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The Frontal Sinus
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The frontal sinus ostium drains into an hourglass shaped space termed the frontal recess. Previously, this was incorrectly termed the frontonasal duct but it is not a tubular structure. The frontal recess is a three-dimensional space which communicates with the ethmoidal infundibulum within the middle meatus. In essence the ventilation and drainage of both the maxillary and frontal sinuses pass through narrow complex clefts and spaces before they reach the middle meatus. These clefts and spaces are part of the anterior ethmoid air cells. A normal healthy frontal sinus is therefore dependent on the health of the anterior ethmoids.
Craniofacial trauma, including management of frontal sinus and nasoethmoidal injuries
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
The treatment of the frontal sinus is controversial, not least of all as prospective studies in this area are few and most algorithms relate to the retrospective analysis of a unit’s data over many years. There is a problem as studies certainly have shown complications many years after the original treatment, often presenting in other centres where the original treatment details are not known. It is safe to assume that one unit’s complications may well be treated by another unit due to the time scales involved. Nonetheless, there has been a consensus about what one is hoping to achieve, namely a ‘safe sinus’ with the least intervention necessary. The frontal sinus is of variable size and is lined by respiratory epithelium that communicates via the frontonasal duct with the middle meatus of the nose. The duct is again in a variable structure, being well defined in some instances, but in more than 60% of cases achieves its drainage via communication with the ethmoidal air cells (Figure 59.19).
Head
Published in Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden, Human Sectional Anatomy, 2017
Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden
This section passes through the apex of the squamous part of the occipital bone (16) and the frontal sinus (3). These are paired but are rarely symmetrical, while the septum between them is usually deviated from the midline. They vary greatly in size, as may be appreciated from viewing a number of skull radiographs. Each lies posterior to the supercilliary arch and extends upwards above the medial part of the eyebrow and back on to the medial part of the orbital roof. Sometimes they are divided by incomplete bony septa; rarely, one or both may be absent. Each drains into the anterior part of the middle meatus on the lateral wall of the nasal cavity via the frontonasal duct.
Patient presenting with frontal subperiosteal abscess and headache: a case of Pott’s puffy tumour
Published in British Journal of Neurosurgery, 2019
In order to evaluate the intracranial cavity and the dura that is adjacent to the erosion in the posterior wall of the frontal sinus, MRI study with contrast was obtained and there was no sign of intracranial abscess. We had the DTI study and ruled out dural inflammation (Figure 2). Ceftriaxone and metronidazole combination was commenced initially. We decided to drain the abscess and remove the osteomyelitic bone to explore the posterior wall as well. Via a supraorbital rim incision, the abscess in forehead was drained externally. Through the same incision, osteomyelitis debridement was performed using a high-speed drill and the frontonasal duct was enlarged endoscopically. Mucus was removed to sustain patency of the duct. Because of the severe nasoseptal deviation as seen on PNS CT scan, endoscopic enlargement of the duct without bone curettage would not be enough to treat the abscess. Bony surfaces were scraped with a curette and drilled as needed. Posterior wall of the frontal sinus seemed to be intact with bare eye exploration, but surgical microscope showed suspicious interruption in its continuity. However, we did not want to cause an iatrogenic wall defect and probable cerebrospinal fluid fistula in the posterior table, so we scraped the posterior wall superficially with diamond drill. Sinus cavity was rinsed intensely with antibiotic added saline. A silastic tube extending into the frontal sinus cavity was placed in the frontonasal duct and kept for a week for irrigation and aeration. Two days later, Pseudomonas aeruoginosa sensitive to ciprofloxacin was isolated and we changed the antibiotic according to the results of the aspirate culture and antibiogram. Antibiotic was continued for a total period of 6 weeks. Nasal sinus rinse was continued daily with saline in the meantime. Since the patient had a severe nasal septum deviation, it was fixed surgically in the end of six weeks. An anterior wall reconstruction surgery was proposed to the patient but he refused. His symptoms totally resolved and all medications were ceased one week after the second surgical intervention. On his third month follow up examinations, we found out that he had fully recovered. His cranial MR scan also discerned radiological recovery.