The Effects of Cranial Orientation on Forensic Frontal Sinus Identification as Assessed by Outline Analyses

The utility of frontal sinuses for personal identification is widely recognized, but potential factors affecting its reliability remain uncertain. Deviations in cranial position between antemortem and postmortem radiographs may affect sinus appearance. This study investigates how slight deviations in orientations affect sinus size and outline shape and potentially impact identification. Frontal sinus models were created from CT scans of 21 individuals and digitally oriented to represent three clinically relevant radiographic views. From each standard view, model orientations were deviated at 5° intervals in horizontal, vertical, and diagonal (e.g., left-up) directions (27 orientations per individual). For each orientation, sinus dimensions were obtained, and outline shape was assessed by elliptical Fourier analyses and principal component (PC) analyses. Wilcoxon sign rank tests indicated that sinus breadth remained relatively stable (p > 0.05), while sinus height was significantly affected with vertical deviations (p < 0.006). Mann–Whitney U tests on Euclidean distances from the PC scores indicated consistently lower intra- versus inter-individual distances (p < 0.05). Two of the three orientations maintained perfect (100%) outline identification matches, while the third had a 98% match rate. Smaller and/or discontinuous sinuses were most problematic, and although match rates are high, practitioners should be aware of possible alterations in sinus variables when conducting frontal sinus identifications.

Co-Infection of Mucormycosis and Actinomycosis in COVID-19 Infection

Coronavirus disease 2019 (COVID-19) is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 infection may be associated with a wide range of bacterial and fungal co-infections. Herewith a case of 46 year-old male patient of post COVID-19 developed co-infection. He had received steroid treatment and improved in last month. He is known case of diabetes type II since last one year and was on treatment. Now presented to our hospital having fever, facial pain, and swelling mid-face region. His RT-PCR test was positive. The CT scan of the nasal septum, medial walls of bilateral maxillary, ethmoid, sphenoid and frontal sinuses exteding into bilateral nasal cavities. Features suggestive of infective pathology invasive fungal rhinosinusitis On clinical, radio imaging and on histopathological findings diagnosed as maxillary mucormycosis with actinomycosis. Conclusion: We are presenting this rare case of COVID-19 associated with co-infection of mucormycosis and actinomycosis for its clinical, radio imaging, and on histopathological findings. Key words: Coronavirus Disease 2019 (COVID-19), Mucormycosis, Actinomycosis, Co-infections.

Fabricating A Maxillofacial Prosthesis with A Novel Suspension Technique for A Person with Exenteration: A Case Report

Introduction: Making a prosthesis is challenging for people who have lost an eye and parts of their cheekbones and nasal tissues. Suspending the prosthesis is a significant problem because of the open nasal cavity and the vast lesion area on the face. Case Presentation: This case report describes a new suspension technique used for a maxillofacial prosthesis on a person who had an exenterated left eye and parts of his maxillary and frontal sinuses had been removed due to infection. Since the sinus and nasal cavities were exposed, we could not use the conventional methods (anatomical, mechanical, chemical, and surgical) for suspending the prosthesis. Therefore, a new prosthetic suspension technique was used to solve this problem. Conclusion: In this clinical report, we used an optimal and effective method to make a prosthesis that can be used in similar cases of eye loss and extensive loss of the face. This new method does not need adhesives and minimizes the donning and doffing time of the prosthesis.

Gas Monitoring in Human Frontal Sinuses–Stability Considerations and Gas Exchange Studies

Acute rhinosinusitis is a common infectious disease, which, in more than 90% of cases, is caused by viruses rather than by bacteria. Even so, antibiotics are often unnecessarily prescribed, and in the long run this contributes to the alarming level of antibiotics resistance. The reason is that there are no good guiding tools for defining the background reason of the infection. One main factor for the clearance of the infection is if there is non-obstructed ventilation from the sinus to the nasal cavity. Gas in Scattering Media Absorption Spectroscopy (GASMAS) has potential for diagnosing this. We have performed a study of frontal sinuses of volunteers with a focus on signal stability and reproducibility over time, accurate oxygen concentration determination, and assessment of gas transport through passages, naturally and after decongestant spray administration. Different from earlier studies on frontal sinuses, water vapor, serving the purpose of oxygen signal normalization, was measured at 818 nm rather than earlier at 937 nm, now closer to the 760 nm oxygen absorption band and thus resulting in more reliable results. In addition, the action of decongestants was objectively demonstrated for the first time. Evaluated oxygen concentration values for left- and right-hand side sinus cavities were found to agree within 0.3%, and a left-right geometrical asymmetry parameter related to anatomical differences was stable within 10%.

Frontal Sinus Schwannoma: Case Report and Literature Review

Whilst schwannomas are mostly developed in the head neck area, the sinonasal involvement is extremely rare, especially those of the frontal sinus. We report a patient with sinonasal schwannoma, invading both frontal sinuses, anterior cranial fossa, the left anterior ethmoidal sinus, and the left nasal cavity. Radiologic imaging showed an isodensed, T2 isointense, T1 hypointense, with heterogeneous enhanced postcontrast mass with bone destruction. The patient underwent resection of the tumor via two approaches, external one and endonasal one. The histological diagnosis was consistent with a schwannoma. The follow-up was marked by the presence of diplopia without any signs of meningitis or cerebrospinal fluid rhinorrhoea.

Orbital Apex Syndrome Due to Mucormycosis – Missed on Initial MRI

A 64-year-old man with a history of diabetes mellitus and end stage renal disease presented with a several day history of cognitive decline, reduced right eye visual acuity accompanied with a complete right ophthalmoplegia in keeping with orbital apex syndrome. Initial MRI was unremarkable other than mucosal thickening in the frontal sinuses. He continued to clinically decline and repeat MRI revealed an edematous right optic nerve and a lack of enhancement within the sinuses was suspicion for invasive fungal infection. Given his history of diabetes, he was started on anti-fungal treatment and taken for debridement but passed away several days later. This case illustrates the importance of the orbital apex syndrome as a localization. Mucormycosis should be considered in acute onset ophthalmoplegia particularly in patients with diabetes and diabetic ketoacidosis. Empiric anti-fungal therapy should be started early for suspected rhino-orbital cerebral mucormycosis, although mortality remains high despite treatment.

Cruveilhier’s Unrecognized Case (c1831) of Dyke-Davidoff-Masson Syndrome

In his serially published atlas of pathology, <i>Anatomie Pathologique du Corps Humain</i> (1829–1842), French anatomist and pathologist Jean Cruveilhier (1791–1874) provided an early clinical-pathologic description of Dyke-Davidoff-Masson syndrome. Cruveilhier’s case was initially published around 1830, more than a century before the clinical and radiologic report of Dyke and colleagues in 1933 based on a series of patients studied with pneumoencephalography. Although Dyke and colleagues were apparently unaware of Cruveilhier’s prior description, Cruveilhier’s case manifested all of the key osseous and neuropathological features of Dyke-Davidoff-Masson syndrome as later elaborated by Dyke and colleagues: (1) cerebral hemiatrophy with <i>ex vacuo</i> dilation of the lateral ventricle, (2) ipsilateral thickening of the diploe of the skull, and (3) ipsilateral hyper-pneumatization of the frontal sinuses. In addition, Cruveilhier noted crossed cerebral-cerebellar atrophy in his case and correctly inferred a “crossed effect” between the involved cerebral hemisphere and the contralateral cerebellum. Cruveilhier’s pathological case from 1830 clearly anticipated both the cases reported more than a century later by Dyke and colleagues based on pneumoencephalography and the more recent case reports recognized with computed tomography or magnetic resonance imaging.

Distinctive morphometric measurement of frontal sinuses among the female ethnic populations living in Karachi

Objective: To determine uniqueness of frontal air sinuses in the female ethnic populations living in Karachi Methods: The study type was cross sectional descriptive study. It was conducted at the Radiology Department of Jinnah Postgraduate Medical Center from November 2018 to April 2019. The research participants were females and 108 in number. They were divided into four ethnic groups. Each ethnic group consisted of 27 members. Mean age of the research participants was 35.14 ± 8.68 years. Before the enrolment of the participants in the research, informed consent was taken. Frontal sinus, X-ray radiography was done by using STEPHNEX machine. The radiological view incorporated was Water’s view. Width, height and area of the right and left frontal sinuses were measured. The radiographs were saved in the JPEG format and then the measurements were done by RadiAnt DICOM digital software. In the proforma measurements of height, width and area were noted. Data analysis was done by using the SPSS version 23.0. Results: Comparison of the ethnic groups was done by using the application of One Way ANOVA. When the parameters of the frontal air sinuses were compared, variability in terms of width, height and area were noted in the right frontal air sinuses (p=0.000). Highly significant variations were also noted for these parameters on the left side (p=0.000). Conclusion: The width, height and area of right and left frontal sinuses showed variability among the female ethnic groups living in Karachi. Continuous...