RESUMEN

OBJECTIVE: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS). METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS. RESULTS: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered. CONCLUSION: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes. LEVEL OF EVIDENCE: NA.

Asunto(s)

Endoscopía , Seno Frontal , Rinitis , Sinusitis , Irrigación Terapéutica , Humanos , Seno Frontal/cirugía , Endoscopía/métodos , Rinitis/cirugía , Sinusitis/cirugía , Enfermedad Crónica

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Objective:Anatomical variation or scar atresia of the drainage channel of the frontal sinus on the affected side, and opening the frontal sinus through the drainage channel of the frontal sinus on the affected side may lead to surgical failure. The purpose of this study is to explore a modified Draf Ⅲ operation to complete the drainage of the affected frontal sinus by removing the floor wall and septum of the frontal sinus and connecting the bilateral frontal sinus through the healthy side of the frontal sinus. Methods:Through the anatomical study of 2 skull bone specimens and 2 fresh frozen specimens, the surgical landmark and surgical approach were explored. Four patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery in Eye & ENT Hospital of Fudan University were retrospectively analyzed. Descriptive method was used to analyze the data. Results:The bottom wall of bilateral frontal sinus was removed, and the bilateral frontal sinus was enlarged above the nasal septum to form a large common cavity. The uncinate process and ethmoid bubble were retained, and the midline drainage of the affected frontal sinus in the healthy side of the nasal cavity was completed. From August 2022 to April 2023, 4 patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery for unilateral frontal sinus papilloma in Eye & ENT Hospital of Fudan University were treated with surgery. The headache symptoms disappeared after surgery, and the drainage of frontal sinus was spacious, the mucosa healed well and the drainage was unobstructed under endoscopy. There were no other postoperative complications. Conclusion:DrafⅢ approach to unilateral frontal sinus for contralateral drainage can drain the affected frontal sinus adequately. The essence of this operation is to drain the bilateral frontal sinus in the unilateral nasal cavity, and this operation has short path, less trauma, and a broader prospect, which is suitable for promotion.

Asunto(s)

Drenaje , Seno Frontal , Humanos , Seno Frontal/cirugía , Estudios Retrospectivos , Drenaje/métodos , Sinusitis Frontal/cirugía , Masculino , Femenino , Cavidad Nasal/cirugía , Tabique Nasal/cirugía , Tabique Nasal/anomalías , Adulto

RESUMEN

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.

Asunto(s)

Frente , Seno Frontal , Mucocele , Tomografía Computarizada por Rayos X , Humanos , Masculino , Mucocele/diagnóstico por imagen , Mucocele/complicaciones , Mucocele/diagnóstico , Mucocele/cirugía , Persona de Mediana Edad , Seno Frontal/diagnóstico por imagen , Seno Frontal/patología , Enfermedad Crónica , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/cirugía , Sinusitis Frontal/complicaciones , Sinusitis Frontal/diagnóstico por imagen

RESUMEN

Here, we describe the unique case of a pneumocephalus originating from an inverted papilloma (IP) in the frontoethmoidal sinus. A 71-year-old man with diabetes presented with headaches and altered consciousness. Imaging revealed the pneumocephalus together with bone destruction in the left frontal sinus. He underwent simultaneous endoscopic endonasal and transcranial surgery using an ORBEYE exoscope. Pathological diagnosis of the tumor confirmed IP. Post-surgery, the pneumocephalus was significantly resolved and the squamous cell carcinoma antigen level, which had been elevated, decreased. This case underscores the importance of a multidisciplinary approach and innovative surgical methods in treating complex sinonasal pathologies.

Asunto(s)

Senos Etmoidales , Seno Frontal , Papiloma Invertido , Neoplasias de los Senos Paranasales , Neumocéfalo , Humanos , Neumocéfalo/diagnóstico por imagen , Neumocéfalo/etiología , Neumocéfalo/cirugía , Masculino , Anciano , Papiloma Invertido/cirugía , Papiloma Invertido/patología , Papiloma Invertido/complicaciones , Seno Frontal/patología , Seno Frontal/diagnóstico por imagen , Seno Frontal/cirugía , Neoplasias de los Senos Paranasales/cirugía , Neoplasias de los Senos Paranasales/complicaciones , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Senos Etmoidales/patología , Senos Etmoidales/diagnóstico por imagen , Senos Etmoidales/cirugía

RESUMEN

BACKGROUND: Penicillin may be administered enterally or intravenously for the treatment of bacterial infections within the oropharynx and the frontal sinuses. We aimed to assess and compare penicillin concentrations in oropharyngeal and frontal sinus tissues following enteral and intravenous administration in a porcine model. METHOD: Twelve pigs were randomized to receive either enteral (0.8 g Penicillin V) or intravenous (1.2 g Penicillin G) penicillin. Microdialysis was used for sampling in oropharyngeal and frontal sinus tissues during a six-hour dosing interval. In addition, plasma samples were collected. The primary endpoints were time with drug concentration above the minimal inhibitory concentration (T>MIC) for two MIC targets: 0.125 (low target) and 0.5 (high target) µg/mL (covering Group A Streptococci, Fusobactarium necrophorum, Streptococcus pneumoniae and Hemophilus influenza) and attainment of these treatment targets for ≥50 % T>MIC. RESULTS: For both the low and high MIC targets, intravenous administration resulted in higher T>MIC in oropharyngeal and frontal sinus tissues compared to enteral administration. In oropharyngeal tissue, the treatment target (≥50 % T>MIC) was achieved for both the low target (96 %) and high target (68 %) when penicillin was administrated intravenously. In frontal sinus tissue, the treatment target was reached for the low target (70 %), but not the high target (35 %) when administered intravenously. None of the two tissues reached the treatment targets when penicillin was administered enterally. CONCLUSION: Intravenous administrated penicillin in standard dosage is superior to enteral administration of penicillin in standard dosage in achieving clinically important T>MIC as the majority of targets were achieved following intravenously administration, while none of the targets were achieved following enteral administration. These results support the general notion of higher tissue concentrations following intravenous compared to enteral administration.

Asunto(s)

Administración Intravenosa , Antibacterianos , Seno Frontal , Microdiálisis , Orofaringe , Animales , Microdiálisis/métodos , Antibacterianos/administración & dosificación , Antibacterianos/farmacocinética , Porcinos , Orofaringe/metabolismo , Orofaringe/microbiología , Penicilinas/administración & dosificación , Penicilinas/farmacocinética , Administración Oral , Pruebas de Sensibilidad Microbiana , Femenino , Penicilina G/administración & dosificación , Penicilina G/farmacocinética , Penicilina V/administración & dosificación , Penicilina V/farmacocinética

RESUMEN

OBJECTIVE: To determine the relationship of anterior occlusion and skeletal variables with the frontal sinus index. METHODS: The retrospective, analytical, cross-sectional, study was conducted from July to November 2020 at Dr Ishratul- Ebad Khan Institute of Oral Health Sciences and Dow Dental College, Dow University of Health Sciences, Karachi, and comprised data from 2015 to 2018 related to pre-treatment lateral cephalograms for determining frontal sinus index and other cephalometric variables. The dental casts were observed for incisor classification. Patients with Class I incisors formed the comparison group, while the rest comprised 5 malocclusion groups. The frontal sinus was traced, and the sinus index was calculated. Data was analysed using STATA 15 and R 3.5.1. RESULTS: Of the 240 subjects, there were 40(16.66%) in each of the 6 groups; 155(64.6%) females and 85(35.4%) males. The mean age of the sample was 21.33±3.52 years (range: 16-29 years). The mean sinus index was higher in all malocclusion groups than the comparison group, but it was significantly higher only in Class II division 2 and anterior open bite groups (p<0.05). The only exception to the trend was Class II division 1 with and without contact in which the value was lower (p>0.05). The anterior cranial base length, sella-nasion mandibular plane angle, and upper incisor palatal plane angle significantly affected the frontal sinus index (p<0.05). CONCLUSIONS: The frontal sinus index could be considered an indicator of harmonious anterior occlusion.

Asunto(s)

Cefalometría , Seno Frontal , Maloclusión , Humanos , Femenino , Masculino , Seno Frontal/diagnóstico por imagen , Seno Frontal/anatomía & histología , Seno Frontal/patología , Estudios Transversales , Adolescente , Adulto , Adulto Joven , Estudios Retrospectivos , Maloclusión/epidemiología , Maloclusión Clase II de Angle , Maloclusión Clase I de Angle/patología , Incisivo/anatomía & histología

RESUMEN

Objective:To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Methods:Using sagittal and coronal CT images, the following lines were delineated: the F-line（a horizontal line passing nasofrontal beak）, the M-line（a vertical line passing paries medialis orbitae）, and the P-line（a vertical line passing the center of the pupil）. Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Results:Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. Conclusion:For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.

Asunto(s)

Endoscopía , Senos Etmoidales , Seno Frontal , Osteoma , Neoplasias de los Senos Paranasales , Tomografía Computarizada por Rayos X , Humanos , Osteoma/cirugía , Osteoma/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Seno Frontal/cirugía , Seno Frontal/diagnóstico por imagen , Senos Etmoidales/cirugía , Senos Etmoidales/diagnóstico por imagen , Adolescente , Tomografía Computarizada por Rayos X/métodos , Neoplasias de los Senos Paranasales/cirugía , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Endoscopía/métodos , Adulto Joven

RESUMEN

OBJECTIVES: To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications. METHODS: A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test. RESULTS: A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories. CONCLUSION: Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.

Asunto(s)

Accidentes de Tránsito , Seno Frontal , Fracturas Craneales , Centros de Atención Terciaria , Humanos , Arabia Saudita/epidemiología , Masculino , Estudios Retrospectivos , Femenino , Seno Frontal/lesiones , Seno Frontal/cirugía , Adulto , Fracturas Craneales/epidemiología , Fracturas Craneales/terapia , Fracturas Craneales/cirugía , Persona de Mediana Edad , Accidentes de Tránsito/estadística & datos numéricos , Incidencia , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven , Adolescente , Complicaciones Posoperatorias/epidemiología , Anciano , Niño

RESUMEN

Brow position, hairline shape, and forehead projection may confer cis-feminine identity, and facial feminization surgery (FFS) can improve gender dysphoria among transfeminine patients. Depending on the Ousterhout classification, burring, osteotomy, anterior frontal sinus setback, and augmentation, with subsequent fixation via metal or bioabsorbable plates, can address forehead projection. However, titanium mesh, often used in frontal sinus fracture repair, has not been described for forehead contouring in FFS. The purpose of this study was to study clinical outcomes associated with the use of titanium mesh for the stabilization of bone following anterior frontal sinus setback. A retrospective cohort study of trans-female and nonbinary patients undergoing primary FFS by our senior author between January 2021 and February 2023 was performed. Variables collected include demographics, Ousterhout classification, operative details, complications, and follow-up duration. Patients with prior FFS or facial trauma were excluded. Data were analyzed using SPSS, (IBM, Armonk, NY). Forty-three transfeminine patients were included for analysis. The cohort had an average age of 33.0±8.7 years and a median follow-up time of 3.0 months (IQR = 1.0-7.0). Among our cohort, 26 patients (60.5%) received titanium mesh and 17 patients (39.5%) underwent burring only for forehead contouring. There were no reported complications (ie, infection, hardware extrusion, or mucocele formation) or a need for forehead revisions among the entire cohort regardless of the frontal sinus reconstruction material utilized. Clinical outcomes were favorable among patients receiving titanium mesh anterior table fixation during FFS. Titanium mesh can be considered as an additional technique for frontal bossing reduction and anterior table fixation in FFS.

Asunto(s)

Frente , Seno Frontal , Mallas Quirúrgicas , Titanio , Humanos , Femenino , Seno Frontal/cirugía , Seno Frontal/lesiones , Estudios Retrospectivos , Masculino , Adulto , Frente/cirugía , Cirugía de Reasignación de Sexo/métodos , Disforia de Género/cirugía , Resultado del Tratamiento , Feminización/cirugía , Personas Transgénero , Osteotomía/métodos

RESUMEN

A patient in his 20s presented with a change in the appearance of his left eye with evidence of relative afferent pupillary defect. Imaging revealed a giant frontoethmoidal osteoma, a benign sinonasal tumour, invading three-quarters of the orbit. Multidisciplinary discussion involving opthalmology, maxillofacial surgery, neurosurgery and otolaryngology resulted in the decision to attempt entirely endoscopic excision of this lesion, which was performed with successful outcomes. This case demonstrates how a sinonasal osteoma should be considered in the differential diagnosis for a patient presenting with proptosis or other eye signs suggestive of compression of the orbital compartment. This case report and literature review highlights the possibility of managing giant sinonasal osteomas with orbital extension through a completely endoscopic approach.

Asunto(s)

Endoscopía , Osteoma , Neoplasias de los Senos Paranasales , Humanos , Osteoma/cirugía , Osteoma/diagnóstico por imagen , Osteoma/patología , Masculino , Endoscopía/métodos , Neoplasias de los Senos Paranasales/cirugía , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Neoplasias de los Senos Paranasales/patología , Hueso Etmoides/diagnóstico por imagen , Hueso Etmoides/cirugía , Hueso Etmoides/patología , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/patología , Senos Etmoidales/diagnóstico por imagen , Senos Etmoidales/cirugía , Senos Etmoidales/patología , Órbita/diagnóstico por imagen , Órbita/cirugía , Órbita/patología , Seno Frontal/diagnóstico por imagen , Seno Frontal/cirugía , Seno Frontal/patología , Tomografía Computarizada por Rayos X , Adulto Joven , Exoftalmia/etiología , Exoftalmia/cirugía , Diagnóstico Diferencial , Adulto

RESUMEN

This study aimed to assess the frontal sinus volume (FSV) on computed tomography (CT) scans in migraine patients. Cranial and paranasal CT images from 75 migraine patients (mean age: 39.14±13.63 y) and 23 control cases (mean age: 38.78±13.32 y) were analyzed retrospectively. Three-dimensionally reconstructed images of frontal sinuses were generated. Total FSV, anterolateral, and transverse diameters of the head were measured. The presence/absence and nature of supraorbital foramen and notches were evaluated. The total FSV was 8.02±5.97 cm 3 in the migraine group and 8.38±4.83 cm 3 in the control group, with no significant differences between them. Mean FSV values showed no statistically significant difference between females (7.79±5.85 cm 3 ) and males (9.12±6.66 cm 3 ) within and between the groups. Single notch was the most observed structure in both groups, with bilateral presence being the most common. Double foramen and notch were observed only in the migraine group, and the coexistence of both structures was higher in the migraine patients than in controls. There was no statistical difference in FSV between migraine and control groups, nor based on sex. Overall, the frontal region anatomy, particularly the exit locations of the supraorbital or supratrochlear foramen/notches, may be influenced by hyperplasia/hypoplasia of FSV. Therefore, assessing FSV using CT may be crucial for surgical planning in migraine patients undergoing open or endoscopic approaches to the frontal region.

Asunto(s)

Seno Frontal , Trastornos Migrañosos , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Trastornos Migrañosos/diagnóstico por imagen , Adulto , Seno Frontal/diagnóstico por imagen , Seno Frontal/patología , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Imagenología Tridimensional , Estudios de Casos y Controles , Persona de Mediana Edad

RESUMEN

Sex determination is essential for identifying unidentified individuals, particularly in forensic contexts. Traditional methods for sex determination involve manual measurements of skeletal features on CBCT scans. However, these manual measurements are labor-intensive, time-consuming, and error-prone. The purpose of this study was to automatically and accurately determine sex on a CBCT scan using a two-stage anatomy-guided attention network (SDetNet). SDetNet consisted of a 2D frontal sinus segmentation network (FSNet) and a 3D anatomy-guided attention network (SDNet). FSNet segmented frontal sinus regions in the CBCT images and extracted regions of interest (ROIs) near them. Then, the ROIs were fed into SDNet to predict sex accurately. To improve sex determination performance, we proposed multi-channel inputs (MSIs) and an anatomy-guided attention module (AGAM), which encouraged SDetNet to learn differences in the anatomical context of the frontal sinus between males and females. SDetNet showed superior sex determination performance in the area under the receiver operating characteristic curve, accuracy, Brier score, and specificity compared with the other 3D CNNs. Moreover, the results of ablation studies showed a notable improvement in sex determination with the embedding of both MSI and AGAM. Consequently, SDetNet demonstrated automatic and accurate sex determination by learning the anatomical context information of the frontal sinus on CBCT scans.

Asunto(s)

Tomografía Computarizada de Haz Cónico , Seno Frontal , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Masculino , Femenino , Seno Frontal/diagnóstico por imagen , Seno Frontal/anatomía & histología , Imagenología Tridimensional/métodos , Adulto , Redes Neurales de la Computación , Procesamiento de Imagen Asistido por Computador/métodos , Determinación del Sexo por el Esqueleto/métodos

Asunto(s)

Aspergilosis , Humanos , Aspergilosis/epidemiología , Aspergilosis/microbiología , Masculino , Femenino , Persona de Mediana Edad , Prevalencia , Sinusitis Frontal/microbiología , Adulto , Anciano , Seno Frontal/microbiología , Seno Frontal/patología , Tomografía Computarizada por Rayos X , Estudios Retrospectivos

RESUMEN

Several code-based methods have been created for comparing the frontal sinus in skeletal identification scenarios. However, little is known regarding matched-pair accuracy rates of these methods or how varying image modalities may affect these rates. The goals of this study were to validate the exclusion rates and to establish matched-pair accuracy rates of two well-cited coding methods, Cameriere et al. [23] and Tatlisumak et al. [24]. Additionally, individual variables were assessed for consistency in scoring between image modalities. Using a sample of U.S. African American, Native American, and European American females and males (n = 225), we examined individual variable scoring and string codes between two different image modalities (radiographs and CT-based 3D models). Arcades showed poor scoring consistency between modalities (p < 0.001). Although exclusion rates were similar to those reported in the original studies (93%-96%), matched-pair accuracy rates were low (13%-18%). None of the demographics (collection, sex, age, ancestry, and orientation) had an effect on the odds of a match. Interobserver and intraobserver analyses showed moderate to near-perfect agreement for all variables except supraorbital cells, which had minimal to no agreement. Currently, we do not recommend the application of these frontal sinus coding methods independent of other supporting identification methods given low variable consistency and accuracy rates. Visual identification should still be used to include or exclude an identification when using the frontal sinus.

Asunto(s)

Antropología Forense , Seno Frontal , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Humanos , Seno Frontal/diagnóstico por imagen , Seno Frontal/anatomía & histología , Masculino , Antropología Forense/métodos , Femenino , Adulto , Adulto Joven , Grupos Raciales , Persona de Mediana Edad , Adolescente , Variaciones Dependientes del Observador , Anciano

RESUMEN

RATIONALE: The present investigation documented a case of bilateral sinonasal inverted papilloma (SNIP) that arose from both sides of the frontal sinus and ethmoid sinus. The occurrence of bilateral involvement of the nasal cavities and frontal sinus is rather infrequent. PATIENT CONCERNS: Informed consent was obtained from the patient. DIAGNOSIS: Bilateral SNIP. INTERVENTIONS: The tumor was completely removed by Draf III endoscopic resection complemented by an external eyebrow arch approach, and the postoperative recovery was uneventful. OUTCOMES: The purpose of this paper is to present a comprehensive reference for the management of bilateral SNIP that affects the frontal sinuses. LESSONS: This study addresses the staging and surgical management of bilateral SNIP, along with a review of the factors contributing to its recurrence. The recommended treatment method involves applying the Draf III technique combined with an external nasal approach.

Asunto(s)

Seno Frontal , Neoplasias de Cabeza y Cuello , Papiloma Invertido , Humanos , Seno Frontal/diagnóstico por imagen , Seno Frontal/cirugía , Papiloma Invertido/cirugía , Senos Etmoidales/cirugía , Hueso Frontal

RESUMEN

The aim of this study was to compare closed percutaneous screw reduction to traditional open reduction-internal fixation (OR-IF) for the treatment of anterior table fractures. Both groups were evaluated in terms of operative variables, complications, and treatment success. Of 32 patients included, 19 patients underwent OR-IF, while 13 underwent percutaneous screw reduction. The median operative time, length of hospital stays, and treatment cost of the OR-IF group were 100 min (range 60-130), 4 days (range 3-9), and $727 (range $642-$1291), respectively. The same variables for the closed reduction group were 30 min (range 20-40), 2 days (range 1-2), and $303 (range $252-$349), respectively. The closed reduction group exhibited a shorter operative time (p< 0.001), reduced length of hospital stays (p< 0.001), lower treatment cost (p< 0.001), and a lower complication rate (p = 0.025) compared to the OR-IF group. Late-term outcomes in both groups showed no visible contour changes or step deformities. In conclusion, the percutaneous screw reduction technique is a safe and effective option with minimal morbidity in the treatment of frontal sinus anterior table fractures. Therefore, traditional OR-IF should be reserved for fractures that are not suitable for reduction using minimally invasive techniques.

Asunto(s)

Tornillos Óseos , Fijación Interna de Fracturas , Seno Frontal , Reducción Abierta , Fracturas Craneales , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Estudios Retrospectivos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Seno Frontal/cirugía , Seno Frontal/lesiones , Reducción Abierta/métodos , Fracturas Craneales/cirugía , Anciano , Adulto Joven , Tiempo de Internación , Tempo Operativo , Adolescente , Resultado del Tratamiento , Reducción Cerrada/métodos

RESUMEN

BACKGROUND: Psammomatoid ossifying fibroma (POF) is a rare craniofacial neoplasm, primarily affecting the maxillofacial region, and typically observed in adolescents and young adults. This case report presents a unique occurrence of POF in a 50-year-old male, defying the conventional age range and exhibiting an unusual anatomical location within the frontal sinus. CASE: A 50-year-old male with a prior history of cecal adenocarcinoma and colectomy presented with left eye proptosis and new-onset headaches. Imaging revealed a well-defined calcified mass in the left frontal sinus, leading to a diagnosis of POF. Open surgical resection was performed to remove the tumor, and histopathological evaluation confirmed its diagnosis as psammomatoid ossifying fibroma. The patient exhibited no postoperative complications or signs of recurrence. CONCLUSION: This case underscores the diverse clinical presentations and diagnostic challenges associated with POF, emphasizing the importance of accurate diagnosis and multidisciplinary collaboration. Further research is needed to explore the genetic underpinnings and optimal management strategies for this intriguing condition.

Asunto(s)

Fibroma Osificante , Seno Frontal , Neoplasias de los Tejidos Blandos , Masculino , Adolescente , Humanos , Persona de Mediana Edad , Fibroma Osificante/diagnóstico por imagen , Fibroma Osificante/cirugía , Seno Frontal/diagnóstico por imagen , Seno Frontal/cirugía , Seno Frontal/patología , Tomografía Computarizada por Rayos X , Neoplasias de los Tejidos Blandos/patología

RESUMEN

BACKGROUND: Large defects of frontal sinus (FS) might be difficult to manage effectively. Mismanagement of the large defects could lead to serious postoperative complications in anterior skull base surgery. This study introduces a simple and reliable method applying small supporting bone pieces to cover or insert into large FS defects, then the large defect of FS was transformed into the small defects which was sealed by bone wax successfully. METHODS: Eleven patients underwent anterior skull base surgery for lesions or aneurysms, with the reconstruction of large FS defects by small supporting bone pieces. During craniotomy, mild violations of the FS mucosa were spared and sterilized, while severe violations required mucosal removal. Small supporting bone pieces were obtained from the inner plate of the bone flap and carefully covered or inserted into the large defects. The large defects were transformed into some small ones, which could be sealed effectively by bone wax. Demographic, intraoperative, and postoperative complication data were collected. RESULTS: Four patients had severe mucosal violations requiring removal, while 7 had mild violations sparing the mucosa. All underwent effective reconstruction with small supporting bone pieces. Median follow-up was 6 months. All cases showed effective FS morphology reconstruction, with no FS-related complications. CONCLUSIONS: Applying the small supporting bone pieces for large FS defect reconstruction can restore the FS morphology, preserve physiological function, and avoid postoperative complications.

Asunto(s)

Seno Frontal , Procedimientos Neuroquirúrgicos , Procedimientos de Cirugía Plástica , Base del Cráneo , Humanos , Masculino , Femenino , Persona de Mediana Edad , Seno Frontal/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Base del Cráneo/cirugía , Anciano , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Craneotomía/métodos , Palmitatos/uso terapéutico , Ceras

RESUMEN

Spontaneous meningoencephaloceles (MECs) are sparsely documented in the literature. Those occurring in the frontal sinus are an exceedingly rare entity. MECs are commonly associated with cerebrospinal fluid (CSF) rhinorrhoea. CSF rhinorrhoea is frequently misdiagnosed, causing delays in diagnosis and management. The subsequently increased risk of bacterial meningitis can be life-threatening to patients. We report the case of a woman in her late 70s with a spontaneous frontal sinus MEC, presenting with a 6-month history of CSF rhinorrhoea. The patient was successfully treated using the novel Carolyn's window approach endoscopically; 9-month follow-up revealed no skull-base breach. Our case emphasises the importance of considering MEC as a differential diagnosis for clear rhinorrhoea and demonstrates successful repair through a novel surgical approach.

Asunto(s)

Rinorrea de Líquido Cefalorraquídeo , Seno Frontal , Meningocele , Femenino , Humanos , Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Rinorrea de Líquido Cefalorraquídeo/etiología , Seno Frontal/diagnóstico por imagen , Seno Frontal/cirugía , Tomografía Computarizada por Rayos X/efectos adversos , Encefalocele/diagnóstico por imagen , Encefalocele/cirugía , Meningocele/diagnóstico por imagen , Meningocele/cirugía

RESUMEN

<b><br>Introduction:</b> Isolated frontal bone fractures constitute 5-15% of traumatic facial fractures cases, with frontal sinus fractures categorized into anterior wall, posterior wall, or complex fractures. The approach is tailored to fracture type and bone fragment displacement. This paper presents the summary of surgical management in patients with isolated and complex fractures of the anterior wall of the frontal sinus.</br> <b><br>Material and Methods:</b> Five patients with different frontal sinus fractures were treated surgically. The same management protocol - diagnosis and surgical intervention was implemented in all cases The retrospective analysis included fracture assessment, surgical approach, and long-term outcomes evaluation.</br> <b><br>Results:</b> The most common cause of fractures was falls, while two complex fractures involved the anterior and posterior walls. External approach, bone fragment removal, endoscopy, and external stabilization were employed in all cases. One patent required delayed revision surgery due to retaining metallic foreign body. Follow-up radiological examinations showed proper healing and cosmetic outcomes were satisfactory in all of the cases.</br> <b><br>Conclusion:</b> Surgical management of isolated fractures of the frontal sinus anterior wall, involving bone fragment removal, realignment, and endoscopy, yielded satisfactory functional and cosmetic outcomes without internal or external stabilization. Long-term monitoring and symptom assessment are crucial, especially in cases with penetrating injuries and foreign body risk.</br>.

Asunto(s)

Cuerpos Extraños , Seno Frontal , Fracturas Craneales , Humanos , Seno Frontal/diagnóstico por imagen , Seno Frontal/cirugía , Seno Frontal/lesiones , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/cirugía , Fracturas Craneales/etiología