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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.
Radiographic Examination
Published in Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez, Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Mark Schoemann, Thomas C. Lee, Srinivasan Jr. Mukundan
Axial views with CT provide the optimal method for assessing injury to the frontal sinus, and coronal views are most useful for determining the status of the nasofrontal outflow tract. Indicators that a frontal sinus fracture is present are an air-fluid level in the sinus and pneumocephalus. Evaluation of the frontal sinus begins by looking at the anterior and posterior walls. If a fracture is present, the degree of comminution and displacement of the walls should be noted. In most patients there is usually an intersinus septation that divides the frontal sinus into a right and left half. However, in approximately 20% of patients the frontal sinus is rudimentary or entirely absent. The frontal sinus drains interiorly via paired hourglass shaped structures, the nasofrontal recesses, which travel through the anterior ethmoidal labyrinth and ultimately drain into the middle meatus. The frontal sinus infundibulum forms the cephalad portion of the hourglass and narrows to form the true frontal sinus ostium. The nasofrontal recess splays out caudal to the frontal sinus ostium and enters the ethmoid infundibulum. The nasofrontal recess is extremely short in 85% of individuals and represents a recess rather than a true ductal structure. Indicators of nasofrontal recess injury are involvement of the base of the frontal sinus or anterior ethmoid complex. Evaluation of the nasofrontal recess is best done with coronal cuts, because the frontal sinus floor and ethmoid complex are better visualized, as seen in Fig. 5-1.
The paranasal sinuses
Published in Rogan J Corbridge, Essential ENT, 2011
Antrostomy involves making a drainage hole into the sinus, usually the maxillary antrum. This may be an artificial hole (made in the inferior meatus) or may involve enlarging the natural sinus ostium (in the middle meatus). Nowadays, this is usually performed with the aid of an endoscope.
Pediatric pituitary adenoma with mixed FSH and TSH immunostaining and FSH hypersecretion in a 6 year-old girl with precocious puberty: case report and multidisciplinary management
Published in International Journal of Neuroscience, 2022
Marco Ceraudo, Diego Criminelli Rossi, Natascia Di Iorgi, Armando Cama, Gianluca Piatelli, Alessandro Consales
The patient successfully underwent transsphenoidal endoscopic resection of the pituitary macroadenoma (Figure 3). After local decongestion of the nasal mucosa, a paraseptal dissection up to the rostrum and sphenoid sinus ostium was performed. Anterior sphenoidectomy allowed the exposure of a large sellar floor. Using high speed drill, sphenoid septa and a thin sellar floor bone layer were removed. Once the dura was incised, a soft and fluffy yellow mass came out. There was no evidence of intralesional hemorrhages or cavernous sinus wall invasion. Using different types of endoscopic curette, complete resection was achieved. Modified endoscopic diving technique hydrodissection [14] was performed in order to remove any tumor residual, check grade of resection and control the integrity of diaphragma sellae and cavernous sinus walls. No CSF leaks were found and skull base reconstruction was performed using heterologous dural substitute, fibrin glue and other haemostatic agents. Nasal swabs were left in both nostrils for the subsequent five days.
Frontoethmoidal mucocele presenting with ocular manifestations
Published in Clinical and Experimental Optometry, 2020
Mucocele of the paranasal sinuses is a slowly expanding benign lesion developing when there is impeded physiological drainage of the mucous produced by the epithelial lining of the paranasal sinuses.2007 The paranasal sinus occlusion occurs at the sinus ostium, which is an opening that connects the sinus to the nasal cavity. Aetiologies of ostial occlusion include infection, allergy, trauma, previous surgery, benign neoplasm (osteoma or fibrous dysplasia), and malignant or metastatic tumours.2003 Other suggested aetiologies include a cystic degeneration of a goblet cell gland.2007 Mucocele were first described in the third century by BC Cannalis, when he described a cranium with changes in the frontal sinus.2017 Citations in the early 1700s are present,2001 in addition to descriptions in 1819 by Langenbeck.1819 The term mucocele was first introduced by Rollet in 1896.1896 Before this time, mucoceles were termed hydatid cysts, from the Greek word hydatis, meaning ‘drop of water’.2008
Recent advances in the diagnosis of allergic rhinitis
Published in Expert Review of Clinical Immunology, 2018
Xiangdong Wang, Kun Du, Wenyu She, Yuhui Ouyang, Yutong Sima, Chengyao Liu, Luo Zhang
Clinical studies have shown that exhaled NO can be used as a noninvasive mediator and clinical biomarker, which can be used to determine the presence and degree of inflammation in the lower respiratory tract [84,85]. In the upper airway, some studies have demonstrated an increased level of nNO in patients with AR [86,87] and a decreased level of nNO in non-AR patients [81] compared with normal subjects. Suojalehto et al. [88] . showed that in patients with allergies, the level of nNO level was low, which could be attributed to sinus ostium obstruction. Previous studies have also demonstrated reduced nNO levels in patients with chronic rhinosinusitis (CRS) [81,89,90], and nasal polyps [83,86,91,92]. Lower nNO level could be found in patients with CRS with nasal polyps (CRSwNP) when compared with CRS without nasal polyps (CRSsNP) [86,93,94]. The levels of nNO have also been shown to be increased in patients with atopic polyps [81,86,95], such as atopic asthma[96]. Therefore, nNO may be a potential clinical biomarker of upper airway inflammation. Further, nNO levels show a significant correlation with nasal mucus inflammation indicators [89,90,92,97].