Left Frontal Sinus Research Articles

Additional Detection of Multiple Osteomas in a Patient with Gardner's Syndrome by Bone SPECT/CT.

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder which generally develops numerous polyps in the colon and rectum during the second decade of life [1]. Gardner’s syndrome is a variant of FAP which has multiple osteomas, dental abnormalities, and fibromas, with incidence ranging between 1 in 4,000 and 1 in 40,000, depending on the region [2–5]. We present the case of a 35-year-old man referred to our department for bone scintigraphy who was shown to have multiple colon polyps and nuchal type fibroma. In this patient, planar image showed intensely increased uptakes of bone agent in the maxilla and mandible (Fig. 1a), which are typical findings of Gardner’s syndrome [6, 7]. Single photon emission computed tomography/computed tomography (SPECT/CT) was acquired to accurately identify and locate abnormal uptakes detected on planar images. SPECT/CT showed numerous osteomas in the maxilla and mandible where intense uptakes of bone agent were seen (Fig. 1b-d). Mildly asymmetrical, focally increased uptake in the superomedial aspect of the left orbit on anterior planar image was shown to be a fontal sinus osteoma on SPECT/CT (Fig. 2a). Enhanced sensitivity of detecting lesions of SPECT/CT superior to planar scintigraphy has been reported in previous studies [8, 9]. In this report, additional osteomas of sphenoidal and ethmoidal sinuses, which were not seen on planar scintigraphy, were detected by SPECT/CT (Fig. 2b, c). This case emphasizes that nuclear physicians should be aware of the typical findings of bone scintigraphy for Gardner’s syndrome and also that SPECT/CT could be helpful to diagnose additional lesions not seen on planar images. Fig. 1 A 35-year-old man presented with a history of growing neck mass in the right posterior neck. Surgical excision was performed, and subsequent biopsy revealed the mass as nuchal type fibroma. To rule out Gardner’s syndrome, colonoscopy was performed ... Fig. 2 The focally asymmetrically increased uptake in the left orbit was found out to be an osteoma in left frontal sinus (a). Moreover, SPECT/CT images showed additional, multiple, focally increased uptakes of bone agent in sphenoidal (b) and ethmoidal (c) ...

Post-Traumatic Blepharocele in an Adult = البليفروسيل الحادث بعد الإصابة في بالغ

Cerebrospinal fluid (CSF) collection in the eyelid is known as blepharocele. It is rarely reported in adults. In this report, we describe one such patient who developed a non-resolving swelling of the left upper eyelid associated with mechanical ptosis following a head injury. He had fractures involving the left orbital rim and roof, and the medial and lateral walls. His left frontal sinus was hypoplastic. The diagnosis of CSF blepharocele was made based on clinical, biochemical and radiological findings. He underwent transcranial repair of the left frontobasal dural tear with a good recovery.

A Case of Orbital Emphysema Associated with Frontal Sinus Pneumocele

Orbital emphysema is usually caused by trauma and fracture of an orbital bone, allowing air to pass from the sinuses into the orbit. Orbital emphysema without any significant trauma is rare. We present a case of a 67-year-old-woman who complained of left exophthalmos without any history of trauma, sneezing, or sinus surgery. Computed tomography scanning showed left orbital emphysema protruding the eyeball forward. The left frontal sinus was remarkably enlarged associated with a partial defect of the orbital roof, allowing air entry into the orbit. In addition, the frontal sinus ostium was occluded with the mucocele that served as a one-way valve between the frontal and the ethmoidal sinuses. We performed frontal craniotomy and removed the mucocele and the inner table of frontal bone to communicate the frontal sinus with the nasal cavity. After operation, her exophthalmos was improved.

Study on the development of frontal sinuses by morphometric analysis of the skull

The frontal sinuses are cranial areas of clinical, forensic and pathology importance whose development mechanisms are still poorly defined. Nasal airflow and brain development are two of the main theories. Current analysis debates whether they are the real determinants of frontal sinuses growth, which may be proved by the skull's morphometric analysis. Four groups of measures related to the external cranial architecture, the pyriform aperture, orbital cavities and frontal sinuses were defined. Thirty-three skulls of individuals, mean age 68 years, from the Laboratory of Anatomy of the Academic Centre of Victoria - UFPE - Brazil, were used. Statistical analysis showed total agenesis of the frontal sinus in 18.2% of the skulls. There was significant correlation between the development of the right frontal sinus and the pyriform aperture, and between the left frontal sinus and two cranial measurements (p ≤ 0.05). Significant differences between mean of pyriform aperture areas of the skulls with or without sinuses were also reported (p ≤ 0.01). Results supported the fact that there was a modulation activity by nasal aeration and brain formation in the development of frontal sinuses.

Spotlight on the Safety Net

**BACKGROUND AND PURPOSE:** The crista galli is part of the ethmoid bone and, as such, it could be expected that aeration of the crista would come from ethmoid cells. After observing crista pneumatization from the frontal sinuses in several cases, we undertook this study to establish how often crista galli pneumatization came from the frontal sinuses rather than from the ethmoid complex. **MATERIALS AND METHODS:** Two hundred consecutive CT scans of the paranasal sinuses were studied in adult patients to obtain the incidence of crista galli pneumatization and the cell of origin for this phenomenon. A second group of 132 children, 0--7 years of age, was studied to see if any crista galli pneumatization occurred before frontal sinus development. A third group of 79 children, 7--12 years of age, was also studied to see when crista pneumatization occurred in children whose frontal sinuses had already extended into the squamosal portion of the frontal bone. **RESULTS:** Of the 200 adult cases, there were 26 patients (13%) with crista galli pneumatization, all from either the left or right frontal sinuses. In the second group of children 0--7 years of age, there were no cases of crista pneumatization. In the third group of children 7--12 years of age, there were 4 cases of crista galli pneumatization, all from well-developed frontal sinuses. **CONCLUSIONS:** Our study indicates that crista galli pneumatization is virtually exclusively from either the left or right frontal sinuses and not from displaced ethmoid complex cells in the frontal recess. This finding may have surgical implications when disease is present in the crista galli.

Primary Intraosseous Hemangioma in the Frontal Bone

Primary Intraosseous Hemangioma in the Frontal Bone

Trephination of the Frontal Sinuses and Instillation of Clotrimazole Cream: A Computed Tomographic Study in Canine Cadavers

To use computed tomography (CT) to assess the distribution of surgically administered clotrimazole cream and associated filling of the frontal sinuses and caudal aspect of the nasal cavities in canine cadavers. Observational study. Small (n = 1) and medium-large (n = 11) breed canine cadavers. CT scans of 12 cadaveric canine heads were used to confirm absence of sinonasal disease. Then after creating an opening into the left and right frontal sinuses with a 3.2 mm Steinmann pin at standardized landmarks, clotrimazole cream (20 g) was instilled into each side. Postoperative CT scans of the heads was used to assess the distribution and degree of filling of the sinonasal cavities with clotrimazole cream, and to identify any damage to local structures. Filling was excellent in 22 sinuses, very poor in 2, and excellent in all caudal nasal cavities. Two cadavers had damage: unilateral penetration of the cranium (2) and unilateral penetration of the lateral sinus wall (1). Excellent filling of most of the frontal sinuses and caudal nasal cavity of cadavers with clotrimazole cream is achieved when administered by this technique. Damage to local structures may occur intraoperatively using this technique.

Anterior table remodeling after treatment for Pott's Puffy Tumor

We report a case of near-complete remodeling of the anterior table of the frontal sinus after treatment for an erosive Pott's Puffy Tumor. A 61-year-old male presented with progressive swelling of his left forehead. Examination showed a doughy left forehead mass, and a sinus CT showed a lateral left frontal sinus mucocele with complete anterior table erosion. Frontal trephination with marsupialization of the mucocele was performed, and at 8 month follow-up, the patient had no visible defect and only minimally palpable bony defect. The anterior table had remodeled with no additional intervention resulting in a cosmetic outcome imperceptible from the patient's baseline.

ONCOCYTIC SCHNEIDERIAN PAPILLOMA OF FRONTAL SINUS

Oncocytic Schneiderian papilloma (OSP) is one of the three morphologically distinct tumors that arise from Schneiderian membrane (the others include exophytic papilloma and inverted papilloma). OSP almost always occurs unilaterally in the paranasal sinuses, usually in the maxillary sinus, ethmoid cells or sphenoid sinus. We report a case of a 64-year-old woman with OSP arising from the left frontal sinus. In the report herein, we describe an OSP originating in the region of frontal sinus, which, to the best of our knowledge, represents the first documented example in English literature of OSP developing in this anatomical site.

Temporary regression of locally invasive polypoid rhinosinusitis in a dog after photodynamic therapy

A 5-year-old male cross-breed dog with chronic rhinosinusitis was presented. Computed tomography (CT) revealed opacities consistent with soft tissue or fluid in the left nasal cavity and frontal sinus. A diagnosis of chronic rhinosinusitis with myxomatous polyps was based on the histology of biopsy samples, so prednisolone treatment was administered for 1 month. Although the clinical signs slightly improved, no changes were observed on the CT images. At 8 months after the initial presentation, the dog was treated with antivascular photodynamic therapy (PDT) using benzoporphyrin derivative monoacid ring A and, 11 days later, CT revealed remarkably decreased soft tissue opacity; the facial swelling and sneezing also resolved. Three additional sessions of PDT were performed at 114, 210, and 303 days after the first PDT because of recurrence of clinical signs. The disease was well controlled for approximately 10 months by antivascular PDT.

Frontal Sinus Cholesteatoma

Objective: To describe a case of frontal sinus cholesteatoma and review the characteristics of this pathology. Method: Case report: 32-year-old white man. First symptoms: frontal pressure, proptosis of left eye with downward displacement (no visual symptoms or eye movement impairment). ENT examination and nasal endoscopy were normal. CT of paranasal sinuses: large mass in the left frontal sinus, with destruction of orbital and cranial blades. Results: An endoscopic approach of the frontal sinus was attempted with no success. Nothing could be extracted from the left frontal sinus. Therefore an open approach was attempted, an external approach, using a Lynch incision. By this method we were able to clear out the medial and lateral parts of the left frontal sinus, taking out enough material to be examined by the pathologist. What came out was a cheese-like debris with a pearly aspect. The final histopathological analysis revealed that the mass was a cholesteatoma of the frontal sinus. Conclusion: Cholesteatoma is a common pathology of the middle ear. There are few cases reported in the paranasal sinuses. The cholesteatoma is a benign tumor that can become locally aggressive when it promotes erosion of the bone by pressure and also by the production of proteolytic substances, invading the surrounding structures.

Rzadki przypadek chłoniaka złośliwego zatoki czołowej objawiający się w postaci pyocele

Lymphoma (mostly NHL) accounts for 3–5% of all malignant tumors. Only 0.17–2% of lymphoma localizes in the sinonasal tract. Lymphoma of the frontal sinus is extremely rare. The symptoms are often nonspecific and differentiating between inflammatory and neoplastic changes of the frontal sinus is very difficult. The aim of this study was to present a case of a patient operated on because of the left frontal sinus pyocele with orbital complication, in which histopathological examination revealed the presence of malignant lymphoma. The complication of sinusitis was suspected because of the rapid development of symptoms in the formerly healthy patient. The CT and MRI revealed erosion of the anterior and posterior table of the frontal bone and the roof of the orbit and the pathological mass of the frontal sinus penetrating into the orbit. The infected mucocele was initially diagnosed. Histopathologic analysis of the mass removed by the external approach revealed diffuse large B-cell lymphoma. The differential diagnosis of the sinus pathology with bone destruction should include malignant tumors, including lymphomas, despite their rarity in this area. The external approach to the frontal sinus affords good visualization and taking the appropriate material for histopathology, which is crucial for the final diagnosis. In the case of malignant lymphoma of the frontal sinus ENT role is limited to the collection of material and treatment of potential inflammatory complications.

Frontal Sinus Osteoma with Osteoblastoma-like Histology and Associated Intracranial Pneumatocele

Osteomas of the cranial sinuses are rare, benign bony tumors that can be complicated by the formation of an intracranial pneumatocele. If not treated promptly, a pneumatocele can lead to abscess formation, meningitis, or ventriculitis. In the present case, an intracerebral pneumatocele was formed when an 18 cm(3) osteoma breached the posterior wall of the frontal sinus creating a one-way valve through which air could enter the intracranial cavity. The patient presented after forceful sneezing with nonspecific symptoms of headache, nausea, and vomiting. CT demonstrated a frontal collection of loculated air with mass effect within the left cerebral hemisphere. A partly mineralized mass occupied the left superior nasal ethmoid sinus and left frontal sinus. Of interest pathologically in this case, the tumor had a substantial osteoblastoma-like component. Surgical repair involved frontal craniotomy to remove the osteoma and debride frontal sinus mucosa, plugging the frontal nasal ducts and sinus with fat and bone wax, and dural restoration using an underwater closed drainage system to vent intracranial air and stabilize the patient.

Cerebrospinal Fluid Rhinorrhea: Causes, Sites, Management and Recurrence

The aim of this study is to report the sites, management and recurrence of rhinorrhea, and to compare our results with those obtained from other centers. The medical records of patients with cerebrospinal fluid rhinorrhea in Otorhinolaryngology, and Head and Neck Surgery Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2003 to May 2011 were retrospectively reviewed. Ten cases of cerebrospinal fluid rhinorrhea were treated during the study period. The most frequent causes were endoscopic sinus surgery (50%), spontaneous (30%) and others (20%). Defects were located at the cerebriform plate (n = 6), left fronto-ethmoidal area (n = 1), at roof of the left frontal sinus (n = 1), at the junction between the cerebriform plate and bulla ethmoidalis (n = 1), and at the roof of the sphenoid sinus (n = 1). Patients were followed up for 6 to 24 months. The initial closure was successful in 6 patients; 5 after endoscopic sinus surgery and 1 after conservative treatment. Overall closure rate was 90.0%; 87.5% after endoscopic sinus surgeries. In conclusion, the most frequent cause of cerebrospinal fluid rhinorrhea was endoscopic sinus surgery and the cerebriform plate was the most common defect location. The overall rate of closure after endoscopic sinus surgery and conservative treatment was high.

Solitary Neurofibroma of the Frontal Sinus

Isolated or solitary neurofibromas of the paranasal sinuses are rare. Mostly, they involve the maxillary sinus and so far, a solitary neurofibroma of the frontal sinus has never been reported in the literature. We present a case of frontal sinus neurofibroma treated successfully with surgical excision. A 28-year-old male presented with forehead swelling and computed tomography images revealed a tumor involving the left frontal sinus. Histopathological examination showed the tumor to be a neurofibroma. We discuss the clinical and pathological characteristics of neurofibroma arising in the nasal cavity and paranasal sinuses.

Recurrent nasal polyp and pansinus mucopyocele associated with bilateral blindness: A case report

A 39 year old female with 24-month history of recurrent mucoid rhinorhea associated with progressive bilateral nasal blockage, headache, anosmia and bilateral impaired vision is reported. There was a past history of sinus surgery. The neuro-ophthalmic examination revealed left non-axial proptosis and visual acuity of nil light perception in both eyes at 3 meters. CT scan of the paranasal sinuses and brain showed markedly expanded left frontal sinus with sclerotic walls and expanded mixed density lesion in all the sinuses. She had surgery via trans-nasal, external and skull base approaches for effective clearance of the polypoidal masses and drainage of the sinus mucopyocele. Histological examination confirmed chronic inflammatory polyp. She remains stable to date although visual impairment and anosmia remained persistent. Patients with nasal polyposis require frequent follow-up even after surgical treatment for the early detection and management of complications to avoid consequences such as visual loss.

Allergic Fungal Sinusitis With Massive Intracranial Extension Presenting With Tearing

A 24-year-old male presented with tearing, and subsequent workup and imaging showed a mass with fluid involving the nasopharynx, the paranasal sinuses, and the posterior dehiscence of the left frontal sinus intracranially compressing the frontal lobe significantly. Microscopic examination confirmed the diagnosis of allergic fungal sinusitis. Endoscopic drainage and sinostomy was performed by the otolaryngology (ear-nose-throat) service. The patient was followed 9 months postoperatively and did well with resolution of the epiphora. Although epiphora alone is an unusual presentation of allergic fungal sinusitis, ophthalmologists need to be aware of this entity, as it may invade the orbit through the sinus cavities or compress on the nasolacrimal duct before it causes other mass-related symptoms. Radiology and the characteristic histopathologic findings are the most useful in establishing the correct diagnosis.

Superior oblique muscle palsy after frontal sinus mini-trephine

ObjectiveThe aim of this study is to present a case of superior oblique muscle dysfunction after a frontal sinus mini-trephine. MethodsThis is a case report of an 18-year-old woman where a mini-trephination approach and endoscope were used to open and marsupialize a symptomatic, opacified type IV cell within the left frontal sinus. After surgery, the patient developed a persisting diplopia; a left superior oblique muscle palsy was diagnosed. Nine cadaveric dissections of the trochlea were undertaken to clarify mechanisms for potential trochlear damage. ResultsCadaveric dissection reveals that the trochlea is more than a simple pulley; it is a complex structure in close proximity to the orbital rim. The superior oblique tendon telescopes and is surrounded by a vascular sheath that could be easily traumatized. ConclusionDamage to the trochlea could occur, as the periosteum is elevated from bone or during healing. Alternatively, prolonged traction on soft tissue near the trochlea could cause swelling of the vascular sheath, fibrosis, and hypomobility of the superior oblique tendon. Careful siting of the incision for external frontal sinus surgery as well as careful retraction of skin flaps and periosteal elevation are all techniques used, which should reduce the risk of damage to the trochlea.

A Case of Paranasal Sinuses Osteoma Detected on Bone SPECT/CT

We present a 51-year-old woman with a history of colectomy for colon cancer who was referred to our department for bone assessment. Planar image revealed a focus of increased uptake of Tc-99m methylene diphosphonate in the nose root. According to the images of SPECT combined with low-dose CT, the abnormal radiotracer uptake at the site of left frontal sinus was considered to be osteoma. We conclude that SPECT/CT provides an accurate evaluation of the localization of the lesions and supplies anatomic information that can be valuable for diagnosis of nonmalignant bone diseases.

Supraorbital Rim Contour Restoration with Porous Polyethylene Implant via Preexisting Scar

Isolated anterior wall fractures with displaced fragments require surgical correction to restore normal forehead contour. The anterior wall is returned to its anatomic position and stabilized with either suture, wire, or metal or resorbable plates, according to the surgeon's desire and the patient's age.1 Treatment principles are emerging from published studies.2 Many cases with solitary depressed anterior wall fractures require anterior wall restoration to obtain aesthetically acceptable contours.3 We present a 40-year-old man who had left supraorbital rim depression caused by blunt trauma 1 year previously. Anterior wall fracture of the left frontal sinus was evaluated with computed tomography (CT; Fig. ​Fig.1).1). He was treated by porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA) sheet implant (1.5 mm thick; 50 mm wide × 76 mm long) via supraorbital preexisting scar to avoid coronal incision (Fig. 1). In the standard treatment modality of frontal sinus fractures, repair is best performed by way of a coronal approach, which offers excellent access.3 The patient did not want a coronal incision for the contour restoration surgery with implant. The patient did not want to autolog bone graft for restoration of the supraorbital rim contour due to the graft donor site morbidity. He was treated by porous polyethylene implant. The porous polyethylene implants have biomaterial properties favorable for facial skeletal contour restoration.4,5 The frontal bar depression was accessed by way of preexisting scar (Fig. 1). First, the scar was removed and the subperiosteal space was entered along the supraorbital rim after incision of the periosteum medially (Fig. 1). Supraorbital soft tissues and neurovascular pedicles were carefully lifted out of the depression area. The porous polyethylene sheet implant overlapped the defect of depression edges. The implant was shaped to bridge the defect and was inserted below the periosteum without any fixation with screws or sutures (Fig. 1). Before implantation, the implant was soaked in antibiotic solution containing 1 g ceftriaxone. Oral first-generation cephalosporin was given every 12 hours for 5 days postoperatively. A compressive garment was used to stabilize the polyethylene implant for 1 week postoperatively. No infection was seen in the early or late postoperative period. At 12-month follow-up, the patient did not complain of any disturbance (Fig. 2). We have experienced these rules in our case: Figure 1 Left supraorbital rim depression (top, left). Preexisting scar on the left supraorbital rim (top, right). Preoperative computed tomography (bottom, left). Medpor sheet implant was inserted the subperiosteal ... Figure 2 Late postoperative view of frontal area. Preexisting scar on the supraorbital area should not be exposed to protect the neurovascular bundle, which is important. If access via the preexisting scar is used for contour restoration, preoperative CT evaluation must be precise to calculate the contour of the defect for the alloplastic material. A compressive garment must be used to stabilize the polyethylene implant for 1 week if rigid fixation material is not used to stabilize the alloplastic material. If the surgeon follows these rules, the surgical approach is less invasive and the operation can be performed without problems in selected cases.