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Frontal sinuses within the frontal bone can be a potential obstacle in neurosurgical approach in this region. Their unintended opening during craniotomy is not beneficial due to the risk of brain infections by bacteria inhabiting the sinus mucosa. Therefore, such opening should be avoided whenever the surgical procedure does not involve the sinus itself. The aim of the study was the morphometric analysis of the frontal sinuses based on computed tomography imaging. The width, height, projection surface area and location of the highest and most lateral points of the sinuses were determined. The vertical diameter of the sinuses was found to be greater in men compared with women. The most lateral point of the sinuses was located higher in men, and in men was located higher on the left side. The results obtained may indicate that the frontal sinuses tend to be larger in men and that air cells in men extend further in the upper - lateral direction on the left side of the frontal bone. This may cause an increased risk of unintentional opening of the left frontal sinus during frontal craniotomy or pterional craniotomy with frontal extension.

A 19 year old man presented with a few years history of increasing headaches. Over the preceding few months, his friends and family noticed a slight protrusion of his left eye. In the last two months, he started experiencing double vision. CT and MRI scans confirmed the presence of fibrous dysplasia of the left frontal sinus with a secondary mucocele formation extending into the left orbit. The mucocele was drained and the fibrous dysplasia reduced through a combined craniotomy and endoscopic sinus surgery. The patient symptoms resolved postoperatively, and he was discharged 5 years later.

Background: Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, are rare. The authors reported a complex case of intradiploic intraosseous metaplastic meningioma of the left medial wall and orbital roof with the left frontal sinus invasion and left ethmoidal body bone substitution. The authors also conducted a systematic review concerning diagnosis and management of patients affected by purely calvarial intradiploic meningiomas along with a focus on fronto-orbito-ethmoidal ones. Methods: A literature search was conducted using PubMed and Scopus databases according to preferred reporting items for systematic reviews and meta-analysis statement and with the following Mesh terms: Intradiploic, intraosseous, calvarial, and meningioma. Eligibility criteria were limited by the nature of existing literature on intradiploic meningiomas, consisting of only case series, and case reports. Results: A total of 128 published studies were identified through our search. 41 studies were included in this systematic review, 59 patients with a female/male ratio of 1.2/1. The mean age of the patients is of 47.69 years (range 3–84 years). Only seven out of 59 patients (11.9%) presented a complex intradiploic meningioma located in fronto-orbito-ethmoidal region like our case. In almost all patients, a gross-total resection was performed (96.6%) and only in two patients (3.4%) a subtotal resection was achieved. Conclusion: The authors shared this successfully treated case to add to the overall clinical experience in the management of this rare subtype tumor, with the hope that more studies are conducted to further address the mechanism of intradiploic meningiomas development.

A 52-year-old Caucasian woman presented with an incidental finding of a bony lesion in the left frontal sinus on a CT scan of the paranasal sinuses. This was requested to investigate chronic rhinosinusitis that had failed to improve despite optimal medical therapy. A diagnosis of a left frontal sinus osteoma was made. The patient underwent functional endoscopic sinus surgery. The frontal sinus osteoma was not removed, and the patient was followed for a few years without progression of the osteoma.

Cranial bone thickness and frontal sinus size are important parameters to be known before cranial procedures. Deep-learning systems have become popular for making bulk analyses to diagnose diseases/disorders and plan treatment algorithms in diverse fields of medicine. Deep-learning systems would be valuable assets also for cranial procedures. Deep-learning systems need normative values and variances of the population on which they are used. In the present study, the authors aimed to find out the normative values for skull bone thickness at 4 anatomical locations, and frontal sinus size. the authors also analyzed whether gender affected these values. Consecutive adult female and male patients that had presented to our outpatient and emergency clinics between December 2019 and April 2020 were evaluated. We included 174 patients (98 female and 76 male) into the final analysis. Skull bone thickness was measured in 4 anatomical compartments, and vertical dimension of the left and right frontal sinuses were measured. The mean thickness of frontal, parietal, temporal, and occipital bones was 7.9 mm, 9.7 mm, 6 mm, and 10.1 mm for men; 8.7 mm, 10.2 mm, 6.1 mm, and 10.1 mm for women, respectively. Women had significantly thicker frontal bone when compared to men (P = 0.009). Men had significantly larger frontal sinuses compared to women (16.1 mm versus 13.7 mm for right frontal sinus, P = 0.031; 16.4 mm versus 13.9 mm for left frontal sinus, P = 0.023). Women and men had thicker frontal bone, and larger frontal sinuses, respectively.

Case summary A 3-year-old male neutered domestic shorthair cat presented for further investigation of a swollen left eyelid and a hard, non-painful bony swelling over the left frontal sinus. Physical examination revealed no nasal discharge or airflow through the left nostril. A CT of the head revealed a left frontal sinus obstruction with expansile remodelling and osteolucency. Drainage of the frontal sinus obstruction was alleviated via placement of a temporary polyvinylchloride (PVC) stent that was left in place for 6 weeks. Purulent material removed from the frontal sinus returned a positive culture for Pseudomonas aeruginosa susceptible to marbofloxacin that was continued for 4 weeks, and for an additional 2 weeks after stent removal. A left-sided mucoid nasal discharge returned 3 months after removal of the stent. Repeat CT performed 20 months after surgery found the presence of a gas-filled frontal sinus and partial resolution in the amount of fluid within the mid and rostral nasal cavity. A repeat positive culture for P aeruginosa was also obtained. The exact cause of the chronic unilateral sinonasal obstruction remains unclear, but an underlying chronic rhinitis with secondary obstructive frontal sinusitis or sinus mucocoele with secondary nasal extension was suspected. Relevance and novel information Chronic rhinosinusitis in cats can be a challenging condition to treat and cure. This case illustrates the partial resolution of chronic unilateral sinonasal obstructive disease in a cat using a temporary PVC stent.

Background: The aim of this study is to evaluate the relationship between frontal sinus morphology and hand-wrist bone maturation by using postero-anterior (PA) cephalometric radiographs. Materials and methods: The study sample consisted of 220 patients divided into 11 groups based on the hand-wrist radiographs. The right and left maximum height, width and area of the frontal sinus parameters were measured in PA cephalometric radiographs of 220 subjects aged 8–18 years. The hand-wrist skeletal maturation stages were evaluated on the hand-wrist radiographs using the method of Fishman. The Kendall tau-b values were analysed to evaluate the correlation between the hand-wrist skeletal maturation stages and the frontal sinus parameters. Results: The right and left frontal sinus areas and widths were found to be larger in males than in females (p < 0.05). In males, a significant difference was observed in all frontal sinus parameters in different maturation stages (p < 0.001), while a statistically significant correlation was found in females between the left frontal sinus area, right frontal sinus height, right frontal sinus width and different maturation stages (p < 0.05). Conclusions: The relationship between frontal sinus dimensions obtained from PA cephalometric radiographs and hand-wrist maturation stages suggests that frontal sinuses can be used in determining growth and development.

Aim The aim of our study was to measure the frontal sinus morphology that could aid us in gender determination and also to assess the difference in measurements between the right and left frontal sinus. Materials and methods A retrospective study was done using 100 cone beam computed tomography (CBCT) images (50 males and 50 females) matched with age and gender with full field of view (FOV). The examinations were carried out using Promax 3DMid (Planmeca Oy., Helsinki, Finland) CBCT unit. The frontal sinus was assessed in coronal, sagittal, and axial planes, and the maximum measurements in each section were recorded. The results to compare the right and left frontal sinus were analyzed using paired t-tests, and independent Student's t-test was used to compare the difference in measurements of frontal sinus between males and females. Results We found that the left side of the frontal sinus was bigger than the right side, and while comparing between the genders, it was found that the measurements were greater in males. Statistically significant results were obtained on comparing between the sides and gender. Conclusion As mentioned in previous studies, frontal sinus measurements are significantly higher in males compared with females which can, therefore, be used in gender identification in cases of mass disasters. Clinical significance Frontal sinus measurements can be used as an adjunct in gender identification in mass disasters and with advances in technology. Cone beam computed tomography, in addition to providing accurate measurements, has overcome all the disadvantages with two-dimensional imaging. How to cite this article Denny C, Jacob AS, Ahmed J, Natarajan S, Binnal A, Sujir N. Frontal Sinus as an aid in Gender Identification in Forensic Dentistry: A Retrospective Study using Cone Beam Computed Tomography. World J Dent 2018;9(1):34-37.

Introduction The open frontal intersinus septum takedown (FISST) technique was first described in 1976. We describe our experience with an endoscopic transnasal approach to manage a frontal sinus pyocele arising from an obstructed frontal sinus outflow tract due to anterolateral thigh flap reconstruction of a maxillectomy defect. Case report A 40-year-old lady experienced upper eyelid swelling and purulent nasal discharge 3 weeks after undergoing a left extended medial maxillectomy with free anterolateral thigh flap reconstruction. A computed tomography (CT) scan revealed total opacification of the left frontal sinus. There was no improvement with intravenous antibiotics and she underwent a surgery, whenshe was found intraoperatively to have a frontal sinus pyocele, which was then drained. She then underwent an endoscopic transnasal FISST to ventilate the left frontal sinus via the contralateral frontal recess with good results. A CT scan performed 3 months postoperatively showed a widely patent interfrontal sinus septal window and right frontal outflow tract with no disease recurrence. Discussion The FISST is a useful technique to manage unilateral frontal sinus disease by taking advantage of the contralateral outflow tract when the ipsilateral frontal recess is obstructed.

Metopism (complete persistence of the metopic suture in adults) is a rare but not exceptional variation of the calvaria. Hypoplasia or aplasia of the frontal sinus may be associated without evident correlation. Nevertheless, a misdiagnosis of these variations may have clinical consequences, especially in a traumatic context. The aim of this paper was to report a case of metopism associated with a unilateral aplasia of the left frontal sinus, originally illustrated with 3D image fusion volume rendering reconstructions.

The study of frontal sinuses for personal identification is a considered approach in the forensic field. In Yoshino's system, the frontal sinus patterns of a given person were formulated as a code number (codY) obtained by arranging the class numbers in each classification item. The aim of this work was to use a new code number (codC) with eight digits that includes other two continuous variables obtained as ratios SOR1 (left frontal sinus area/left orbit area) and SOR2 (right frontal sinus area/right orbit area), comparing the results with that of Yoshino. Digital radiographic images of the skulls of 150 Chinese people were analyzed. Spearman's partial correlation coefficients were evaluated between variables characterizing frontal sinus patterns. We used a maximum-weight dependence tree for statistical analysis. Results demonstrated that codC significantly reduced the probability of having the same personal code number compared with codY. Our scientific approach results valid for personal identification purposes.

We present a case of a 26-year-old man who sustained a close-range gunshot wound to the head. His injuries included significant left orbital injury resulting in a ruptured, blind eye and severely comminuted fractures of the left orbital roof, superior and inferior orbital rims, and orbital floor. Associated injuries included left frontal lobe injury, anterior and posterior table fractures of the left frontal sinus, and a comminuted left zygomaticomaxillary complex fracture. We employed an interdisciplinary surgical approach with collaboration among the Otolaryngology, Neurosurgery, and Oculoplastic Surgery services performed in two stages. Management of such extensive craniofacial injuries can be challenging and requires a coordinated, interdisciplinary approach.

The aim of this study was to evaluate the morphologic structure of the frontal sinuses with postero-anterior cephalometric radiographs in Turkish adolescents and to compare the findings between genders. The study sample consisted of 148 subjects divided into two groups (74 male subjects; mean age: 14.55 ± 1.42 years-74 female subjects; mean age: 14.95 ± 1.80 years). The right and left maximum height and width of the frontal sinus, maxillary width, nasal width, cranial width, antegonial width parameters were measured in 148 postero-anterior cephalometric radiographs. The data were analyzed using independent t and Mann Whitney U test. Spearman correlation analyses were used to evaluate the relationships of the frontal sinus measurements and transversal cephalometric parameters. The mean values of the right and left frontal sinus width, maxillary width, antegonial width, and cranial width were larger in males than females (P < 0.05). The right frontal sinus height were positively correlated with antegonial width (r = 0.243; P < 0.05) and the right frontal sinus width were positively correlated with antegonial width (r = 0.327; P < 0.01) in males. The right frontal sinus width were positively correlated with nasal width (r = 0.244; P < 0.05) and the left frontal sinus width were positively correlated with nasal width (r = 0.231; P < 0.05) in females. Frontal sinuses were unique to each individual due to their morphological structures, and in forensic science, taking advantage of these features was very important for personal identification.

We present the case of a male with a history of nasal polyposis underwent bilateral nasosinusal endoscopic surgery. He went to the emergency department because of having behavioral changes and left frontal headache. An emergency CT showed nasal-sinus polyposis and several nodular lesions with a characteristic “ring” enhancement and perilesional edema. These findings were compatible facial mucocele complicated with rupture of the bone wall of the left frontal sinus and frontal abscess. Urgent surgery was performed, with left frontal craniectomy and drainage of the abscesses. Mucoceles are benign slowly growing lesions which can associate important complications. The most frequent are abscesses and the invasion of neighboring structures. It is very important to remember that frontal mucoceles can cause intracranial invasion when there is an erosion of the internal osseous table.

Osteomas are benign tumors of the paranasal sinuses, and are mostly located in the frontal sinus. The evolution of the osteomas is slow and silent. The osteomas are often discovered incidentally on a craniofacial CT scan. Due to the slow growing nature of this tumour, the therapeutic approach is usually “watch and wait”. When symptoms occur, the surgical approach is required. This can be external, endoscopic or combined. The authors report the case of a 55-year-old female patient who was admitted to the hospital with a history of progressive frontal headache for 12 months. The clinical ENT examination and the paralinical exams (nasal endoscopy, computed tomography – head, paranasal sinuses) were suggestive for a left frontal sinus osteoma. The surgical management of the osteoma was a combined approach, including the external Ogston-Luc technique and the endoscopic approach. The postoperative period was uneventful, with no complications, and the drain tube was removed 14 days after surgery.

The frontal sinuses are cranial areas of clinical, forensic and pathology importance whose development mechanisms are still poorly defined. Nasal airflow and brain development are two of the main theories. Current analysis debates whether they are the real determinants of frontal sinuses growth, which may be proved by the skull's morphometric analysis. Four groups of measures related to the external cranial architecture, the pyriform aperture, orbital cavities and frontal sinuses were defined. Thirty-three skulls of individuals, mean age 68 years, from the Laboratory of Anatomy of the Academic Centre of Victoria - UFPE - Brazil, were used. Statistical analysis showed total agenesis of the frontal sinus in 18.2% of the skulls. There was significant correlation between the development of the right frontal sinus and the pyriform aperture, and between the left frontal sinus and two cranial measurements (p ≤ 0.05). Significant differences between mean of pyriform aperture areas of the skulls with or without sinuses were also reported (p ≤ 0.01). Results supported the fact that there was a modulation activity by nasal aeration and brain formation in the development of frontal sinuses.

Amac : Bu calismanin amaci; farkli sagittal iskeletsel iliskiye sahip bireylerde, frontal sinus morfolojisini postero-anterior sefalometrik radyograflar kullanarak arastirilmasidir. Gerec ve Yontem : 75 bireyden olusan calisma cenelerin sagittal iskeletsel iliskisine gore 3 gruba ayrilmistir (Sinif I bireyler; ortalama yas: 15,14±1,40 yil, Sinif II bireyler; ortalama yas: 15,21±1,77 yil, Sinif III bireyler; ortalama yas: 15,16±1,57 yil). Frontal sinusun sag ve sol maksimum yuksekligi ve genisligi, maksiller genislik, nazal genislik, kranial genislik ve antegonial genislik parametreleri 75 postero-anterior sefalometrik radyograf uzerinde olculmustur. Veriler bagimsiz t, Mann Whitney U, tek yonlu varyans analizi ve Kruskal-Wallis testleri kullanilarak analiz edilmistir. Bulgular : Sag frontal sinus yuksekligi, sol frontal sinus yuksekligi ve genisligi gruplar arasinda istatistiksel olarak anlamli farklilik gostermistir ( P

The frontal sinus is a sturdy part of the skull that is likely to be retrieved for forensic investigations. We evaluated frontal sinus parameters in paranasal sinus computed tomography (CT) images for sex determination. The study was conducted on 200 normal paranasal sinus CT images of 100 men and 100 women of Persian origin. We categorized the studied population into three age groups of 20-34, 35-49 and ⩾ 50 years. The number of partial septa in the right frontal sinus and the maximum height and width were significantly different between the two sexes. The highest precision for sex determination was for the maximum height of the left frontal sinus (61.3%). In the 20-34 years age-group, height and width of the frontal sinus were significantly different between the two sexes and the height of the left sinus had the highest precision (60.8%). In the 35-49 years age-group, right anterior-posterior diameter had a sex determination precision of 52.3%. No frontal sinus parameter reached a statistically significant level for sex determination in the ⩾ 50 years age-group. The number of septa and scallopings were not useful in sex determination. Frontal sinus parameters did not have a high precision in sex determination among Persian adults.

A case of transitional cell carcinoma (TCC) of the frontal sinus is reported. An 83-year-old man complained of left exophthalmos and nasal obstruction. On examination, the nasal cavity was blocked with a polypoid swelling. Computed tomography and magnetic resonance imaging demonstrated tumor in the frontal sinus and mucocele in the paranasal sinus. The mass in the left frontal sinus was excised and diagnosed as TCC. The treatment was performed by a linear accelerator. The prescribed dose was 70Gy. Irradiation was performed without effect, and the patient died 1 year later. Previous reports of TCC in the paranasal sinus are reviewed and discussed.

A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot–Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy.

We report a case of a 69-year-old woman with a giant frontal-ethmoid cyst with intracranial involvement. Without any previous operation or trauma, she complained of swelling in the medial angle of the left eye. Based on CT and MRI images, a giant cystic lesion was seen in the left frontal sinus and both ethmoid sinuses, which had caused a defect in the posterior wall of the cranial bone. The giant cyst pressed against the left frontal lobe of the brain. We opened the cystic wall solely by endoscopic technique and gently drained the cystic contents. After the operation, the sinus cavity was cured without herniation of the brain. There has been no recurrence for 7 years and 6 months.

Cerebrospinal fluid (CSF) collection in the eyelid is known as blepharocele. It is rarely reported in adults. In this report, we describe one such patient who developed a non-resolving swelling of the left upper eyelid associated with mechanical ptosis following a head injury. He had fractures involving the left orbital rim and roof, and the medial and lateral walls. His left frontal sinus was hypoplastic. The diagnosis of CSF blepharocele was made based on clinical, biochemical and radiological findings. He underwent transcranial repair of the left frontobasal dural tear with a good recovery.

Giant cell tumor (GCT) is an uncommon aggressive primary bone tumor usually affects long bones. It is rarely involving skull bones, and to less extent the frontal bone. Up to date only 3 adult cases reported of the frontal bone, only one of them was occupying the frontal sinus. Here, we present a 49 year old male presented with slowly growing left supraorbital swelling for 3 years. This swelling was a firm mass with destruction of anterior table of frontal bone. Diagnostic radiological work-up showed a mass in left frontal sinus, mass excised with external approach. Reporting this case with its clinical, radiological and histopathological images should add significant material to the literature for further studies of GCT of paranasal sinuses.

A 27-year-old male complaining of anterior frontal swelling and pain was sent to our hospital for further examination and treatment. Examinations, including X-ray, CTscan, MRI, led to a diagnosis of frontal sinusitis with bone defect of the anterior wall and a fistula between the frontal sinus and the skin. After radical maxilloethmoidectomy, an extranasal frontal sinus operation employing a coronal incision was performed under general anesthesia. A bone defect was found in the medio-superior portion of the left frontal sinus. The defect connected with the fistula to the frontal skin as an extension of the frontal sinus lesion. After complete removal of the inner wall lesions in the frontal sinus and nasofrontal duct, the latter was plugged with autogenous iliac bone grafts. Then autogenous abdominal fat was implanted into the frontal sinus. The anterior wall of the frontal sinus was reconstructed with an iliac bone graft. During the 34 months since surgery, he has had no recurrent infection and no cosmetic or functional problem. In conclusion, frontal sinus surgery via a coronal incision approach is feasible when a wide surgical field with direct visualization of the frontal sinus is required, and it can produce satisfactory results.

Objective: To describe a case of frontal sinus cholesteatoma and review the characteristics of this pathology.Method: Case report: 32-year-old white man. First symptoms: frontal pressure, proptosis of left eye with downward displacement (no visual symptoms or eye movement impairment). ENT examination and nasal endoscopy were normal. CT of paranasal sinuses: large mass in the left frontal sinus, with destruction of orbital and cranial blades.Results: An endoscopic approach of the frontal sinus was attempted with no success. Nothing could be extracted from the left frontal sinus. Therefore an open approach was attempted, an external approach, using a Lynch incision. By this method we were able to clear out the medial and lateral parts of the left frontal sinus, taking out enough material to be examined by the pathologist. What came out was a cheese-like debris with a pearly aspect. The final histopathological analysis revealed that the mass was a cholesteatoma of the frontal sinus.Conclusion: Cholesteatoma ...

Isolated or solitary neurofibromas of the paranasal sinuses are rare. Mostly, they involve the maxillary sinus and so far, a solitary neurofibroma of the frontal sinus has never been reported in the literature. We present a case of frontal sinus neurofibroma treated successfully with surgical excision. A 28-year-old male presented with forehead swelling and computed tomography images revealed a tumor involving the left frontal sinus. Histopathological examination showed the tumor to be a neurofibroma. We discuss the clinical and pathological characteristics of neurofibroma arising in the nasal cavity and paranasal sinuses.

We present a 51-year-old woman with a history of colectomy for colon cancer who was referred to our department for bone assessment. Planar image revealed a focus of increased uptake of Tc-99m methylene diphosphonate in the nose root. According to the images of SPECT combined with low-dose CT, the abnormal radiotracer uptake at the site of left frontal sinus was considered to be osteoma. We conclude that SPECT/CT provides an accurate evaluation of the localization of the lesions and supplies anatomic information that can be valuable for diagnosis of nonmalignant bone diseases.

We present the case of an osteoma situated in the orbital portion of the left frontal sinus in a 22 year- old male, who also presented pulsatile exophtalmos, diplopia and headache. The neuro-radiological tests revealed also a large intracranial air cavity. Surgery demonstrated the relation between the osteoma and pneumatocele, where the tumor produced effacement of the orbitary roof; this placed the sinusal cavity in contact with the subdural space. A valve mechanism is suggested to explain the accumulation of intracranial air without liquorrhea. Finally, the rarity of the case in the literature is commented on.

A multilobular tumour of bone with left orbital involvement was diagnosed at post mortem examination in an eight-year-old German shepherd cross dog. The tumour resulted in progressive exophthalmos with lateral deviation of the left eye. Radiographs revealed that the mass was mineralised and originated from the left frontal bone with invasion of the left frontal sinus and destruction of the cribriform plate. This is the third reported case of this type of tumour involving the orbit of the dog and thus multilobular tumour of bone should be considered as a differentia] diagnosis of exophthalmos.

A 73-year-old man, with no medical history of note, presented with a 4-week history of an isolated left-sided ptosis and associated periorbital and retro-orbital discomfort. His pupils were spared, his eye movements were not restricted and he was not proptosed. A prompt CT orbits and head scan revealed a large left frontal sinus mucocoele that had eroded into the left orbit. The patient had successful endoscopic sinus surgery under the ear, nose and throat team and 1 month later was seen in ophthalmology clinic. His ptosis and discomfort had fully resolved and he had no neurological sequelae from the surgery.

WOS: 000225326900022 PubMed: 15519874 Fibrous dysplasia of the cranial air sinuses is rarely reported in the literature. This is the first report of frontal lobe abscess (FLA) associated with fibrous dysplasia of the frontal sinus (FDFS). A 29-year-old female presented with seizures and acute confusion. Cranial computed tomography (CT) revealed fibrous dysplasia of the left frontal sinus and associated FLA. She was referred to the neurosurgical service and the abscess and dysplastic tissue were removed. Histological examination confirmed fibrous dysplasia. We review the radiological appearance of FDFS with FLA. Clinicians should be aware of the association between these two conditions. (C) 2004 Elsevier Ltd. All rights reserved.

We report a case of meningitis caused by Comamonas testosteroni in a 54-year-old, alcoholic, homeless man. He, as a pedestrian, was struck by a car and suffered multiple fractures of the facial bones including the left frontal sinus. Over the course of 2-week hospitalization, he was clinically diagnosed with multiple cerebral and cerebellar infarcts resulting in altered mental status. He was pronounced dead 15 days after the injury. At the time of autopsy, diffuse purulent meningitis was found on gross examination. A swab culture of the brain surface was positive for C. Testosteroni, a saprophytic organism commonly found in soil and water. This is the first reported case of fatal meningitis caused by this micro-organism.

Although mucocele of the frontal sinus was not dealt with as a problem in therapeutics in authoritative medical literature earlier than the eighteenth century, this pathologic condition must have existed in ancient times. An interesting bit of writing indicating this is the description by Boenninghaus 1 of a skull discovered by him among the thousands ornately arranged on the walls of the famous chapel at Tscherbeney, built entirely of human bones. Boenninghaus made a careful examination of this skull. He found the bone structure large and strong, with the teeth for the most part absent; the skull appeared to be that of a person of middle age. The cranial capsule was perfectly preserved. A large part of the anterior wall of the frontal sinus was absent. In the cerebral wall of the left frontal sinus was a roundish defect, approximately 1 cm. in diameter. From these and other observations Boenninghaus concluded

REPORT OF CASE A woman aged 21, a Puerto Rican, was admitted to the Vanderbilt Clinic complaining of a large, firm swelling above the left eye. According to her story, she had first noticed the swelling a year before over the lower portion of her forehead. It had grown slowly downward until it had become most prominent at the inner canthus of the eye. At the same time she suffered from severe pain in that region and displayed changes in personality, becoming gloomy and addicted to fits of crying. Examination. —A firm, nontender swelling was noted over the left frontal sinus, extending into the orbit on that side and displacing the eye outward. There was a firm mass in the left ethmoid region. Biopsy of the mass in the nose showed what appeared to be an osteoma. Roentgenograms revealed the swelling to be a cyst occupying most of the left

Foreign bodies of all kinds have been described in most parts of the body, but they are unusual in the frontal sinuses. In the case described below, multiple foreign bodies (fragments of glass) were found to be present in the left frontal sinus following trauma. The patient, a man of 28, was admitted to the casualty department at the Bristol Royal Infirmary on November 19, 1966. He had been a passenger in the front seat of a car, involved in a head-on collision with another vehicle. At the moment of impact his head had gone through the windscreen, but he was not ejected. He did not lose consciousness at any time. On examination there were deep lacerations in the left frontal region, one extending vertically upwards towards the hair line, and another smaller one extending laterally on the left side beneath the eyebrow (Fig. 1).

Triple post operative cyst in a 62 years old man was reported. Left pansinectomy was done 25 years ago, and again he was operated for left post operative maxillar cyst 20 yearslater.Recently we found post operative cyst in left frontal sinus and ethmoidal cells.Only two cases of double post operative cyst have been reported in Japan, and these two cases were that of othmoidal cells and maxillar sinuses.This case of triple post operative cyst might be said to be the first reported case in Japan.

A 32-year-old man had a history of acquired Brown's syndrome associated with diplopia, proptosis, downward displacement of the globe, and lid edema. A CT scan of the orbit revealed an osleoma arising from the left frontal sinus and extending into the left orbit. After surgical extirpation the proptosis and diplopìa disappeared and the globe returned to normal. To our knowledge, such a case has not been reported previously.

Many studies have examined the characteristics of the frontal sinuses and their use for forensic purposes, particularly when an individual is edentulous. One of the most widespread classification systems is that proposed by Yoshino et al. The aim of this study was to improve the performance of Yoshino's method for identifying unknown skeletal remains by replacing the first two morphological items, frontal sinus size and bilateral asymmetry, by SOR1 = left frontal sinus area/left orbit area, and SOR2 = right frontal sinus area/right orbit area. According to the bivariate distribution of SOR = (SOR1, SOR2) and available data, we also estimated the probability of positive misclassification.

Isolated frontal sinus aspergillosis is extremely uncommon. Frontal sinus is commonly involved secondarily in association with other sinuses. A case of isolated frontal sinus aspergillosis is being reported which presented as Pott’s puffy tumor. Frontal sinus exploration was done under general anesthesia. A small focus of the osteomyelitic bone in the anterior wall of the frontal sinus was removed. The fungus ball filling the left frontal sinus was removed.

The article about epistaxis inThe Journal, April 30, induces me to relate the following case: On March 25 a 19-year-old boy consulted me for very severe headache. About two weeks previously he had influenza and four days previously his head began to pain him, so that sleep was impossible; his nose began to run at the same time. Percussion on the left frontal sinus was painful; also pressure in the left upper inner orbital corner. The left middle turbinate was swollen and, after depletion by cocain and epinephrin (adrenalin), pus came from below and above the turbinate. My diagnosis was left frontal sinusitis and ethmoiditis. The symptoms had not improved markedly the next day, so I removed the middle concha. No abnormality was noticed, the headache was controlled, and packing removed the following week. Eight days after the operation slight nosebleed occurred, but the cotton plug soaked in hydrogen