Clinical and Radiologic Characterization of Frontal Sinusitis in the Pediatric Population

2021 ◽  
pp. 000348942098796
Author(s):  
Nathalia Velasquez ◽  
William Strober ◽  
Amber Shaffer ◽  
Amanda Stapleton
Keyword(s):  
Frontal Sinus ◽  
Pediatric Population ◽  
Statistical Significance ◽  
Sinus Surgery ◽  
Treatment Modalities ◽  
Correct Identification ◽  
Frontal Sinusitis ◽  
Normal Flora ◽  
Sinus Disease ◽  
Male Predominance

Introduction: Frontal sinusitis in the pediatric population is a disease that has not been thoroughly studied or characterized. The goals of this study are to characterize the clinical presentation, radiologic variables, treatment modalities, complications, and prognosis associated with acute and chronic frontal sinus disease in the pediatric population. Methods: IRB-approved retrospective cohort study of pediatric patients who were diagnosed with acute (AFS) or chronic frontal sinusitis (CFS) and underwent frontal sinus surgery at a tertiary level Children’s Hospital from 2006 to 2016. Patients with AFS were compared to patients with CFS. Statistical analysis completed using chi-square test or Fisher’s exact test, statistical significance set at P < .05. Results: A total of 19 patients with AFS and 15 patients with CFS were analyzed. There was a male predominance in AFS and female predominance in CFS ( P < .05).AFS patients were less likely to have allergies, prior sinus disease, or significant comorbidities ( P < .05).Additionally, AFS patients presented with constitutional, neurologic, and ocular symptoms. The CFS group had predominantly sinonasal symptoms. CT-scan analysis showed that AFS patients had higher prevalence of complex frontal anatomy (Type-II cells, concha bullosa) compared with CFS patients ( P < .05). Culture results were positive in 78% of the AFS group, with S. Anginosus (53%), Anaerobes (20%), and normal flora (17%). In the CFS group cultures were positive in 60% of the patients, 56% grew normal flora, 13% H. Influenzae, 6.5% Pseudomonas, and 24.5% other species. CFS patients were more likely to have persistent sinus disease and require repeat sinus procedures ( P < .05). Conclusion: There are 2 distinct presentations of frontal sinus disease in the pediatric population. Patients with AFS vary significantly from those with CFS. Males, ages 13 to 18 years old, who cultured positive for S. Anginosus (former S.Milleri) dominated the AFS subgroup. Whereas as female patients with a history of allergic rhinitis and muco-cilliary disease were more prominent in the CRS subgroup. Correct identification and understanding of these 2 different entities are crucial for the appropriate short and long-term patient management.

Role of the Agger Nasi Cell in Chronic Frontal Sinusitis

1996 ◽  
Vol 105 (9) ◽  
pp. 694-700 ◽  
Author(s):  
Joseph B. Jacobs ◽  
Barry A. Shpizner ◽  
Eugenie Brunner ◽  
Richard A. Lebowitz ◽  
Roy A. Holliday
Keyword(s):  
Frontal Sinus ◽  
Clinical History ◽  
Sinus Surgery ◽  
Frontal Sinusitis ◽  
Sinus Disease ◽  
Computed Tomographic ◽  
Mucosal Disease ◽  
Region Data ◽  
History Of

Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease.

scholarly journals Role of Osteoplastic Frontal Sinus Obliteration in the Era of Endoscopic Sinus Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Joshua B. Silverman ◽  
Stacey T. Gray ◽  
Nicolas Y. Busaba
Keyword(s):  
Frontal Sinus ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Salvage Procedure ◽  
Frontal Sinusitis ◽  
First Line ◽  
Total Study Population ◽  
Sinus Disease ◽  
History Of ◽  
Sinus Obliteration

Objective. Determining the indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease.Study Design. Retrospective case series from a single tertiary care facility.Methods. Thirty-four patients who underwent OFSO for chronic frontal sinusitis () and frontal sinus mucocele () comprised our study group. Data reviewed included demographics, history of prior frontal sinus operation(s), imaging, diagnosis, and operative complications.Results. The age range was 19 to 76 years. Seventy percent of patients with chronic frontal sinusitis underwent OFSO as a salvage surgery after previous frontal sinus surgery failures, while 30% underwent OFSO as a primary surgery. For those in whom OFSO was a salvage procedure, the failed surgeries were endoscopic approaches to the frontal sinus (69%), Lynch procedure (12%), and OFSO outside this study period (19%). For patients with frontal sinus mucocele, 72% had OFSO as a first-line surgery. Within the total study population, 15% of patients presented for OFSO with history of prior obliteration, with a range of 3 to 30 years between representations.Conclusions. Osteoplastic frontal sinus obliteration remains a key surgical treatment for chronic inflammatory frontal sinus disease both as a salvage procedure and first-line surgical therapy.

scholarly journals Extended endoscopic frontal nasal sinus surgery in management of chronic and recurrent frontal sinus diseases

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Sobhi Abdelaal ◽  
Mohamed Kamel Al Awady ◽  
Tawfik Abdelaty Elkholy
Keyword(s):  
Frontal Sinus ◽  
Anatomical Variation ◽  
Sinus Surgery ◽  
Frontal Sinusitis ◽  
Office Visits ◽  
Nasal Sinus ◽  
Frontal Sinus Surgery ◽  
Operative Care ◽  
Intimate Relation

Abstract Background The anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases. Results The neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations. Conclusion The chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

scholarly journals The Relationship Between the Width of the Frontal Recess and the Frontal Recess Cells in Japanese Patients

2019 ◽  
Vol 12 ◽  
pp. 117955061988494
Author(s):  
Seiichiro Makihara ◽  
Shin Kariya ◽  
Mitsuhiro Okano ◽  
Tomoyuki Naito ◽  
Kensuke Uraguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Frontal Sinus ◽  
Significant Positive Correlation ◽  
Japanese Patients ◽  
Cell Types ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Frontal Sinusitis ◽  
Frontal Recess ◽  
The Relationship

Objective: The agger nasi cell (ANC) is an easily identifiable landmark when approaching the frontal sinus. The success of endoscopic frontal sinus surgery may be influenced by the width of the frontal recess (FR). The aim of this study is to examine the relationship between the FR width and the ANC size in Japanese patients. In addition, the effect of various frontal recess cells (FRCs) on the development of frontal sinusitis has been examined. Materials and methods: Multiplanar computed tomography (CT) scans of the nasal cavities and paranasal sinuses in 95 patients (190 sides) before endoscopic sinus surgery were reviewed. The presence of FRCs, the thickness of the frontal beak (FB), the ANC size, and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR were evaluated in patients with and without frontal sinusitis. Results: The prevalence of the ANC, frontal cell types 1, 2, 3, and 4, frontal bullar cell (FBC), suprabullar cell, supraorbital ethmoid cell, and interfrontal sinus septal cell was 85.3%, 11.6%, 0%, 7.9%, 0%, 25.3%, 45.8%, 16.8%, and 15.3%, respectively. The ANC volume showed a significant positive correlation with the A-P length of the FI and FR. The incidence of frontal sinusitis in the patients with FBCs was significantly higher than that without FBCs. Conclusion: A large ANC offers a greater potential to facilitating the approach to the frontal sinus because of the extensiveness of the FR in Japanese patients. The presence of FBCs may be related to a higher incidence of frontal sinusitis.

Long-term stenting for chronic frontal sinus disease: case series and literature review

2010 ◽  
Vol 124 (11) ◽  
pp. 1216-1222 ◽  
Author(s):  
B Hunter ◽  
S Silva ◽  
R Youngs ◽  
A Saeed ◽  
V Varadarajan
Keyword(s):  
Frontal Sinus ◽  
Relevant Literature ◽  
Case Series ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Narrow Channels ◽  
Co Morbidity ◽  
Disease Case

AbstractObjective:The frontal sinus outflow tract consists anatomically of narrow channels prone to stenosis. Following both endonasal and external approach surgery, up to 30 per cent of patients suffer post-operative re-stenosis of the frontal sinus outflow tract, with recurrent frontal sinus disease. This paper proposes the surgical placement of a long-term frontal sinus stent to maintain fronto-nasal patency, as an alternative to more aggressive surgical procedures such as frontal sinus obliteration and modified Lothrop procedures.Design:We present a series of three patients with frontal sinus disease and significant co-morbidity, the latter making extensive surgery a significant health risk. We also review the relevant literature and discuss the use of long-term frontal sinus stenting.Results:These three cases were successfully treated with long-term frontal sinus stenting. Stents remained in situ for a period ranging from 48 to over 60 months.Conclusion:Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

scholarly journals Validation of the Maxillary Sinus Roof as a Landmark for Navigating the Pediatric Skull Base

2019 ◽  
Vol 129 (1) ◽  
pp. 12-17
Author(s):  
Sean S. Evans ◽  
Catherine Banks ◽  
Joshua Richman ◽  
Audie Woolley ◽  
Do Yeon Cho ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Skull Base ◽  
Retrospective Analysis ◽  
Pediatric Population ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Growth Patterns ◽  
Sinus Surgery ◽  
Nasal Floor ◽  
Anatomic Relationship

Objective: To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population. Study Design: Retrospective analysis. Setting: Tertiary care children hospital. Subjects and Methods: A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children’s hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a P-value of .05 indicating statistical significance. Results: Three hundred and seven unique scans were reviewed (38.9% female; n = 122; P = .58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS ( P < .001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ = .99 and .98 respectively, P ≤ .001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, P ≤ .001). Conclusion: Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery. Level of Evidence: 4

Frontal Sinus Surgery: The State of the Art

2016 ◽  
Vol 7 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Michael J Marino ◽  
Edward D McCoul
Keyword(s):  
Outcomes Research ◽  
Frontal Sinus ◽  
State Of The Art ◽  
The State ◽  
Sinus Surgery ◽  
Indications For Surgery ◽  
Ongoing Research ◽  
Sinus Disease ◽  
Frontal Sinus Surgery ◽  
Essential Components

ABSTRACT Aim: Review and describe the essential components of modern frontal sinus surgery. Background Frontal sinus surgery has evolved considerably over the last century, and advances in imaging, optics, and instrumentation have contributed to contemporary treatment paradigms. Outcomes assessment has had an important role in identifying indications for surgery and future areas of research. Review results Numerous advancements are part of modern frontal sinus surgery and the treatment of frontal sinusitis. Anatomic studies have revealed variations that are associated with disease and pose challenges for surgery. Open approaches remain relevant in situations of difficult disease or as part of combined approaches. Endoscopic surgery, however, is central to contemporary surgical management of frontal sinus disease. Evolving instrumentation and the development of new implantable devices are increasingly relevant in the endoscopic era. Outcomes research has refined indications for surgery and identifies areas for ongoing research. Conclusion State-of-the-art frontal sinus surgery is the product of significant evolution and advancement. Modern surgery is reflective of improved optics and new instrumentation, and the central role of endoscopic approaches in treating frontal sinus disease. Outcomes research has been essential for developing an evidenced-based approach to frontal sinus surgery. Clinical significance A review of the essential components of state-of-the-art frontal sinus surgery for the practicing otolaryngologist. How to cite this article Marino MJ, McCoul ED. Frontal Sinus Surgery: The State of the Art. Int J Head Neck Surg 2016;7(1): 5-12.

scholarly journals In-office Balloon Dilation and Drainage of Frontal Sinus Mucocele

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0041 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Jean Daniel Eloy ◽  
Paul D. Langer
Keyword(s):  
Patient Satisfaction ◽  
Operating Room ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Balloon Dilation ◽  
Sinus Surgery ◽  
Surgical Drainage ◽  
Sinus Disease ◽  
The Past ◽  
Office Procedures

Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Recently, there has been an increased interest in in-office procedures in otolaryngology because of patient satisfaction and substantial savings of time and cost for both patients and physicians. Similarly, the past few years have witnessed an increased use of balloon dilation devices in sinus surgery. Previously, we have described the in-office use of this device in treating patients who failed prior conventional frontal sinusotomy in the operating room. In this report, we describe our step-by-step in-office experience using this tool for drainage of a large frontal sinus mucocele.

scholarly journals A prospective study of the prevalence of Kuhn’s frontal cells and their relation to frontal sinus disease

2019 ◽  
Vol 5 (5) ◽  
pp. 1249
Author(s):  
Raam Deepak Krishnasamy ◽  
Karthikeyan Padmanabhan
Keyword(s):  
Frontal Sinus ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
P Value ◽  
Transverse Diameter ◽  
Frontal Sinusitis ◽  
Tertiary Care Centre ◽  
High Resolution Computed Tomography ◽  
Sinus Disease ◽  
Frontal Recess

<p class="abstract"><strong>Background:</strong> The involvement of frontal cells in the frontal sinus disease pathology remains an understudied area. There are very few reports on the prevalence of frontal recess cells in India. In this context the present study was designed to determine the frequency of occurrence of Kuhn frontal cells and to determine whether the size of the frontal isthmus or the presence of frontal cells is related to the presence of frontal sinus disease.</p><p class="abstract"><strong>Methods:</strong> This study included 80 patients who presented with signs and symptoms of chronic rhino-sinusitis after satisfying the inclusion criteria to the Department of ENT in a tertiary care centre (Mahatma Gandhi Medical College and Research Institute) in Pondicherry from January 2017 to April 2018. The patients were subjected to detailed clinical history, basic preoperative blood investigations, diagnostic nasal endoscopy and High Resolution Computed Tomography of nose and para-nasal sinuses after which the diagnosis was established.</p><p class="abstract"><strong>Results:</strong> Out of the 80 study participants subjected to our study the number of individuals who had frontal sinusitis was 50%. The association between frontal sinusitis and Kuhn cells was insignificant. The mean value of anteroposterior diameter of the naso-frontal isthmus in case of patients with and without frontal sinusitis was 0.705-0.735. In case of transverse diameter it was 0.725-0.720 and in case of the area of the frontal isthmus it was 30.86-31.12 which had a p value of 0.49</p><p><strong>Conclusions:</strong> Therefore in our study we concluded that there is no significant relation for any particular frontal recess cell or the size of the nasofrontal isthmus for being the sole cause for chronic frontal sinusitis.</p>

Frontal Sinus Disease: Treatment Options—Frontal Drillout

1995 ◽  
Vol 112 (5) ◽  
pp. P45-P45
Author(s):  
Charles W. Gross ◽  
Daniel G. Becker ◽  
William E. Gross
Keyword(s):  
Frontal Sinus ◽  
Treatment Options ◽  
Frontal Sinusitis ◽  
Educational Objectives ◽  
Disease Treatment ◽  
Full Spectrum ◽  
Sinus Disease

Educational objectives: To have an understanding of the full spectrum of medical and surgical modalities available in the treatment of severe persisting frontal sinusitis and to understand the anatomic principles and practical aspects of the modified transnasal endoscopic Lothrop procedure using drills or “frontal drillout. “

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