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DETERMINATION OF THE STRUCTURE OF THE WALLS OF THE FRONTAL SINUS ACCORDING TO SPIRAL COMPUTED TOMOGRAPHY Alekseeva V., Gargin V. The anatomical structure of the frontal sinus is of key importance for the development of its inflammation and the development of complications with spread to neighboring organs and tissues (orbital phlegmon, brain abscesses, meningitis). The aim of our study was to compare the density and thickness of the bone tissue of the unchanged frontal sinus and in various forms of chronic inflammation. Materials and methods. We observed 121 patients with various forms of chronic frontal sinusitis: 56 with chronic hyperplastic (mucosal hyperplasia (up to 6 mm) and 33 patients with chronic purulent-polypous frontal sinusitis, manifested by a total and subtotal decrease in sinus pneumatization according to spiral computed tomography (SCT). 32 SCT samples were selected to form a comparison group without any abnormalities of the paranasal sinuses. Results. The maximum density typical for the lower wall of the frontal sinus under physiological conditions and was found to be 107.96 ± 201.64Hu, the minimum for the posterior wall in purulent-polypous frontal sinusitis was -103.74 ± 195.37Hu. The bone thickness both in the posterior region and in the region practically does not depend on the degree of the severity of pathological changes in it and is 1.0006 ± 0.538 mm, 0.91 ± 0.26 mm, 0.82 ± 0.169 mm under physiological conditions , with mucosal hyperplasia and with purulent-polypous frontal sinusitis in the posterior wall, respectively. In the region of the lower wall, 4.05 ± 2.04 mm, 2.32 ± 1.16 mm, and 4.002 ± 1.16 mm, respectively, according to the above order. Conclusion. It can be assumed that the larger the change in PNSs, the lower the bone density. This in turn affects the prediction of possible complications during surgical treatment of chronic frontal sinusitis. Key words: frontal sinus, computed tomography, bone thickness, bone density Резюме. ВИЗНАЧЕННЯ МОРФОЛОГІЧНОЇ СТРУКТУРИ СТІНОК ЛОБНОЇ ПАЗУХИ ЗА ДОПОМОГОЮ СПІРАЛЬНОЇ КОМП'ЮТЕРНОЇ ТОМОГРАФІЇ Алєксєєва B.B., Гаргін B.B. Анатомічна будова лобної пазухи має ключове значення для виникнення запальних процесів та розвитку ускладнень із поширенням на сусідні органи та тканини (формування флегмони орбіти, абсцесів мозку, менінгіту). Метою нашого дослідження було порівняння щільності та товщини кісткової тканини лобної пазухи в фізіологічних умовах та при різних формах хронічного запального процесу. Матеріали та методи. Під спостереженням було 89 пацієнтів з різними формами хронічного фронтального синуситу: 56 - з хронічним гіперпластичним фронтальним синуситом (гіперплазією слизової оболонки до 6 мм) та 33 пацієнти з хронічним гнійно-поліпозним фронтальним синуситом, що при проведенні спіральної комп’ютерної томографії (СКТ) проявлявся тотальним і субтотальним зниженням пневматизації. Контрольна група - 32 СКТ людей з фізіологічним станом навколоносових пазух. Результати. Максимальна щільність кісткової тканини була визначена в області нижньої стінки лобної пазухи та становила - 107.96 ± 201.64 Hu, мінімальна - в області задньої стінки при гнійно-поліпозному лобному синуситі - -103.74 ± 195.37 Hu. Товщина кісток практично не залежала від ступеня виразності патологічних змін у ній і становить в області задньої стінки - 1.0006 ± 0.538 мм, 0.91 ± 0.26 мм, 0.82 ± 0.169 мм у фізіологічних умовах, при гіперплазії слизової оболонки і при гнійно-поліпозному фронтальному синуситі. В області нижньої стінки 4.05 ± 2.04 мм, 2.32 ± 1,16 мм та 4.002 ± 1.16 мм відповідно. Висновки. Можна припустити, що щільність кісткової тканини залежить від ступеня виразності патологічних змін в лобній пазусі. Це в свою чергу впливає на прогнозування розвитку ускладнень. Ключові слова: лобна пазуха, спіральна комп'ютерна томографія, товщина кісток, щільність кісток. Резюме. ОПРЕДЕЛЕНИЕ МОРФОЛОГИЧЕСКОЙ СТРУКТУРЫ СТЕНОК ЛОБНОЙ ПАЗУХИ С ПОМОЩЬЮ СПИРАЛЬНОЙ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ Алексеева B.B., Гаргин B.B. Анатомическое строение лобной пазухи имеет ключевое значение для возникновения воспалительных процессов и развития осложнений с распространением на соседние органы и ткани (формирование флегмоны орбиты, абсцессов мозга, менингита). Целью нашего исследования было сравнение плотности и толщины костной ткани лобной пазухи в физиологических условиях и при различных формах хронического воспалительного процесса.Материалы и методы. Под наблюдением находилось 89 пациентов с различными формами хронического фронтального синусита: 56 - с хроническим гиперпластическим фронтальным синуситом (гиперплазией слизистой оболочки до 6 мм) и 33 пациента с хроническим гнойно-полипозным фронтальным синуситом, что при проведении спиральной компьютерной томографии (СКТ) проявлялся тотальным и субтотальным снижением пневматизации. Контрольная группа - 32 СКТ людей с физиологическим состоянием околоносовых пазух.Результаты. Максимальная плотность костной ткани была определена в области нижней стенки лобной пазухи в физиологических условиях и составила - 107.96 ± 201.64 Hu, минимальная - в области задней стенки при гнойно-полипозном лобном синусите - -103.74 ± 195.37 Hu. Толщина костей практически не зависила от степени выраженности патологических изменений в ней и составляла в области задней стенки - 1.0006 ± 0.538 мм, 0.91 ± 0.26 мм, 0.82 ± 0.169 мм в физиологических условиях, при гиперплазии слизистой оболочки и при гнойно-полипозном фронтальном синусите. В области нижней стенки 4.05 ± 2.04 мм, 2.32 ± 1.16 мм и 4.002 ± 1.16 мм, соответственно. Выводы. Можно предположить, что плотность костной ткани зависит от степени выраженности патологических изменений в лобной пазухе. Это в свою очередь влияет на прогнозирование возможности развития осложнений. Ключевые слова: лобная пазуха, спиральная компьютерная томография, толщина костей, плотность костей.

Background/Objective Complicated acute rhinosinusitis in the pediatric population is an uncommon problem that may affect the orbit or brain and is life‐threatening. This condition requires surgical intervention with endoscopic sinus surgery for source control, and prior studies have demonstrated the safety of balloon sinuplasty in chronic frontal sinusitis. Methods/Results We present our approach with a balloon sinus dilation hybrid procedure to resolve four distinct types of complicated acute frontal sinusitis in pediatric patients, including intracranial manifestations, intraorbital complications, and recurrent disease. All four patients were able to be managed operatively with frontal balloon sinuplasty. Conclusions Prior efficacy has been demonstrated for chronic frontal sinusitis in the pediatric population. We demonstrate that frontal balloon sinuplasty is also feasible in the proper clinical setting for acute frontal sinusitis, even in the presence of regional complications or recurrent disease. Level of Evidence 4, We report a case series of four pediatric patients with acute frontal rhinosinusitis manifesting with extra‐sinonasal complications who underwent surgical intervention with endoscopic sinus surgery. In all four patients, we were able to successfully use balloon sinus dilation in the acute setting.

Isolated frontal sinus disease is a rare and highly morbid condition. Although chronic frontal sinusitis has been described in literature, clinically it is quite uncommon in the absence of paranasal sinusitis and rhinitis. Here we examine a case of isolated chronic frontal sinusitis presenting with anosmia-a curious clinical manifestation.

Objective:This study prospectively assessed the axillary flap approach versus punch-out procedure for agger nasi cell (ANC) removal.This is akey for successful frontal sinus surgery and its implication on the patency of the frontal ostium and middle turbinate lateralization(MTL). Subjects and Methods: The study subjects consisted of 50 patients of whom 30 patients were males (80 frontal sinuses; 30 patients with bilateral disease and 20 patients with unilateral disease) with proven chronic frontal sinusitis, with pneumatized ANC according to CT findings.All patients undergone Endoscopic Sinus Surgery (ESS) with dissection of frontal recess. Group I included 40 sides that undergone removal of ANC using the axillary flap procedure (procedure 1), Group II included 40 sides that undergone removal of ANC using the punch out procedure (procedure 2). Adelaide chronic rhinosinusitis (CRS) symptom scoring questionnaires was used to all patients during their last follow-up visit 3 months after surgery. Results: ANC were the most common variation and were observed in all the patients (20 patients unilaterally and 30 patients bilaterally). MTL following ANC removal has been found in 7.5% ofGroup I and 25% in Group II patients. Association between Adelaide symptoms severity score of postoperative symptoms and MTL was significant for nasal obstruction and rhinorrhea in both procedures (1 and 2). Non visualization of the frontal ostium following ANC removal has been found in 7.5% of Group I and 15% in Group II.Comparison between both procedures on MTL and non-visualization shows that the number of patients with MTL-positive using procedure 1 was significantly less than procedure 2 while there was a non-significant difference between procedure 1 and 2 regarding non-visualization. Conclusions: The axillary flap technique is a safer procedure for resection of the ANC with perfect healing and less incidence of intraoperative and postoperative complications.However, it is a relatively difficult procedure and very time consuming while punch out procedure is a relatively easy, less time consuming procedure.

Objectives: To report one institution’s experience with 22 cases of the Riedel procedure in order to establish a profi le for those patients with chronic frontal sinusitis who develop chronic osteomyelitis.

Frontal sinus outflow tract (FSOT) injury may occur in cases of frontal sinus fractures and nasoethmoid orbital fractures. Since the FSOT is lined with mucosa that is responsible for the path from the frontal sinus to the nasal cavity, an untreated injury may lead to complications such as mucocele formation or chronic frontal sinusitis. Therefore, evaluation of FSOT is of clinical significance, with FSOT being diagnosed mostly by computed tomography or intraoperative dye. Several options are available to surgeons when treating FSOT injury, and they need to be familiar with these options to take the proper treatment measures in order to follow the treatment principle for FSOT, which is a safe sinus, and to reduce complications. This paper aimed to examine the surrounding anatomy, diagnosis, and treatment of FSOT.

The Messerklinger technique is an endoscopic approach to sinus surgery designed to be minimally invasive and preserve mucosa and hence physiological function. More recently there have been advocates for more radical endoscopic approaches to the frontal sinus such as the Modified Lothrop. This review discusses different approaches to frontal sinus surgery including any advantages and disadvantages to each approach. After examining the evidence from the literature, meticulously performed endoscopic frontal sinusotomy with or without computer guidance appears to be the most effective minimally invasive procedure for treating chronic frontal sinusitis secondary to outflow tract obstruction. Properly performed, it is almost always effective in dealing with even the most diseased frontal sinus. It offers clear advantages in reducing complications and recurrence rates in frontal sinus disease, even for revision cases.

A frontocutaneous fistula secondary to chronic frontal sinusitis can present with a fistulous opening in the forehead or in the eyelid. It may or may not be associated with Pott's puffy tumor. In this article, we present 2 cases. A case of frontocutaenous fistula with opening in the upper eyelid at the lateral portion of floor of frontal sinus and another case of chronic frontal sinusitis with sub-periosteal abscess in the forehead on the right side near the eyebrow. Relevant literature has also been reviewed.

Objectives: The frontal sinus has the most complex and variable drainage routes of all paranasal sinus regions. The goal of this study was to identify these anatomical factors and inflammation areas relating to chronic frontal sinusitis by comparing radiological presentations in patients with and without frontal sinusitis. Methods: All adult patients with chronic rhinosinusitis who had received computed tomography (CT) scans of the nasal cavities and paranasal sinuses between October 2010 and September 2011. Logistic regression analysis was used to compare the distribution of various frontal recess cells and surrounding inflammatory conditions in patients with and without frontal sinusitis. Results: Analysis of 240 sides of CT scans was performed with 66 sides excluded. The opacification of the frontal recess and sinus lateralis demonstrated a strong association with an increased presence of frontal sinusitis by multiple logistic regression models. Conclusion: Opacification of the frontal recess and sinus lateralis was found to be associated with a significantly increased risk of frontal sinusitis and developing severe blockage of drainage pathways. It provides evidence that mucosal inflammation disease in these two areas is a very important factor leading to chronic frontal sinusitis.

For chronic sinusitis surgery, the Draf III approach provides a common median drainage pathway for bilateral frontal sinuses from orbit to orbit. The Draf IIb provides unilateral drainage from orbit to septum. In several cases, inclusion of the nasal and frontal sinus septum in a Draf IIb was advantageous without extension to the opposite frontal recess. The proposed nomenclature is Draf IIc. This study was designed to (1) develop a surgical option for chronic frontal sinusitis where access to one frontal recess is limited or unnecessary and (2) minimize unnecessary surgical manipulation of uninvolved areas. Revision endoscopic frontal sinus surgery was performed on two patients with persistent frontal sinus opacification. Surgery crossed midline including one frontal recess with resection of the superior nasal septum. The surgical result was assessed on endoscopy and computed tomography (CT). The postoperative course was unremarkable with relief of frontal pressure. Postoperative CT scan showed well-aerated frontal sinuses with a widely patent common drainage pathway. Postoperative nasal endoscopy revealed normal mucosa with no exposed bone or edema. The Draf IIc extends the Draf IIb across the midline, without including the opposite frontal recess. This can be accomplished most easily using an interfrontal sinus septal cell or an eccentric interfrontal sinus septum. The Draf IIc is a surgical option in cases of chronic or recalcitrant frontal sinus diseases, including unilateral or bilateral obstruction, where access to the ipsilateral frontal recess is limited or favorable anatomy allows drainage with reduced manipulation of an uninvolved side.

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.

The volume of literature on frontal sinus surgery suggests that the success of surgery to cure frontal sinus pathology is inversely proportional to the total number of techniques described. In an attempt to develop an effective means of treating acute and chronic frontal sinusitis, including iatrogenic naso frontal communication obstruction, an endoscopic stenting procedure has evolved. This method might be contemplated, in selected patients, as the preferred surgery or a useful low morbidity alternative, to more invasive traditional frontal sinus surgery. A high degree of technical difficulty is associated with endoscopic frontal sinus procedures, and they are definitely not recommended for the novice or occasional sinus surgeon. Several years of follow up are required to evaluate the validity of any frontal sinus procedure. More observation of these subjects' clinical progress is necessary before endoscopic stenting of the nasofrontal communication passes the test of time.

The influence of otorhino laryngological operation on the human body was studrid using theurine protein test, Hatnasaki's and Donaggio-Sato's tests.The fatigue after the operation returned to the preoperative state within one week, and were parallel to the degree of bleeding and damage to the tissue.The highest fatigue value obtained in our experiments was in a case with the killian's radicaloperation for chronic frontal sinusitis and then in the order of chronic maxillary sinusitis conbinedwith ethomoiditis, radical mastoidectomy for chronic otitis media, tonsillectomy, submucous resection of septum and tonsil lo-adenotomy.It can be said that the measurement of fatigue value after operatios is valuable to find out the shortness in nutrition, in the determination of succeeding operation or discharge from the hospital.

Capacity of the frontal sinuses was measured by means of filling them with saline solution during the sinuses operation was doing and size was determined by measuring postero-frontal view of roentgenograms. From this data pneumatization of the frontal sinuses was estimated.On the other hand, the form of the frontal sinuses was classified into three groups, namely ethmoidal type in which the lumen is limited in the ethmoidal region, frontal type in which the lumen is localized in the vertical plate of the frontal bone, and ethmo-frontal type in which the lumen is extended from the frontal bone to the ethmoidal region.According to the studies of T. Goto and M. Yamauchi, the ethmo-frontal type was most frequently seen, though the frontal type is commonly considered the general type of the frontal sinus.In the relationship between the form of the frontal sinus and its pneumatszation, the frontal sinuses of the etnmo-frontal type are most remarkable, and those of the frontal type are secondary in development. The ethmoidal type has a very small lumen.The relationship between histological finding of the mucous membrane and pneumatizational findings of the frontal sinuse confirmed similar results in the other sinuses as follows; the well developed sinuses revealed mainly edematous changes in the mucous membrane anb the under-developed sinuses reveales fibrous thickening in the mucous membrane.Edematous changes were noted predominately in ethmo-frontal type, fibrous thickening change in ethmoidal type, and an intermingling changes of the two in frontal type.The authors noted frequent incidence of slight change of the frontal sinusitis and they concluded that thise slightly changed cases must be set aside from the generally original classification of the mucous membrane, bacause the developmental trend is slight cases for definite classification.

Today, obliteration of the frontal sinus is attempted only in those cases in which there has been extensive necrosis of the bony wall, and our treatment is directed to establishing ventilation and drainage. Various operators have devised new methods and modified old ones of opening the frontal sinus intranasally since Schaeffer, in 1890, published his method of penetrating the floor of the sinus through the ethmoid cells. This method had been abandoned until it was revised and improved in 1905 by E. Fletcher Ingals, who later used gold tubes. In the same year it was improved by Segura, we are told by Watson Williams and also by Ingals in their interesting historical reviews of the subject. In 1906 Max Halle described his operation of removing part of the nasal crest with burrs. He has since modified his method by making a flap of mucoperiosteum, which has not proved advantageous in