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Aim: The study was done with the aim to check for the reliability of morphometric parameters of frontal and maxillary sinuses along with pyriform aperture for sexual dimorphism on posteroanterior skull radiograph in young adults. Material and method: 30 individuals with equal distribution of females and males were selected considering inclusion and exclusion criteria and PA skull view of same were analyzed for frontal sinus, maxillary sinus and pyriform aperture parameters using Carestream Dental imaging software 6.14.7 CS 3D. Statistics and Result: Statistical analysis establishes frontal and maxillary sinus parameters in comparison to pyriform aperture parameters as reliable tool for gender assessment. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of the present study was to determine the dimorphic potential of the frontal sinus (FS) index, area, and the combination of both variables to ascertain its accuracy in sex discrimination among Bosnian, Chinese, and Nepalese. Methods A retrospective study analyzed the digital standardized lateral cephalometric of 654 Bosnian, Chinese, and Nepalese adult patients (116 females, 102 males; age range 17–40 years). The following FS parameters were analyzed: The maximum height, width, and area of the FS, and the ratio of height and width was calculated as the FS index. The measurements were analyzed using logistic regression analysis for the FS index, area, and combined FS index and area. Results Statistically significant differences were observed between the mean values of the FS index and the area between females and males in each population. The highest frequency of bilateral absence of FS was detected among females, specifically in Chinese (6.6%). Logistic regression equation derived from the present study differentiated between sexes with higher classification percentages for the FS index and area with 62.4%, 75.2%, and 78.4% among Bosnian, Chinese, and Nepalese subjects, respectively. Conclusions The results of the present study highlight the implications of the combined FS index and area as a reliable approach in sex estimation in forensic science whenever both the FS structure and lateral cephalometric are available.

Mucoceles of the paranasal sinuses are benign, expansile lesions that develop secondary to sinus ostia obstruction. Presenting signs and symptoms vary widely but frequently include frontal headache and swelling, as well as visual changes and globe displacement depending on orbital involvement in the case of frontal sinus mucoceles. Given the potential for orbital or intracranial involvement, urgent imaging with computed tomography (CT) is important for patients with symptoms concerning for a frontal sinus mucocele. Definitive treatment is surgical. In this article, we report a case of a 50-year-old male who presented to a primary care clinic with a painful forehead mass, found to have a frontal sinus mucocele with erosion through the frontal bone that was eventually treated surgically. We also summarize presenting signs and symptoms of frontal mucoceles reported in the literature as these are important for clinicians to be familiar with, considering the potential emergent complications. [ABSTRACT FROM AUTHOR]

Background: Measurement of craniofacial parameters plays an important role in sex determination in forensic science. The present study was done using cone beam computed tomography (CBCT) scans to evaluate the morphologic structure of the frontal sinuses and compare it with the width of nasal, cranial, maxillary and mandibular width which might help us in sex determination. Methods: A cross-sectional retrospective study was conducted using 142 full field of view (FOV) scans of patients archived from the department. The width of the nose, cranium, maxilla, and mandibular width was measured and compared with the frontal sinus between the two sexes. Results: A paired t-test was done to compare the linear measurements for both sexes' right and left frontal sinuses. The measurements were higher in males when compared to females. There was a statistically significant asymmetry (larger dimension on the left side) of the anterioposterior (p-value of 0.012) and superior-inferior dimensions in males (p-value of 0.135). Spearman's correlation showed that frontal sinus correlated with other craniofacial parameters like nasal, cranial, maxillary and mandibular width among both sexes. The frontal sinus, nasal, cranial, maxillary and mandibular widths were higher in males when compared to females (independent t-test). Discriminant function scores showed 66-68% accuracy to discriminate sex, using the anteroposterior dimension and mandibular width. Conclusions: The measurement of craniofacial parameters using CBCT can aid in determining the sex of unidentified and decomposed bodies.

To evaluate differences in the morphology of the frontal sinus in adolescents and adults with different craniofacial patterns, searches up to April 2024 were conducted in six databases and other information sources to identify observational studies. Study selection, data extraction, and quality assessment using the NOS scale were performed independently by two reviewers. Random effects meta-analyses were conducted to estimate the difference in frontal sinus measurements between different craniofacial skeletal patterns (α = 0.05). The certainty of the evidence was evaluated according to GRADE. Fourteen studies were included in the review. All studies had methodological limitations that affected their quality. The syntheses showed that skeletal Class II subjects presented a significantly smaller width of the frontal sinus than skeletal Class I subjects (MD = 0.56; 95% CI: 0.38, 0.74; p < 0.0001; I2 = 3%). Skeletal Class III subjects showed a frontal sinus width (MD = −0.91; 95% CI: −1.35, −0.47; p < 0.0001; I2 = 36%) and area (MD = −28.13; 95% CI: −49.03, −7.23; p = 0.0084; I2 = 66%) significantly larger than those of the skeletal Class I subjects. The available evidence suggests a positive relationship between mandibular and frontal sinus size. There is limited evidence to make reliable estimates of the association of other craniofacial patterns and frontal sinus characteristics. These reported results are not conclusive and should be evaluated carefully due to the very low certainty of the evidence. The current evidence is scarce and consists of studies with methodological limitations; the results of the studies are often inconsistent, and the pooled estimates are imprecise. New high-quality research is still necessary.

Osteomas are slow growing fibro-osseous lesions. Very rare to occur in paranasal sinuses. Small osteomas don't require any intervention. Giant osteomas may require surgical intervention due to its cosmetic and functional compromises. A 28 year old male presented with swelling over forehead and left orbit for more than 4 years. The swelling is around 6 × 5 cm with gross lateral and inferior deviation of left eyeball. Extradural fronto-ethmoidectomy was done with combined external and endoscopic approach. There was pearly white bony hard, fixed tumor mass seen infiltrating anterior and posterior table of frontal bone. All the tumors removed in piecemeals. Wait and watch policy is the usual treatment policy for small and asymptomatic osteomas. Combine external and endoscopic approach is the treatment of choice for giant frontoethmoid osteoma. [ABSTRACT FROM AUTHOR]

This article discusses the perioperative anesthetic challenges faced in the case of a 35-year-old female patient with malignant nasal melanoma. Malignant nasal melanomas are rare tumors that require complete surgical resection as the main treatment. The patient presented with various symptoms, including swelling, proptosis of the right eye, and nasal obstruction. The article highlights the anesthetic concerns, such as difficult airway and major blood loss, and describes the successful management of the case. The authors emphasize the rarity of this disease and the need for further research on anesthetic challenges in similar cases. [Extracted from the article]

Introduction: Knowledge of variable anatomy, narrow frontal sinus ostium and vital anatomical structures near outflow tract, is very important during preoperative planning for exposure of the frontal sinus recess during endoscopic sinus surgery. Preoperative knowledge of distance of nasofrontal beak and anterior skull base from columella is very helpful in avoiding intraoperative complication by deeper penetration into cranial cavity. Aim: To analyse distance from columella to the anterior and posterior border of the Frontal sinus ostium in males and females by CT PNS. Materials and methods: This retrospective observational study carried out in katihar medical college, Katihar during the period of 01 July 2021 to 31 December 2021 including 31 patients. Result and Conclusion: A distance approx 60.9 mm in men and 57.34 mm in women from the columella to frontal sinus ostium is safe during endoscopic sinus surgery. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the prevalence of the frontal cell variants according to International Frontal Sinus Anatomy Classification (IFAC), in the population of a Brazilian tertiary hospital, and analyze the reliability of the classification between observers. Methods: A cross-sectional study in the Hospital de Clínicas of the State University of Campinas, Brazil. One hundred and three Computed Tomography's (CTs) were evaluated by radiologists and otorhinolaryngologist to estimate the prevalence of frontoethmoidal cells according to the IFAC. Intraclass Correlation Coefficient (ICC) among examinators was used to evaluate reliability of this findings. Results: 103 CT scans, totaling 206 sides, were evaluated independently. The agger nasi cell was the most prevalent, present in 95.63% of cases, 37.86% of the exams contained supra agger cells, frontal supra agger cell showed prevalence 37.37%; suprabular cell was present in 77.18% of the sides. As for the frontal suprabular cell, the prevalence was 30.09%, the supraorbital ethmoid cell was present in 32.03%, and frontal septal cell had a 33.49% prevalence. The ICC among the evaluators was classified as “good reliability” or “excellent reliability” for all cells. Conclusion: This study describes the frontal cell prevalence among a population in tertiary Brazilian hospital, using the IFAC. This classification had a high ICC. Level of evidence: Level 2: Individual cross-sectional study with consistently applied reference standard and blinding.

Background: Measurement of craniofacial parameters plays an important role in sex determination in forensic science. The present study was done using cone beam computed tomography (CBCT) scans to evaluate the morphologic structure of the frontal sinuses and compare it with the width of nasal, cranial, maxillary and mandibular width which might help us in sex determination. Methods: A cross-sectional retrospective study was conducted using 142 full field of view (FOV) scans of patients archived from the department. The width of the nose, cranium, maxilla, and mandibular width was measured and compared with the frontal sinus between the two sexes. Results: A paired t-test was done to compare the linear measurements for both sexes' right and left frontal sinuses. The measurements were higher in males when compared to females. There was a statistically significant asymmetry (larger dimension on the left side) of the anterioposterior (p-value of 0.012) and superior-inferior dimensions in males (p-value of 0.135). Spearman's correlation showed that frontal sinus correlated with other craniofacial parameters like nasal, cranial, maxillary and mandibular width among both sexes. The frontal sinus, nasal, cranial, maxillary and mandibular widths were higher in males when compared to females (independent t-test). Discriminant function scores showed 66-68% accuracy to discriminate sex, using the anteroposterior dimension and mandibular width. Conclusions: The measurement of craniofacial parameters using CBCT can aid in determining the sex of unidentified and decomposed bodies.

Background: Osteoma associated with Mucocele remains an extremely rare occurrence. Case description: A 49-year-old female with high blood pressure, under medical treatment. She presented a 7-month history of right periorbital swelling with ptosis followed by intermittent headaches and dizziness. Brain imaging revealed a right ethmoido-front-orbital bone lesion, heterogeneous condensing, and polycyclic contours, surrounded by a fluid collection with hyperdense walls. A right frontal craniotomy was retained. Both tumors, Osteoma and Mucocele were excised and confirmed by histology. A depletive lumbar puncture was done to prevent any increase in intracranial pressure. Conclusion: Osteoma and Mucocele are rare benign brain tumors. The combination of both remains rare. Early diagnosis and treatment of Osteomas might prevent surges of multiple complications, the most notable one being Mucocele.

Background Frontal sinus carcinoma is commonly seen as an extension of the ethmoid sinus, overlying skin, or lacrimal gland. The existence of this disease has been unclear. We aimed to describe the occurrence of primary frontal sinus carcinoma. Methods We conducted a systematic literature review and a retrospective review of the medical records at our institution in the past 10 years. Results Sixty-four articles were included in the literature review. Most frontal sinus carcinomas involved surrounding structures as the sphenoid or ethmoid sinus, and a primary origin in the frontal sinus could not be confirmed. No cases of primary frontal sinus carcinoma were identified at our hospital. Conclusion Isolated primary frontal sinus carcinoma, if exists, is very rare. There is uncertainty regarding the primary origin of frontal sinus carcinoma in most studies. The frontal sinus seems to be immune from primary carcinoma. Further studies are needed to explain such immunity. [ABSTRACT FROM AUTHOR]

Background: Puncture and lavage of the paranasal sinuses, previously the primary treatment for unresponsive acute bacterial rhinosinusitis before surgery, has been abandoned due to procedural discomfort and advancements in antibiotic efficacy and endoscopic surgery. The rise in antibiotic-resistant bacteria has renewed the interest in minimally invasive sinus lavage to both avoid aggressive surgical interventions and identify appropriate antibiotic therapy. In this article, we describe the safety and feasibility of a new device in human patients and evaluate its efficacy as a treatment before the traditional sinus surgery in acute rhinosinusitis. Methods: The device with its seeker-shaped guiding tube and rotating wire can enter the sinus cavity through the natural ostium, pulverize the inspissated mucus, and enable lavage and culture sampling without the need for sinus puncturing. It was tested in 6 patients with chronic sinusitis under general anesthesia during endoscopic sinus surgery and in additional 10 patients with maxillary acute bacterial rhinosinusitis in outpatient settings under local anesthesia. Results: The device enabled rapid, efficient, and atraumatic insertion of the wire into the occluded sinuses. The rotating wire permitted pulverization of the thick mucus, which enabled irrigation without mucosal damage or adverse events. Overall, 9 of 10 patients with acute bacterial rhinosinusitis demonstrated remarkable improvements and were discharged the following day with no acute symptoms. The visual analog scale score for pain dropped from 8.9 to 0.4. The remaining one patient underwent endoscopic sinus surgery subsequently. None of the patients treated during endoscopic sinus surgery developed any adverse events. [ABSTRACT FROM AUTHOR]

Objectives: To study the effects of age on the olfactory function recovery of chronic rhinosinusitis patients after endoscopic sinus surgery and related risk factors. Methods: A total of 176 chronic rhinosinusitis (CRS) patients enrolled from February 2017 to October 2019 were divided into child, youth, middle-aged, and elderly groups. Their baseline data, T&T olfactory test score, visual analogue scale (VAS) olfactory score, sinus computed tomography (CT) Lund-Mackay score, and Lund-Kennedy score were compared. Based on postoperative olfactory function, they were divided into good and poor improvement groups. Results: Complication with nasal polyps, allergic rhinitis history, and sinus surgery history had significant differences among patients of different ages (P <.05). Three months after surgery, T&T olfactory, VAS olfactory, Lund-Mackay, and Lund-Kennedy scores all rose with increasing age, with significant differences between any 2 groups (P <.05). The improvement of postoperative olfactory function became poorer with aging (P <.05). T&T and VAS olfactory scores had significant positive correlations with Lund-Mackay and Lund-Kennedy scores (P <.001). Age, preoperative Lund-Mackay and Lund-Kennedy scores, complication with nasal polyps, allergic rhinitis history, sinus surgery history, and postoperative complications were risk factors for the poor improvement of postoperative olfactory function. Doctor-directed treatment was a protective factor for good improvement. Conclusions: The improvement of olfactory function of CRS patients after endoscopic sinus surgery declines with aging. Age, preoperative Lund-Mackay and Lund-Kennedy scores, complication with nasal polyps, allergic rhinitis history, sinus surgery history, and postoperative complications are risk factors for the poor improvement of postoperative olfactory function. Doctor-directed treatment is a protective factor for good improvement. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine whether patients with unoperated craniosynostosis have different frontal sinus pneumatization than unaffected controls. Methods: Retrospective review was performed between 2009 and 2020 of previously unoperated patients with craniosynostosis older than 5 years old at first presentation to our institution. Total frontal sinus volume (FSV) was calculated using 3D volume rendering tool in Sectra IDS7 PACS system. Age-matched normative FSV data was collected from 100 normal CT scans for the control group. The two groups were statistically compared using Fisher's exact test and T-test. Results: Study group included nine patients, 5–39 years old, median age 7 years. Frontal sinus pneumatization was absent in 12% of the normal 7-year-old controls, while frontal sinus pneumatization was absent in 89% of the studied craniosynostosis patients (p <.001). Mean FSV of the study group (113 ± 340 mm3) was significantly different from that of age matched control mean FSV (2016 ± 2529 mm3) (p =.027). Conclusions: Frontal sinus pneumatization is suppressed in unreleased craniosynostosis and may be an intracranial space conservation phenomenon. This absent frontal sinus can have implications in future frontal region trauma and frontal osteotomies. [ABSTRACT FROM AUTHOR]

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of lymphoma, involving the lumen of predominantly small blood vessels, especially capillaries. The orbit is an uncommon site of involvement for IVLBCL, and diagnosis before autopsy is even more rare as most cases are established post-mortem. Herein, the authors describe a 73-year-old male who presented with 3 weeks of progressive bilateral ptosis and ophthalmoplegia. Computed tomography (CT) and subsequent magnetic resonance imaging (MRI) revealed diffuse abnormal thickening and enhancement of bilateral orbital apices, superior orbital fissures, and cavernous sinus, along with persistent focal opacification of the left frontal and ethmoid sinuses. Infectious and inflammatory workup of serum and cerebrospinal fluid was negative. Ethmoidal sinus and middle turbinate biopsy confirmed intravascular large B-cell lymphoma and the patient was started on R-CHOP chemotherapy regimen. [ABSTRACT FROM AUTHOR]

Background: The radiological and surgical anatomy of the frontal sinus should be well-known in all age groups to successfully manage frontal sinus diseases and reduce the risk of complications in sinus surgery. Purpose: To define frontal sinus and frontal cells according to the International Frontal Sinus Anatomy Classification (IFAC) criteria in pediatrics and adults. Material and Methods: A total of 320 frontal recess regions of 160 individuals (80 pediatric, 80 adults) who underwent a computed tomography (CT) scan of the paranasal sinus (PNS) were included in the study. Agger nasi cells, supra agger cells, supra agger frontal cells, suprabullar cells, suprabullar frontal cells, supraorbital ethmoid cells, and frontal septal cells were evaluated in the CT analysis. Results: The incidence rates of the investigated cells were determined to be 93.1%, 41.9%, 60.0%, 76.3%, 58.5%, 18.8%, and 0% in the pediatric group, respectively, and 86.3%, 35.0%, 44.4%, 54.4%, 46.9%, 19.4%, and 3.4% in the adult group, respectively. Considering the unilateral and bilateral incidence of the cells, agger nasi cells were highly observed bilaterally in both the pediatric group (89.87%) and the adult group (86.48%). Conclusion: Our study results show that IFAC can be used as a guide to increase the chance of surgical treatment in the pediatric and adult groups and that the prevalence of frontal cells can be determined radiologically and contributes to the generation of estimations of the prevalence of frontal cells. [ABSTRACT FROM AUTHOR]

Keywords: Draf III; endoscopic sinus surgery; frontal sinus inverted papilloma; nasoseptal flap; restenosis EN Draf III endoscopic sinus surgery frontal sinus inverted papilloma nasoseptal flap restenosis 1546 1549 4 07/26/23 20230801 NES 230801 INTRODUCTION Draf III procedure is an important approach for treating complex frontal sinus lesions. CONCLUSION The ZWFs can provide sufficient mucosa coverage on the bare bone for bilateral frontal sinus IPs after the Draf III procedure, thus promoting epithelization and reducing the restenosis risk of the neo-ostium. [Extracted from the article]

Objective: Osteomyelitis of the frontal bone is a rare but devastating complication of frontal sinusitis. Treatment involves aggressive surgery to remove all sequestra in combination with long-term antibiotic therapy. However, systemic antibiotics may struggle to penetrate any remaining infection in devascularised areas, and the morbidity associated with surgical resection of some areas of the skull base is too high. In contrast, locally implanted antibiotics provide a reliable, high concentration of treatment to these areas while also minimising potential systemic side effects. The clinical application of tobramycin beads has primarily been used in orthopaedics as an adjunct to the treatment of tibial osteomyelitis or prosthetic joint infection. Case report: To the best of the authors' knowledge, the two cases discussed here represent the first use of tobramycin antibiotic beads in frontal sinus osteomyelitis secondary to chronic rhinosinusitis. Conclusion: These cases show promising use of tobramycin beads in recalcitrant frontal osteomyelitis. [ABSTRACT FROM AUTHOR]

Objective: Although several mucosal flap techniques have been reported to improve the outcomes in Draf IIb and Draf III procedures, there is scant knowledge on frontal ostium neo‐osteogenesis after reconstruction with mucosa flap. This study evaluates the potential benefits of mucosa flaps on frontal ostium neo‐osteogenesis after frontal sinus drill‐out procedures. Methods: Forty‐three patients who underwent extended Draf IIb and Draf III were enrolled. Among them, 20 patients had frontal neo‐ostium (FNO) reconstructed by mucosal flap (group A), and 23 patients did not have neo‐ostium reconstruction (group B). The cross‐sectional area of FNO, frontonasal bone, and the amount of frontal neo‐osteogenesis (FNOG) were measured with OsiriX®. In addition, the Global Osteitis Scoring Scale (GOSS), Lund–Mackay score (LMS), and Lund–Kennedy score (LKS) were also evaluated. Results: At one year postoperatively, the remaining neo‐ostium area was significantly larger in group A (p =.001), and group A had significantly less FNOG (p <.05). The month 12 postoperative GOSS score was significantly decreased in group A. In contrast, it slightly increased in group B. Both the average LKS and LMS were significantly reduced in groups A and B at month 12 postoperatively. Still, the average LKS of group A significantly decreased than that of group B at month 12 postoperatively. Conclusion: Coverage of the bare frontal bone with the mucosal flap could prevent excessive neo‐osteogenesis and keep the neo‐ostium open widely. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

Silent sinus syndrome (SSS) is a rare entity, almost exclusively involving the maxillary sinus, frontal location being very rarely reported. The aim of the present study was to describe clinical and radiological characteristics and surgical treatment using the CARE methodology. One woman and 2 men were referred for chronic unilateral frontal pain with imagery showing silent sinus syndrome. All showed partial or complete liquid opacification of the affected sinus associated with a thin interfrontal sinus (IFS) retracted toward the affected sinus. Functional endoscopic sinus surgery was performed in all cases, with good functional results. We describe 3 cases of SSS with IFS involvement. The frontal sinus wall seemed most vulnerable, probably most liable to be weakened by atelectasis. The study suggests that frontal SSS can be an etiology in chronic frontal sinusitis. Preoperative findings of IFS retraction are useful for surgical restoration of frontal sinus ventilation, relieving chronic pain and preventing complications. [ABSTRACT FROM AUTHOR]

Simple Summary: The topical administration of antibiotics for the treatment of nasal cavity and frontal sinus infections has not been assessed in dogs. In ten healthy beagle dogs, we administered gentamycin by inhalation twice daily for 3 min (3-min protocol) and 10 min (10-min protocol), as well as by drop administration (drop protocol) twice daily, for one week each. We found that the gentamicin concentration in the nasal lavage fluid (NALF) was always effective and was the highest after the drop protocol, while it was always below the toxic dosage in the serum. The drop protocol appears the most adequate method to administer gentamicin for nasal topical treatment. Antimicrobials' topical administration efficacy has not been assessed in dogs with upper respiratory tract disease. The aim was to compare the concentration of gentamicin in nasal lavage fluid (NALF) and in serum after three topical protocols. This was a prospective crossover study of ten healthy dogs. Gentamicin was nebulized for a duration of 1 week, twice a day, for 10 min in the first protocol (10-min protocol) and for 3 min in the second protocol (3-min protocol), while the third protocol consisted of the administration of 0.25 mL of gentamicin in each nostril (drop protocol). Median concentrations of gentamicin in NALF were 9.39 µg/mL (8.12–19.97 interquartile range), 4.96 µg/mL (4.60–6.43) and 137.00 µg/mL (110.5–162.00) in the 10-min protocol, 3-min protocol and drop protocol, respectively. The result for the drop protocol was significantly higher than those of both nebulization protocols in NALF (p = 0.039). In serum, the gentamicin concentration was 0.98 µg/mL (0.65–1.53) and 0.25 µg/mL (0.25–0.44) in the 10-min and 3-min protocols, respectively. Gentamicin was not detected in the serum of seven out of ten dogs in the drop protocol, and gentamicin was significantly higher in the 10-min protocol compared to the drop protocol (p = 0.001). This study found that the 10-min, 3-min and drop protocols achieved superior concentrations in NALF compared to the minimum inhibitory concentration for gentamicin-sensitive bacteria, while remaining below the toxic values in blood. [ABSTRACT FROM AUTHOR]

Objective: Classical management of complex fractures involving the frontal sinus outflow tract (FSOT) favors obliteration or cranialization to avoid delayed complications. We aim to exhibit success with a novel application of balloon sinuplasty and frontal stenting in the management of complex injuries disrupting the FSOT, which might have otherwise required more invasive interventions. Study Design: Retrospective review. Setting: Single institution, level 1 trauma center. Methods: Retrospective review of patients presenting to a level 1 trauma center with fractures involving the FSOT. Outcomes include patency of the FSOT on imaging and endoscopy, rate of complications, degree of residual tabular displacement, and need for revision surgery. Results: Twenty‐five patients met inclusion criteria, with complete FSOT obstruction seen in all cases on computed tomography. All patients underwent balloon sinuplasty with frontal sinus stenting; 48% underwent concurrent anterior table repair, and 36% open repair of nasoorbitoethmoid complex fractures. The mean follow‐up length was 13.9 months, at which time 91.3% of patients demonstrated radiographic and endoscopic FSOT patency. No residual sinus opacification or pneumocephalus was observed. Conclusion: Balloon sinuplasty with frontal sinus stenting is a straightforward and minimally invasive technique that can create a safe sinus in complex fractures disrupting the FSOT while avoiding the need for more invasive procedures. [ABSTRACT FROM AUTHOR]

Background: Ossifying fibroma of the paranasal sinuses and skull base in paediatric patients is difficult to operate and can recur easily after surgery. This study aimed to analyse factors associated with recurrence after transnasal endoscopic resection of ossifying fibroma in paediatric patients. Methods: This retrospective observational study included 34 patients under 17 years of age who underwent transnasal endoscopic resection of ossifying fibroma of the paranasal sinuses and skull base from 2005 to 2021 at a single tertiary medical centre. Clinical indicators such as age; surgical history; pathological type; intraoperative bleeding; and orbit, anterior skull base, sphenoid bone, sella turcica, clivus, or frontal sinus involvement were subjected to univariate analysis using the χ2 test, to investigate whether any of these factors affected recurrence. Results: All 34 patients underwent transnasal endoscopic resection. The follow-up period was 6–120 months (mean: 48.0 months). Five patients experienced local recurrence during the follow-up period (14.7%). Results of χ2 tests indicated that a history of previous surgery, the amount of intraoperative bleeding, and sphenoid and/or sella turcica and clivus involvement were significantly associated with recurrence (P < 0.05). Age; pathological stage; and orbit, anterior skull base, and frontal sinus involvement were not associated with recurrence (P > 0.05). Conclusions: The increased risk of recurrence after transnasal endoscopic resection of nasal–skull base ossifying fibroma should be considered during endoscopic surgery in paediatric patients with a history of previous surgery, intraoperative bleeding tendency, and sphenoid and/or sella turcica and clivus involvement. These patients require careful postoperative follow-up. [ABSTRACT FROM AUTHOR]

Simple Summary: Personal identification is a paramount activity in forensic anthropology and can be achieved through the comparison of antemortem and postmortem images. Among the most individualizing skeletal structures are paranasal sinuses, which have been extensively investigated for identification purposes, with great emphasis on frontal sinuses. This paper extends this research line and assesses the uniqueness of the maxillary sinuses by applying 3D superimposition to investigate the reliability of these sinuses as reference anatomical structures for personal identification. Models of maxillary sinuses were acquired twice from CT scans to simulate antemortem and postmortem images; then, they were superimposed by pairing models from the same individual and from different individuals. The point-to-point distance between the models was used as a proxy to evaluate if the models belong to the same person. The optimal results suggest that maxillary sinus are reliable indicators of identity, although further research is needed to evaluate the performance of the method when the surface of the maxillary sinuses undergoes modifications due to pathological conditions. Paranasal sinuses represent one of the most individualizing structures of the human body and some of them have been already analyzed for possible applications to personal identification, such as the frontal and sphenoid sinuses. This study explores the application of 3D–3D superimposition to maxillary sinuses in personal identification. One hundred head CT-scans of adult subjects (equally divided among males and females) were extracted from a hospital database. Maxillary sinuses were segmented twice from each subject through ITK-SNAP software and the correspondent 3D models were automatically superimposed to obtain 100 matches (when they belonged to the same person) and 100 mismatches (when they were extracted from different individuals), both from the right and left side. Average RMS (root mean square) point-to-point distance was then calculated for all the superimpositions; differences according to sex, side, and group (matches and mismatches) were assessed through three-way ANOVA test (p < 0.017). On average, RMS values were lower in matches (0.26 ± 0.19 mm in males, 0.24 ± 0.18 mm in females) than in mismatches (2.44 ± 0.87 mm in males, 2.20 ± 0.73 mm in females) with a significant difference (p < 0.001). No significant differences were found according to sex or side (p > 0.017). The study verified the potential of maxillary sinuses as reliable anatomical structures for personal identification in the forensic context. [ABSTRACT FROM AUTHOR]

Objectives: The possibility of visualization of the frontal sinus during endoscopic surgery depends on 3-dimensional configuration of the frontal sinus opening (FSO). We aimed to determine the prevalence of unfavorable angulation of the lower part of the posterior wall of the frontal sinus and its relation to FSO diameter. Methods: One hundred and twenty-eight computed tomography (CT) scans were retrospectively reviewed to measure (1) the angle between the nasal floor and the plane tangent to the posterior table of the frontal sinus above the most posterior aspect of the anterior buttress (frontal angle, FA) and (2) dimensions of the FSO. Results: The FA ranged from below 30° to 90°. Nearly 13% of sinuses (16.4% of patients) showed FA about 90°, which should enable good visualization of the sinus with the 30° scope after opening and clearing the frontal recess, while 4% (6.25% of patients) showed FA ≤ 30°. The anterior–posterior diameter (A-PD) was below 5 mm in 17.6% of sinuses (26.6% of patients). There was a significant correlation between FA and A-PD. Unfavorable combination of FA and A-PD (<45°, <5 mm) was present in 5.2% of sinuses (8.6% of patients), and extremely unfavorable combination (<30°, <5 mm) in 0.8% (0.8% of patients). Conclusions: The FA shows great interindividual variability, which is very likely to reflect the possibility of inspection of the frontal sinus. This implies a need for further prospective clinical studies to validate FA as a predictor of difficulty in frontal sinus surgery. [ABSTRACT FROM AUTHOR]

Currently, surgical obliterations are a mainstay for treating dural arteriovenous fistula (DAVF) in the anterior cranial fossa (ACF), which has high risks of hemorrhage and functional disorder. By introducing an endoscope into a high frontal approach and utilizing its advantages, we attempted to establish it as a new surgical procedure that eliminates the drawbacks of various approaches that have been used to date. By using 30 clinical datasets of venous-phase head computed tomography angiogram, measurements and comparisons on a 3-dimensional workstation were performed to identify the appropriate positioning of keyhole craniotomy for endoscope-controlled high frontal approach (EHFA). Based on these data, a cadaver-based surgery was simulated to verify the feasibility of EHFA and develop an efficient procedure. In EHFA, though raising the position of the keyhole craniotomy made the operative field deeper, significant advantages were obtained in the angle between the operative axis and the medial-anterior cranial base and the amount of bone removal required at the anterior edge of craniotomy. Minimally invasive EHFA, performed through a keyhole craniotomy without opening the frontal sinus, proved to be feasible on 10 sides of 5 cadaver heads. Moreover, 3 patients with DAVF in ACF were successfully treated by clipping the fistula via EHFA. EHFA, which provided a direct corridor to the medial ACF at the level of the foramen cecum and crista galli and the minimum necessary operative field, was found to be a suitable procedure for clipping the fistula of DAVF in ACF. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the common interventions performed by neurosurgery and otolaryngology in dural invasion in frontal sinus related pathologies. Materials and Methods: A comprehensive study involving 45 patients who underwent surgical interventions for frontal sinus-associated pathologies between January 2018 and July 2023 was conducted collaboratively by otorhinolaryngology and neurosurgery departments. Patient data, including demographics, pathology types, and surgical approaches, were collected from medical records, surgical reports, imaging studies, and videos. Interdisciplinary surgical teams executed tailored interventions with documented techniques. Results: Among 45 patients, 31 were female (68.8%) with a mean age of 44. Posterior wall defects were detected 13 (28.8%) patients, and intervention was necessary for only 8 of them. Among the 8 (17.7%) patients with identified dural invasion, pathological dural tissue was excised, and duraplasty was performed in 5 (11.1%) cases. There were no neurological complications observed patients during the postoperative period. Conclusion: Despite limitations, the findings contribute to evolving knowledge and highlight the need for prospective studies to optimize patient care strategies. [ABSTRACT FROM AUTHOR]

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Background: The squamous cell carcinoma is the most common subtype of malignant sinonasal tumours, predominantly involving the maxillary sinuses and nasal cavities in 70 to 80% of cases, and the frontal sinus is extremely rarely involved, in less than 1% of cases. Early clinical and radiological diagnosis is difficult due to overlap of findings with inflammatory sinonasal disease. Case presentation: A 55-year-old Caucasian male patient had presented to the emergency department with three-month history of progressive right frontal swelling, acute frontal pain, recent exacerbation of right eye vision impairment and new lid swelling. There was no recent history of trauma and no neurological deficit on examination. Contrast-enhanced CT head was performed which demonstrated large bony destruction of frontal sinus with partly enhancing necrotic-looking tumour within the sinus. There was further intraorbital and intracranial extension of disease. Subsequent MRI confirmed these findings with better demonstration of intracranial and intraorbital component of the disease. The PET imaging did not reveal any avid disease elsewhere. Histopathology confirmed squamous cell carcinoma. Conclusions: Frontal sinus squamous cell carcinoma is a rare and the least common site within the paranasal sinuses. Early clinical and imaging diagnosis could be challenging; however, the index of suspicion should be high with indeterminate imaging findings. CT and MRI are the complimentary imaging techniques. [ABSTRACT FROM AUTHOR]

Introduction: Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal communication between the intracranial and extracranial venous systems [1]. Sinus pericranii is most commonly seen in the distribution areas of the superior sagittal and transverse sinuses [2]. There are no uniform criteria for the etiology, pathogenesis, diagnostic criteria, treatment options, or prognosis of sinus pericranii [3]. Case description: In this paper, we present the diagnosis and treatment of a child admitted to our neurosurgery department in 2019 with rapidly growing frontal sinus pericranii, as well as the 3-year postoperative follow-up. Discussion: The authors summarize the clinical presentation characteristics, diagnosis and treatment methods, and prognosis of this disease using relevant domestic and international literature to improve clinicians' understanding of this disease. Conclusion: It is rare to see a significant growing of the sinus pericranii within a short period, and the mechanism of their occurrence needs to be further explored. [ABSTRACT FROM AUTHOR]

The Functional endoscopic sinus surgery through transnasal approach is a common modality of treatment for disorders of the nasal cavity, paranasal air sinuses as well as cranial cavity. The olfactory fossa (OF) is located along the superior aspect of cribriform plate which varies in shape and depth. This variable measurement of the depth of OF is mostly responsible for greater risk of intracranial infiltration during endoscopic procedures in and around the nasal cavity. The morphology of frontal and ethmoid sinus (ES) vary from simple to complex. This cadaveric study is planned to improve the ability of the otolaryngologist, radiologist to understand the possible morphological variations and plan steps of less invasive "precision surgery" to have a safe and complication free procedures. A total of 37 human head regions were included in the study. For classification of OF, Modified Kero's classification was used. The size, shape and cells of frontal and ES were noted. We found, type II (60.8%) OF was more common followed by type I (29.7%) than type III (9.5%). The shape of frontal sinus was comma shaped (55.4%) followed by oval (18.9%) than irregular (16.2%). Most common two cells type of ES was seen in 50.0% of both anterior and posterior ES. Out of 74 ES, 8.1% of Onodi cells and 14.9% of agger nasi cells were seen. [ABSTRACT FROM AUTHOR]

In the present day scenario complications arising from sinusitis are rare, since the introduction of antibiotics. However Sinusitis and its complications are still existing and masking of symptoms due to inadequate dosage and duration of antibiotics, which is life threatening and if neglected may result in high morbidity and mortality. This case has been presented for its rare presentation of parafalcine abscess of left occipital lobe of middle cranial fossa, which is secondary to frontal sinusitis. A 40 year old male patient was admitted in ICU with chief complaints of fever for 3 days, headache and neck stiffness for 2 days and altered sensorium for 1 day. Computed tomography showed both frontals, ethmoids and maxillary sinusitis on the left side. Patient was given conservative treatment and showed partial improvement of symptoms. On repeat CT brain (after 2 weeks) showed abscess parasagittally in left occipital lobe. Neurosurgeon aspirated abscess through parasagittal approach. Later the patient referred to the ENT department and ESS (endoscopic sinus surgery) DRAF II procedure done for clearance of frontal sinus to avoid recurrence of intracranial complications. [ABSTRACT FROM AUTHOR]

Reports on canine frontal sinus carcinomas (FSCs) are scarce. This retrospective review of 41 dogs with FSC (2001–2022) describes demographic and clinical characteristics of canine FSC and reports the clinical experience and overall survival following treatment with toceranib phosphate (TOC) and meloxicam in 10 cases. Median age at diagnosis was 10.6 years (range: 6.5–15.4 years). There was a male‐to‐female‐ratio of 2.4:1. The most common breeds were Jack Russell Terriers (JRT) (n = 7; 17.1%) and Rottweilers (n = 3, 7.3%). Mesocephalic breeds (70.6%) were most commonly affected, brachycephalics accounted for 8.8%. The most frequent clinical signs included skull deformation dorsomedial to the eye (87.5%), pain/head‐shyness (40.0%), ocular (22.5%)/nasal (17.5%) discharge, and exophthalmos (17.5%). Duration of symptoms prior to diagnosis varied from a few days to 9 months. There were no neurological signs at initial presentation despite imaging evidence of osteolysis of the lamina interna of the frontal bone in most dogs (69.4%). In 11.5%, pulmonary changes suggestive of metastasis or concurrent primary pulmonary neoplasia were present. Tumour types included squamous cell carcinoma (58.5%), unspecified carcinoma (29.3%), and adenocarcinoma (9.8%). Ten dogs were treated with TOC (median 2.8 mg/kg EOD or three times per week) and meloxicam (0.1 mg/kg, EOD) (TOC‐M), resulting in subjective regression of skull deformity in 8/10 (80.0%) patients. Overall median survival time with TOC‐M was 183.5 days (range: 120–434 days). FSCs typically present with skull deformation, but no overt neurological signs. Male dogs and JRT may be overrepresented. The use of TOC‐M in FSC appears promising and warrants further prospective evaluation. [ABSTRACT FROM AUTHOR]

In this study, we analyzed the patients who underwent surgery using their adipose tissue, which is a practical and economical approach to the reconstructing the frontal sinus during bifrontal craniotomy. The study aimed to evaluate the economic feasibility and safety of this classical technique to repair the frontal sinus and reduce complications. Patients who were underwent bifrontal craniotomy for anterior skull base tumors and underwent intraoperative frontal sinus repair between January 1, 2016 and January 1, 2022 were retrospectively evaluated. Demographic characteristics of the patients (age, gender), duration of hospitalization, etiological causes, post operation complications, management of complications, and follow-up periods were analyzed.A total of 25 patients were included in the study. Of the patients, 11 were male (46%) and 14 were female (54%). The median age of the patients was 59 (49.5-66) years. The median duration of hospitalization and follow-up period were 7 (6-8.5) days and 27 (17-48) months, respectively. Cerebrospinal fluid leakage developed as a complication in only one patient (4%) in the postoperative period. We applied the classical technique of using the patient's own adipose tissue for repair after frontal sinus opening that occurs in bifrontal craniotomies for anterior skull base tumors. This is a practical, effective, and economical method that causes less harm to patients. [ABSTRACT FROM AUTHOR]

This study aimed to establish and verify the validity of an acoustic simulation method during sustained phonation of the Japanese vowels /i/ and /u/. The study participants were six healthy adults. First, vocal tract models were constructed based on computed tomography (CT) data, such as the range from the frontal sinus to the glottis, during sustained phonation of /i/ and /u/. To imitate the trachea, after being virtually extended by 12 cm, cylindrical shapes were then added to the vocal tract models between the tracheal bifurcation and the lower part of the glottis. Next, the boundary element method and the Kirchhoff–Helmholtz integral equation were used for discretization and to represent the wave equation for sound propagation, respectively. As a result, the relative discrimination thresholds of the vowel formant frequencies for /i/ and /u/ against actual voice were 1.1–10.2% and 0.4–9.3% for the first formant and 3.9–7.5% and 5.0–12.5% for the second formant, respectively. In the vocal tract model with nasal coupling, a pole–zero pair was observed at around 500 Hz, and for both /i/ and /u/, a pole–zero pair was observed at around 1000 Hz regardless of the presence or absence of nasal coupling. Therefore, the boundary element method, which produces solutions by analysis of boundary problems rather than three-dimensional aspects, was thought to be effective for simulating the Japanese vowels /i/ and /u/ with high validity for the vocal tract models encompassing a wide range, from the frontal sinuses to the trachea, constructed from CT data obtained during sustained phonation. [ABSTRACT FROM AUTHOR]

Unusual manifestations in commonly occurring diseases often mislead the diagnostic approaches of general veterinary practitioners. A 2.5‐year‐old male Spitz dog was evaluated for frequent episodes of nasal discharges. With no resolution of signs with treatments, the dog was brought to the Teaching Veterinary Hospital. On presentation, the dog had purulent nasal discharge from the right nostrils, right eye and from an opening in the right frontal sinus region along with mild swelling on the right nasal region and stertor. Anterior rhinoscopy confirmed the concurrent presence of frontal sinus, oculo‐nasal and oro‐nasal fistula. Endoscopic aspirations and washing confirmed an extra genital form of canine transmissible venereal tumour. Interestingly no genital lesions were seen. Treatment with vincristine resulted in complete remission with no further relapses over the last 8 years. Chronic nasal signs should be taken as warning signs and nasal washings should be evaluated for possible tumour cells, as observed in this study. [ABSTRACT FROM AUTHOR]

Osteoma is a common, slow growing bone tumor, and often affects the paranasal sinus. Typically, it shows a very hyperdense osseous lesion on computed tomography (CT) scan and low-intensity change on T2-weighted image on magnetic resonance imaging (MRI). No report has mentioned osteomas in blood supply on MRI. A 57-year-old male patient presented with a prolonged declined activity and a gigantic osseous tumor that originated from the frontal sinus, which markedly compressed the bilateral frontal lobe. MRI revealed a slightly enhanced front basal part of the tumor by gadolinium, with blood supply from ethmoidal arteries. The patient underwent surgery, and the diagnosis of osteoma was made based on histological findings. We reported a case of giant osteoma originating from the frontal sinus with unusual blood supply on 4-dimensional MR angiography.

Introduction: Radiology is an essential branch of medicine well known for its nature as “seeing the unseen.” It is now extending its wings to the field of forensics to “identify the unseen” during mass disasters and natural calamities. Even after catastrophes, parts of the facial skeleton, such as the maxillary sinus, frontal sinus, and other alternate sections of the human facial skeleton, are being explored for sex identification. Researchers have proven that the frontal sinus is also a valuable tool for assessing the gender of a person. The frontal sinus and its structural diversity suggest that it is an important anatomical area to be analyzed for forensic purposes, notably in identifying sex using skull dimensions. Hence, this study aimed to identify sexual dimorphism by evaluating the frontal sinus using cone beam computed tomography (CBCT). Materials and Methods: In this study, a total of 50 patients were selected and were divided into two groups, group I (25 males) and group II (25 females), where the frontal sinus height (superioinferior) and width (mediolateral) dimensions were evaluated using CBCT scans All the measurements were performed in coronal sections. Results: The independent t-test and Mann–Whitney U-test were used to analyze the data. Shapiro–Wilk test was used to assess normality. Right frontal sinus height (P-0.11) and width (P-0.1), and frontal sinus index (P-0.81) were higher in males than in females. Left frontal sinus height (P < 0.001), width (P < 0.001), and frontal sinus index (P-0.64) were higher in males than in females. Left frontal sinus height and width were statistically significant, depicting the sexual dimorphism. Conclusion: The gender predictor variable of the frontal sinus in the current study using parameters such as height, width, and frontal sinus index on CBCT was higher in males compared to females. Left frontal sinus can be considered as a useful predictor in the gender determination of the individual.

Background: Frontal sinus pattern is unique for each individual which has made it an important tool in forensic sciences. The dimensions of the maxillary sinus also tend to stabilize after puberty and remain intact when skull bones are poorly disfigured. These sinuses exhibit different dimensions among male and female subjects. Nasal septum patterns can be utilized as a tool. Aims and Objective: The present study is intended to determine the sexual dimorphism with dimensions of the frontal sinus, maxillary sinus, and nasal septum pattern by cone beam computed topography. Materials and Method: The study subject consisted of 100 images of CBCT images which were collected from the database retrospectively. The obtained data were statistically analyzed. Results: The parameters were higher in male in comparison to female subjects. The length, height of the maxillary sinus, and frontal sinus width showed statistically significant results. The deviated nasal septum was not statistically significant. Conclusion: The maxillary sinus and frontal sinus are utilized for personal identification and gender determination with the nasal septum as an adjuvant tool.

Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations. Methods: Retrospectively, 1220 frontal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex. Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral ( pppp Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.

Background: Measurement of craniofacial parameters plays an important role in sex determination in forensic science. The present study was done using cone beam computed tomography (CBCT) scans to evaluate the morphologic structure of the frontal sinuses and compare it with the width of nasal, cranial, maxillary and mandibular width which might help us in sex determination. Methods: A cross-sectional retrospective study was conducted using 142 full field of view (FOV) scans of patients archived from the department. The width of the nose, cranium, maxilla, and mandibular width was measured and compared with the frontal sinus between the two sexes. Results: A paired t-test was done to compare the linear measurements for both sexes' right and left frontal sinuses. The measurements were higher in males when compared to females. There was a statistically significant asymmetry (larger dimension on the left side) of the anterioposterior (p-value of 0.012) and superior-inferior dimensions in males (p-value of 0.135). Spearman's correlation showed that frontal sinus correlated with other craniofacial parameters like nasal, cranial, maxillary and mandibular width among both sexes. The frontal sinus, nasal, cranial, maxillary and mandibular widths were higher in males when compared to females (independent t-test). Discriminant function scores showed 66-68% accuracy to discriminate sex, using the anteroposterior dimension and mandibular width. Conclusions: The measurement of craniofacial parameters using CBCT can aid in determining the sex of unidentified and decomposed bodies.