agent. He was asymptomatic at 1 week postinjury.

Epidural abscess following frontal sinusitis-demonstration of communication by epidural contrast medium and coronal computerized tomography

A case of epidural abscess following sinusitis is presented with rhinorrhoea after irrigation of the abscess cavity postoperatively. Coronal computerized tomography and instillation of contrast medium through the catheter showed communication between epidural space and left frontal sinus.

Raynaud's disease.

We report five children who presented with Raynaud's disease in whom we could find no clinical, haematological, or immunological evidence of a collagen disorder. Oral phenoxybenzamine proved useful for maintenance treatment in most, with infusions of prostacyclin, nitroprusside, and ketanserin during acute attacks.

Giant mucocele of paranasal sinuses

A large mucocele of the frontal and ethmoidal sinuses with extracranial, intracranial, and intraorbital extension accompanied by total destruction of the left frontal sinus was treated successfully. We chose a two-stage surgical procedure for radical removal of the lesion. It is important to ascertain the degree of dural involvement, not only because extensive involvement of the dura mater presents technical surgical difficulties, but also because this knowledge provides clues regarding the pathology of the lesion. Even after surgical treatment, the mucocele may recur if the patent sinus ostium is exposed to the dura mater, or if the ostium subsequently becomes blocked

Acute Subdural Empyema

The patient, a 19-year-old male, began suffering from severe headache, vomiting, and high fever. Two days later the patient was admitted in a semicomatose state and with left hemiplegia. Nuchal rigidity and choked disc were not noticed. WBC count was 12, 500/mm3. CT scan disclosed marked swelling of the right cerebral hemisphere with midline shift. Except for a small lucent space in the parafalcial region, no extracerebral collection was noted in either pre- or post-contrast scans. Plain craniograms showed clouding of the left frontal, ethmoidal, and sphenoidal sinuses. Carotid angiography revealed prolongation of the circulation time and stenosis of the supraclinoidal portion of the right carotid artery. Right fronto-parietal decompressive craniectomy was performed. Subdural empyema was found and evacuated. Curettage and drainage of the empyema in the paranasal sinuses were also done. A bone defect 4 mm in diameter was detected on the medial-upper wall of the left frontal sinus. The causative organism was confirmed as α-Streptococcus. Both systemic and local antibiotics were administered and the patient recovered well and was discharged without any neurological deficit. The authors emphasized that cerebral angiography is necessary for its accurate diagnosis of subdural empyema in its acute stage and that emergency intracranial and rhino-otological operations should be concomitantly performed.

A CASE OF SUBDURAL ABSCESS WITH APHASIA, FOLLOWING FRONTAL SINUSITIS

A 13-year-old boy came to hospital on Septe- mber 12, 1963 complaining of fever, headache, nausea and vomitting. Upon examination, his left eyelid was swollen rigidity of the neck and the pathologic reflex was positive. Lumbar puncture revealed the cloudy spinal fluid, the pressure of 200mm (water), and the cell count 270/3. In the Ist operation, the dura was seen to be exposed on the posterior wall of his left frontal sinus. When this was cut, greyish pus oozed out, and was washed out Energetic chemotherapy, and continuous drainage of the cisterna lumbalis was carried out. He, however, continued to have fever, and the 2nd operation was performed on September 18. Purulent fluid accumulated in the middle cra- nial fossa. The patient returned to nearly normal condition for a time, but on November, he was affected with occaisional convulsions and the motor aphasia gradually turned to sensory. It was suspected, therefore, that the cerebral abscess was the cause, and his angiogram was sur- veyed on March 19, 1964 with a result that a space occupying view was seen on the left-parieto- temporal region. Craniotomy was under-taken and an abscess the size of an egg was seen directly under the dura, and was diagnosed as subdural abscess. Subsequent improvemeut of the patient's cond- ition was seen, and is at present physically fit, except for slightly noticeable intelligence degen- eracy.

Acute staphylococcic frontal sinusitis with fulminant fatal subdural abscess. Report of a case transmitted by a carrier.

A semiconscious white youth, 16 years old, was admitted to Georgia Baptist Hospital on July 11, 1959, at 11:30 a.m. His mother said that he had been in good health until two nights previously at which time he came home from a swimming party complaining of a headache, became nauseated, and vomited several times. The next day he was no better, so the family physician was called; he prescribed tetracycline to be taken orally. That night the patient was also restless; he was feverish and had some trouble talking. The following morning there was difficulty in arousing him and he was brought to the hospital. The patient was a well-developed, muscular young man with a tender swollen area over the left frontal sinus about the size of a half dollar. Reflexes were generally hyperactive with moderate nuchal rigidity, and partial paralysis of the left facial nerve was noted. Retinal veins

A CASE OF TRIPLE POST OPERATIVE CYSY

Triple post operative cyst in a 62 years old man was reported. Left pansinectomy was done 25 years ago, and again he was operated for left post operative maxillar cyst 20 yearslater.Recently we found post operative cyst in left frontal sinus and ethmoidal cells.Only two cases of double post operative cyst have been reported in Japan, and these two cases were that of othmoidal cells and maxillar sinuses.This case of triple post operative cyst might be said to be the first reported case in Japan.

MAXILLARY SINUSITIS AND ETHMOIDITIS OF THE RIGHT SIDE DEVELOPING DURING INTRAMUSCULAR INJECTION OF PENICILLIN FOR PANSINUSITIS OF THE LEFT SIDE

THE case to be reported is of particular interest because of the following observations: Porosity of the anterior and posterior walls of the left frontal sinus disappeared and acute pansinusitis of the left side cleared up completely except for a cyst in the left antrum when penicillin was injected intramuscularly in a dosage of 100,000 to 200,000 units per day for three weeks. Treatment for an infection of a flat bone, including the frontal bone, is adequate when 200,000 units of penicillin is injected daily for three weeks,1 so far as intramuscular injection of penicillin may aid in lessening the need for surgical intervention in this condition. In other words, an adequate trial of penicillin for the prevention or the treatment of osteomyelitis of a flat bone has been made when 200,000 units has been injected intramuscularly daily for three weeks. Of course, such a trial may be unsuccessful, with

AIR IN THE CRANIAL CAVITY: A CRITICAL REVIEW, WITH REFERENCE TO AN UNUSUAL CASE

1 The history and bibliography of pneumocephalus are reviewed. 2 Its pathology, symptomatology and diagnosis are described. 3 Classification and terminology according to the site of the air are advocated. 4 A routine for general management is indicated, and various therapeutic operative procedures are mentioned. 5 A complicated case of pneumocephalus, associated with compound comminuted fracture of the left orbital cavity, frontal bone and frontal sinus, with loss of the left eye, with damage to the frontal lobes and with traumatic epilepsy and meningitis, following a self-inflicted gunshot wound of the left temple, is presented. 6 Many unusual and puzzling features, with comments on their significance and their treatment, are discussed.

OSTEITIS FIBROSA CYSTICA OF THE LEFT FRONTAL SINUS: Report of a Case

<h3>REPORT OF CASE</h3> A woman aged 21, a Puerto Rican, was admitted to the Vanderbilt Clinic complaining of a large, firm swelling above the left eye. According to her story, she had first noticed the swelling a year before over the lower portion of her forehead. It had grown slowly downward until it had become most prominent at the inner canthus of the eye. At the same time she suffered from severe pain in that region and displayed changes in personality, becoming gloomy and addicted to fits of crying. <i>Examination.</i>—A firm, nontender swelling was noted over the left frontal sinus, extending into the orbit on that side and displacing the eye outward. There was a firm mass in the left ethmoid region. Biopsy of the mass in the nose showed what appeared to be an osteoma. Roentgenograms revealed the swelling to be a cyst occupying most of the left

MUCOCELE OF THE FRONTAL SINUS: REPORT OF A CASE

Although mucocele of the frontal sinus was not dealt with as a problem in therapeutics in authoritative medical literature earlier than the eighteenth century, this pathologic condition must have existed in ancient times. An interesting bit of writing indicating this is the description by Boenninghaus 1 of a skull discovered by him among the thousands ornately arranged on the walls of the famous chapel at Tscherbeney, built entirely of human bones. Boenninghaus made a careful examination of this skull. He found the bone structure large and strong, with the teeth for the most part absent; the skull appeared to be that of a person of middle age. The cranial capsule was perfectly preserved. A large part of the anterior wall of the frontal sinus was absent. In the cerebral wall of the left frontal sinus was a roundish defect, approximately 1 cm. in diameter. From these and other observations Boenninghaus concluded

Chronic Suppuration of Left Frontal and Ethmoidal Sinuses Cured by External Operation after Eight Intranasal Interventions

Chronic Suppuration of Left Frontal and Ethmoidal Sinuses Cured by External Operation after Eight Intranasal Interventions

Suppurative Disease of Left Frontal Sinus and Left Maxillary Antrum.

Suppurative Disease of Left Frontal Sinus and Left Maxillary Antrum.