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Objective: To develop an appropriate method for removing giant frontoethmoidal osteomas and the immediate reconstruction of the anterior wall of the frontal sinus. Methods: Between 2016 and 2020, five patients (4 men and 1 woman) were admitted with an osteoma of the paranasal sinuses, of which three (2 men and 1 woman) were diagnosed with giant osteomas of the frontal and ethmoid region. The patients were aged 28 to 49 years. Routine clinical examinations were carried out, including collecting patient history and a CT scan of the paranasal sinuses. The giant osteomas were removed by minimally invasive transnasal endoscopic surgery with a combined anterior wall approach to the frontal sinus. The tumour size was reduced by excision with a surgical drill before removal to minimise the defect in the frontal sinus's anterior wall. The procedure was completed with the immediate reconstruction of the anterior wall of the frontal sinus using titanium nickelide mesh. Results: The length of hospital stay was 10 days. Wound healing occurred by primary intention, and the sutures were removed on the 8th day. Followup periods were between 1 month and 1 year. Follow-up examinations were carried out 1 week, 1, 6 and 12 months after hospital discharge. On the follow-up CT scans performed a year after the operation, the implanted titanium nickelide mesh was stable, the aeration of the frontal sinus was normal, and satisfactory cosmetic outcomes were reported. Conclusion: CT is the gold standard in determining the size of the osteoma, its spread, and the state of the walls of the paranasal sinuses. A combined surgical approach and debulking of the giant osteomas using a surgical drill with the immediate reconstruction of the anterior wall of the frontal sinus by titanium nickelide mesh produce favourable outcomes.

The present paper was aimed at the study of the peculiarities of the mucociliary system of the mucous membrane normal human frontal sinus (FS). Object and methods. Cadaveric material obtained from people of both sexes aged 26 to 75 years who died of causes not related to pathology of the paranasal sinuses has been studied in accordance with international guidelines for biological research. Results. The investigated glands are complex alveolar-tubular glands, which consist of a system of excretory ducts with the acini. The findings of our study showed a certain difference between the structure of the acini of the glands on the inferior wall, where they were divided into 2 types. The first type is characterized by the formation of the acini by the cuboidal cells, and the second type by the pyramidal cells. By the secretory products, the glands of the inferior wall are defined as proteinaceous and mucous, and the glands of the posterior wall are mixed. The morphometry showed that the values of the average thickness (pm) of the submucous layer of the posterior wall (PW) on both sides were by 74% lower compared to the parameter for the inferior wall (IW). No significant difference in the outer diameter (pm) of the acini of the glands of the specified walls on both sides was found. [ABSTRACT FROM AUTHOR]

Objective: to identify the variability of frontal sinuses size patterns divided by sex and age in adults. Material and Methods. 83 X-ray computer tomograms of the head of adults without any signs of paranasal sinuses pathology and without traces of surgery on the external structures and internal nose in the history were studied. Results. It has been found the best pneumatized frontal bones in males; the rapid growth of the frontal sinuses occurs more in men in the 1st age group, whereas in women, the formation of the frontal sinus is smoother and more uniform during the whole life. Conclusion. Men have depth prevailing characteristics of frontal sinuses in the 1st age group and the width on the left side in the 2nd age group differing significantly in comparison to women group; height of the sinus in men decreases with age, whereas in women it does not change its value significantly; bilateral values for the parameters of the frontal sinus do not have reliable sex and age differences.

Abstract. The purpose of the article is to present current surgical approaches to the removal of frontal ethmoid osteoma. The article analyzes and describes surgical techniques used at the department of otorhinolaryngology of the Central Clinical Hospital and Polyclinic for the treatment of osteomas located in the frontal sinus, frontal recess and ethmoidal labyrinth roof. Headache and eye symptoms are the main manifestations of the disease. The method of choice for symptomatic osteoma is surgical removal of neoplasm. The article describes different types of interventions including external, endoscopic endonasal and combined approach. In external approach preference should be given to access with the formation of bicoronary osteoplastic flap. The methods is appropriate in cases when the patient is operated for the first time, the osteoma occupies the majority of the sinus or is located laterally thus making it impossible to remove it transnasally. If the patient underwent a frontal sinus surgery earlier and has a cosmetic deformity, it is feasible to resort to radical surgery on frontal sinus with fat obliteration. Endoscopic endonasal access is applied in cases where the osteoma is located in the roof of ethmoidal labyrinth or frontal recess, as well as in cases when the frontal sinus osteoma does not obstruct outflow and frontal sinusitis is caused by anatomical narrowing of nasofrontal junction. In asymptomatic osteomas watchful waiting is recommended.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

Objective: Determine the frequency of crista galli (crest of the rooster) pneumatization and the presence of communication of the pneumatized crista galli with the paranasal sinuses., Material and Methods: Computed tomography data of the paranasal sinuses of 251 patients. The patients' age ranged from 23 to 70 years. Variations in crista galli were classified according to the degree of pneumatization., Results: The pneumatic type of crista galli structure was observed in 14.7% of cases. The most commonly crista galli pneumatized had a connection with the frontal sinus. In some cases, in the presence of sinusitis, the crista galli cavity was involved in the inflammatory process. The article presents a case of inflammation of pneumatized crista galli , in which a patient complained of a stubborn headache in the frontal sinus. Attention is drawn to the importance of diagnosing this pathology using objective imaging methods. Videoendoscopy and computed tomography revealed crista galli pneumatization with thickening of the mucous membrane and the presence of fluid. As a result, the optimal surgical approach was chosen - transseptal dissection with removal of one of the walls of pneumatized crista galli .

Treatment of patients with severe chronic and recurrent forms of frontal sinusitis, often caused by scarring as a result of repeated interventions in the frontal sinuses, is a difficult task. In such cases, for adequate drainage of the frontal sinus and ensuring stable patency of the nasolabial anastomosis, an endoscopic extended frontotomy can be the choice operation, the possibility of which certainly depends on the experience of the surgeon, anatomical features of the structure of the frontal sinus and the nature of the pathological process. The article shows the effectiveness of surgical treatment of chronic purulent frontal sinusitis that developed after 5 interventions on the paranasal sinuses with external and combined access, accompanied by the development of a fistulous passage of the anterior wall of the frontal sinus. For wide drainage of the frontal sinus and stable preservation of patency of the nasolabial fistula, the patient underwent extended endoscopic frontotomy (Draf III operation according to the international classification).

Defects localized in the frontal sinus are difficult for surgical treatment, since there is a large number of anatomical variations in the structure of the naso-frontal canal and the sinus itself. With the development of endoscopic technology and paying attention to the modern tendency of minimal invasive surgery, new invasive approaches to reach frontal sinus, such as endoscopic approach according to Draf I-III and combined approaches were developed and put into practice., Objective: To summarize and to analyze the results of treatment of nasal liquorrhea with localization of the defect in the frontal sinus using endoscopic endonasal and combined intra-extranasal approaches., Material and Methods: A retrospective analysis of a series of 43 cases of nasal liquorrhea with a frontal sinus defect being treated at the NMRCN Burdenko during the period from 2001 to 2017. To select access, a classification of frontal sinus defects according to their localization was developed. The analysis of demographic and clinical data of patients, as well as intraoperative and postoperative data analysis were done., Results: In the series of 43 patients, endoscopic endonasal approach was performed in 28 (65%) cases. Combined approach was performed at 15 (35%) patients. The success rate of plastic surgery with endoscopic endonasal approach was 86% (24 of 28), with combined approach - 93% (14 of 15)., Conclusion: Endoscopic endonasal and combined approaches are the methods of choice for plastic surgery of defects of the skull base in the frontal sinus as they are effective and safe. The choice of approach depends on anatomical features of the frontal sinus and on the localization of defect.

Mucocele of the paranasal sinuses is a rare disease not infrequently associated with massive bone destruction, orbital and intracranial complications. The authors report a patient presenting with the giant post-traumatic frontal mucopyocele associated with the erosion of the posterior and inferior sinus walls that was clinically manifested as hypo- and exophthalmos and has caused the inferolateral eye deviation and orbital decompression. The patient displayed the ophtalmological symptoms 8 years after the frontal sinus fracture. The mucopyocele was treated effectively with the combination of the endoscopic trans-ethmoidal and open trans-frontal approaches. The noticeable intraoperative finding in this patient was the absence of complaints as well as the combination of dura mater defects in the form of its erosion and the leakage of the cerebrospinal fluid together with the presence of purulent discharge in the sinus in the absence of intracranial complications.

The surgical intervention for the management of frontal sinusitis is required in a large fraction of patients presenting with this condition. The treatment of choice for the pathology in question is endoscopic endonasal frontotomy. Whenever the endoscopic technique is impossible to employ, the surgeon has to resort to an extranasal operation on the frontal sinus. The indications for the application of such strategy include the pathological conditions complicated by the intracranial and orbital processes, the presence of large benign tumours, recurrent post-surgical purulent sinusitis and traumatic frontal sinusitis. For the preservation of the functionally competent frontal sinus during extranasal frontotomy, a frontonasal fistula with all bony walls and maximally spared mucous membrane can be created. In order to remove an osteotoma from the frontal sinus, we applied the osteoplastic approach with the formation of the osteo-periosteal flap from the frontal wall of the sinus. In those cases when it was impossible to restore the frontal sinus and there was a closed bone cavity undergoing purulent inflammation we practiced obliteration of the cavity with the use of a porous carbon implant.

The authors describe a clinical case of pyocele of the frontal sinus in the patient presenting with polypous pansinisitis and pronouncd hypertrophy of the frontal sinuses with special reference to the specific features of diagnostics and surgical strategy for the treatment of this condition.

The paper specifies x-ray picture of surgically treated frontal and maxillary sinuses in uneventful healing without inflammation relapses (30 cases), in relapse of purulent (21 sinuses), purulent-polypous (15 sinuses), polypous (4 sinuses) sinusitis, in pain syndrome in the region of the operated on maxillary sinus projection (7 patients). X-ray symptoms of postoperative changes in the sinuses, varying in clinical course, are characterized.

Thirty-seven patients (15 women and 22 men), aged 22 to 67 years, with various frontal sinus pathologies were examined. The pathology was unilateral in all the patients. The following pathologies were identified: mucocele of frontal sinuses--2 cases; mucocele of the frontoethmoid area--4 cases; acute frontitis--5 cases; exacerbation of chronic frontitis (state after frontoethmoid trepanation)--14 cases; suppurative hemisinusitis--7 cases; frontal sinus cyst--2 cases; frontal sinus osteoma--3 cases. Final diagnosis was made with the aid of computer tomography because routine tomography proved inadequate. Computer tomography made it possible to clarify the state of the posterior and upper walls of the frontal sinus in the case of inflammation, mucocele, cysts, and osteomas and thus helped to elaborate adequate conservative or surgical therapy.