Frontal Sinus

CSF rhinorrhea secondary to use of a Mayfield head clamp

June 30, 2008     Ioannis Moumoulidis, MD, MRCS and Helen Fernandes, FRCS; Ran De, FRCS
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Abstract

Various complications with use of a Mayfield head clamp have been reported, from minor skin necrosis and lacerations to the more significant extradural hematomas and meningitis. To the best of our knowledge, our report describes for the first time in the medical literature, the uncommon complication of frontal sinus fracture and cerebrospinal flu-id leak caused by a scalp pin of a head clamp used during a frontal craniotomy. The cerebrospinal fluid leak settled with conservative management, and no surgical intervention was necessary. Clinicians should appreciate the possibility of such a complication and assess preoperative scans for frontal sinuses that extend to a high level, as in our patient.

The use of a telescope in sinus balloon dilation

August 31, 2007     Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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Balloon catheter dilation is being used to help improve paranasal sinus ventilation.1,2 Those who teach the technique emphasize the use of the C-arm fluoroscope and the tactile introduction of a sinus guidewire. This is followed by the insertion of the sinus balloon catheter over the sinus guidewire. The balloon is inflated, deflated, and withdrawn. All of this can usually be accomplished without the use of a sinus telescope. However, we have found that the use of a telescope in addition to fluoroscopy is quite helpful.

Pneumosinus dilatans

April 30, 2007     Thomas P. Nowlin IV, MD; Daniel J. Hall, MD; Eric B. Purdom, DO; Michael R. Holtel, MD
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Cavernous hemangioma of the frontal bone

April 30, 2007     Sofia Avitia, MD; Ryan F. Osborne, MD, FACS
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Fibrous dysplasia of the frontal bone

September 30, 2006     John M. Hempel, MD; Petros D. Karkos, MPhil, AFRCSI; Wolfgang J. Issing, MD
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Abstract
Fibrous dysplasia typically occurs in patients between the ages of 5 and 15 years. We report the case of a middle-aged woman with longstanding monostotic fibrous dysplasia who responded well to conservative treatment. She had presented with a very long (15 yr) history of frontal headache and pressure over the frontal sinus. On examination, a protuberance was noted in the region of the right frontal sinus. No other symptoms were evident, and findings on the ENT examination were normal. Computed tomography (CT) detected a widening of the frontal bone with osteolytic changes of the cancellous bone of the diploƫ. Partial multiphase skeletal scintigraphy and single-photon emission CT of the cranium showed increased bone metabolism in the area of the right frontal bone. No other hot spots were seen. In view of the absence of any complications, no tissue biopsy was performed. The patient was prescribed bisphosphonates for symptom relief. Follow-up CT 1 year later revealed no progression of the lesion. Overtreatment of fibrous dysplasia should be avoided because most patients respond to conservative management. In those cases that are refractory to medical treatment, surgery-in experienced hands-can result in a good functional and cosmetic outcome.

Sinonasal lymphoma: A case report

April 30, 2006     M. Panduranga Kamath, MS; Gurudath Kamath, MS; Kiran Bhojwani, MS; Mukhta Pai, MD; Ahamed Shameem, MBBS; Salil Agarwal, MBBS
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Abstract
Sinonasal lymphomas are uncommon malignancies. They are difficult to differentiate from carcinomas, and immunohistochemistry is needed to make the diagnosis. We describe an unusual case of a T cell lymphoma that involved only the paranasal sinuses in a middle-aged man. The patient presented with a complete loss of vision in one eye and lateral rectus muscle palsy, but no nasal symptoms.

Pneumosinus dilatans frontalis: A case report

December 1, 2005     Giacomo De Riu, MD; Alessandro Bay, MD; Antonio Tullio, MD
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Abstract
Deformity of the forehead is usually the first clinical presentation of the abnormally large frontal sinus caused by pneumosinus dilatans. We report the diagnosis and surgical treatment of a case. The type of osteotomy we describe is recommended as a method of surgical treatment for this condition when the aesthetic problem is the major complaint.

Endoscopic view of obstructing frontal recess polyps

November 1, 2005     Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD
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Total necrosis of the intranasal structures and soft palate as a result of nasal inhalation of crushed OxyContin

July 31, 2005     David Greene, MD, FACS
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Abstract
Nasal inhalation of substances such as cocaine has long been linked to septal necrosis and more recently to palatal perforation. This report describes the case of a 37-year-old man who was addicted to crushed OxyContin (sustained-release oxycodone HCl) tablets and who presented with total necrosis of the septum, sinuses, and soft palate. To the best of the author's knowledge, this is the first reported case of nasal and palatal necrosis linked to nasal inhalation of crushed OxyContin, which is a relatively new form of drug abuse. The pathophysiology of drug-induced sinonasal disease and a review of the literature are also presented.

Sinonasal leiomyoma: Report of 2 cases

April 1, 2005     A.K. Agarwal, MS; Ramanuj Bansal, MS; Deepti Singhal, MS
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Abstract

Leiomyomas are benign smooth-muscle tumors that are common in the alimentary tract, uterus, skin, and subcutaneous tissue. They are very uncommon in the upper respiratory tract and rare in the nasal cavity and paranasal sinuses. To the best of our knowledge, only 23 such cases have heretofore been published in the literature. We report 2 new cases of sinonasal leiomyoma that originated at different sites in the nasal cavity. We also discuss the various investigative and therapeutic modalities available.

Primary non-Hodgkin's lymphoma of the frontal sinus: Case report and review of the literature

January 1, 2005     Maura C. Neves, MD; Marcus M. Lessa, MD, PhD; Richard L. Voegels, MD, PhD; Ossamu Butugan, MD, PhD
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Abstract
Non-Hodgkin's lymphoma of the sinonasal tract is an uncommon lesion, representing 1.5 to 15% of all lymphomas. Most cases of primary non-Hodgkin's lymphoma of the sinonasal tract occur in the maxillary sinus, ethmoid sinus, and nasal cavity; its occurrence in the frontal sinus is extremely rare. We report a case of primary type B non-Hodgkin's lymphoma of the frontal sinus in a 43-year-old man. The patient complained of frontal headaches that had not improved with analgesic drugs, and he presented with a frontal bulge that involved the left upper eyelid; the bulge had progressively enlarged over a 3-month period. A biopsy of the mass identified the type B non-Hodgkin's lymphoma. Immunohistochemical study not only confirmed the histologic type of the tumor, it also provided some important information about the primary tumor site. Advances in immunohistochemistry have shown that type B non-Hodgkin's lymphoma is more common in North American and European patients, whereas subtype T is more common in Asians and in some Latin Americans. The treatment of this condition is still controversial, but the combination of radiotherapy and chemotherapy has yielded the best results in all stages of the disease.

Endoscopic view of an esthesioneuroblastoma that resembles a benign polyp

September 30, 2004     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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