Frontal Sinus

Frontal infundibular cells: Pathway to the frontal sinus

March 1, 2012     Ozum Tuncyurek, MD, Murat Songu, MD, Zehra Hilal Adibelli, MD, and Kazim Onal, MD
article

Abstract

A frontal infundibular cell (FIC) is an uncommon anatomic variant of an anterior ethmoid pneumatization that originates from the frontal recess and typically extends into the lumen of the frontal sinus ostium. FICs may show several anatomic variants that impact the anatomy of the frontal recess. Familiarity with these variants is required for safe endoscopic sinus surgical procedures. We conducted a retrospective chart review, examining 1,040 frontal recesses in 520 adults with no frontal sinus disease, to explore the anatomy of the healthy frontal recess and to describe the prevalence of FICs in patients without a history of conditions that cause frontal pneumatization. Review of axial and coronal computed tomography data, which were reformatted for sagittal reconstruction, was performed at a computer workstation. Bent and Kuhn's classification was used to define types of FICs. We identified 167 patients (32.1%) as having unilateral or bilateral FICs. Type I infundibular cells were the most common type (found in 15.7% of the entire study population). Type II and type III FICs were found in 3.8% and 12.1%, respectively; type IV FICs were present in 0.4%. The FIC has not been emphasized as an important potential cause of frontal sinus obstruction in the radiology literature, but clinicians should specifically watch for it on all routine computed tomography of the frontal sinus. Fine-cut computed tomography scans aid in the identification of each individual cell and allow the surgeon to formulate a clear and precise surgical plan. A surgical plan with a thorough understanding of the anatomy enables confident dissection of this complex and difficult area.

Endoscopic view of a frontal recess obstruction causing frontal sinusitis

February 18, 2012     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS

Sphenopalatine artery pseudoaneurysm after endoscopic sinus surgery: A case report and literature review

February 18, 2012     Raewyn G. Campbell, BMed(Hons), BApplSci(Physio)
article

Abstract

Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.

Endoscopic view of an illuminated frontal sinus viewed from within the sinus

December 15, 2011     Ken Yanagisawa, MD, FACS, Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS

Primary adenocarcinoma of the frontal sinus

October 26, 2011     Raman Wadhera, MS, S.P. Gulati, MS, Ajay Garg, MS, Anju Ghai, MD, and Sanjay Kumar, MD
article

Abstract

When tumor involvement of the frontal sinus occurs, it is usually the result of the direct spread of the mass from the nasal cavity or anterior ethmoid sinuses. Primary frontal sinus tumors are extremely rare. We describe a case of primary adenocarcinoma of the frontal sinus in a 53-year-old man. The patient refused surgery, so he was treated with chemotherapy followed by radiotherapy. At the 1-year follow-up, only a slight reduction of the swelling was noted. Thereafter, he was lost to follow-up. This case represents a typical example of a paranasal cancer extending beyond the bony margins, with a silent onset that simulated benign disease. The best hope for an early diagnosis of such a tumor lies in the greater use of computed tomography to assess chronic rhinosinusitis.

Primary frontal sinus carcinoma with extradural anterior cranial fossa involvement

October 26, 2011     J. Madana, MS, DNB, Deeke Yolmo, MS, S. Gopalakrishnan, MS, and Sunil Kumar Saxena, MS
article

Abstract

Paranasal sinus carcinoma is rare, with an estimated annual incidence of less than 1 per 100,000 population. Primary frontal sinus involvement is extremely rare, accounting for only 0.3% of all paranasal sinus malignancies. A frontal sinus cancer may be mistaken for a mucocele, pyocele, or osteomyelitis. We report the case of a 48-year-old woman with a carcinoma that originated in the frontal sinus. Computed tomography and magnetic resonance imaging demonstrated bony destruction with intracranial extension but no involvement of the bulbus. The patient underwent a frontal craniotomy, tumor excision, and postoperative radiotherapy. One year later, she remained symptom-free.

Endoscopic view of frontal sinus discharge following balloon dilation

August 15, 2011     Ken Yanagisawa, MD, FACS, Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS

Malignant proliferating trichilemmal tumor involving the sinuses

July 13, 2011     Tashneem Harris, MBChB, FC ORL(SA), Estie Meyer, MBChB, FC ORL(SA), Darlene E. Lubbe, MBChB, FC ORL(SA), Werner Smit, MBChB, FC Plast Surg(SA), and Chris Walker, MBChB, FC Path(SA) Anat
article

Abstract

Proliferating trichilemmal tumor (PTT) is a rare adnexal neoplasm that arises from the outer sheath of the hair follicle. It is believed that PTTs originate in trichilemmal cysts. These tumors have the potential for malignant transformation; when this occurs, the tumor is known as a malignant PTT (MPTT). Recurrence after simple local excision is common, and it can cause considerable morbidity. We report a case of MPTT that was initially diagnosed as a benign PTT. The primary tumor had arisen from the skin over the glabella. It was excised, but it recurred 3 years postoperatively. The recurrent tumor involved the eyelid, nasal cavity, and frontal and ethmoid sinuses, and it extended into the orbit. The recurrent tumor was excised via combined endoscopic and open surgery. As far as we know, this is the first documented case of an MPTT that involved the sinuses.

Bilateral asymmetrical mucoceles of the paranasal sinuses with unilateral orbital complications

February 1, 2011     Aun Wee Chong, MS(ORL), Narayanan Prepageran, MS(ORL), FRCS(Edin), Omar Rahmat, MS(ORL), Viswaraja Subrayan, FRCS(Ophthal), and Mohd Amin Jalaludin, FRCS
article

Abstract

We report the rare occurrence of bilateral asymmetrical mucoceles of the paranasal sinuses that resulted in a unilateral orbital complication. The patient was a 47-year-old woman who presented with complaints of diplopia, blurred vision, and protrusion of her right eye that had progressed over a period of several months following an upper respiratory tract infection. Computed tomography detected the presence of two large, asymmetrical mucoceles. The lesion on the right involved the frontal and ethmoid sinuses, and the one on the left involved the ethmoid sinus. The mucoceles were locally expansile and had eroded the surrounding bony structures on the right. The expansile nature of the right-sided mass had displaced the right orbit, which was the cause of the vision deterioration. Transnasal endoscopic surgery was performed to excise and marsupialize the mucoceles. This modality was preferred over conventional open surgery because it affords good visualization, it is safe, and it is a less morbid procedure. The patient's recovery was uneventful, and she was discharged home on the third postoperative day. On continuing follow-up, her vision had improved, her intraocular pressure had returned to normal, and her orbits were in their normal position. Based on our literature search, no case of bilateral frontal and ethmoid sinus mucoceles has been previously reported.

Primary carcinoid tumor of the frontal sinus: A case report

September 30, 2010     Michael W. Chu, MD, Daniel W. Karakla, MD, FACS, Marc Silverberg, MD, and Joseph K. Han, MD
article

Abstract

Carcinoid tumors are rare, indolent, neuroendocrine tumors that are most commonly found in the gastrointestinal tract and lungs. They occasionally develop in the head and neck, either as a primary tumor or, more commonly, as a metastasis. The most common sites of head and neck carcinoids are the larynx and middle ear. Only a few cases of carcinoid in the nasal cavity and paranasal sinuses have been reported. We describe a case of primary typical carcinoid of the frontal sinus in a 61-year-old man, and we review the clinical, imaging, surgical, and histochemical findings in this case. The patient was treated with endoscopic resection. A subsequent workup for metastatic and occult primary disease was negative, confirming that the frontal sinus was the primary source. At follow-up 12 months postoperatively, the patient remained without disease. To the best of our knowledge, this is the first report of a primary typical carcinoid tumor originating in the frontal sinus.

Is it more reasonable to categorize frontal cells on the basis of their location rather than on their type?

August 31, 2010     Altan Yildirim, MD
article

Abstract

Frontal cells appear in two locations-in the frontal recess and in the frontal sinus. The aim of this study was to analyze the anatomic and clinical differences between the frontal cells at each location. The author reviewed 487 left and right sides of coronal computed tomography (CT) scans of the sinuses obtained from 300 consecutively presenting patients (600 sides) who were being evaluated for chronic sinusitis. For the purposes of this study, the frontal cells were classified according to location; group A cells were located in the area of the frontal recess (Bent and Kuhn cell types I and II), and group B cells were those that had invaded the frontal sinus itself (Bent and Kuhn cell types III and IV). The presence or absence of frontal sinusitis and concha bullosa was determined, as was the degree of frontal sinus pneumatization. Analysis revealed statistically significant differences between group A and group B in all three parameters; the prevalence of frontal sinusitis and hyperpneumatization of the frontal sinus was higher in group B, and the prevalence of concha bullosa was higher in group A (all p < 0.05). These findings imply that it might be more reasonable both clinically and anatomically to categorize frontal cells based on their location rather than on their Bent and Kuhn type.

The use of a lighted guidewire and telescope without fluoroscopy for balloon sinus ostia dilation

July 31, 2010     Ken Yanagisawa, MD, FACS, Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
PreviousPage
of 4Next