Diseases of the frontal sinuses. What is the frontal sinus and what does it look like? Anterior and posterior walls of the frontal sinuses

Frontal sinusitis or frontal sinusitis is an inflammation of the frontal paranasal sinus. In the modern world, this disease is one of the most common. Frontal sinusitis affects about 10-15 percent of the entire world population. About 10 percent of all patients suffer from a chronic form of this disease.

Recently, the incidence of this disease not only does not decrease, but also gradually progresses. Among the population of the Russian Federation, about 1 million people a year suffer from frontal sinusitis. To understand the etiology and causes of the disease, it is necessary to know the anatomy of the frontal sinuses.

A distinctive feature of the frontal sinuses is their absence at the time of birth.

The paranasal sinuses adjacent to the nasal cavity are divided into:

maxillary or maxillary;
wedge-shaped;
frontal;
lattice labyrinth.

They are small cavities located in the bones of the skull, thanks to which the nasal passages open. According to the norm, the sinuses should contain air.

The sinuses perform important functions, namely:

lighten the bones of the skull;
moisturize and warm the air that enters the human body;
play a buffer role in various facial injuries;
protect eyeballs and tooth roots from temperature fluctuations;
act as a vocal resonator.

In the frontal bone of the skull there are two frontal sinuses, which have a pyramidal shape, with the pyramid located base down and divided into two parts by a bony septum.

Each frontal sinus has 4 walls: orbital or inferior, anterior, internal and posterior. The thickest is the anterior septum of the sinus, and the thinnest is the lower one. As for the size of the sinus, they can vary depending on the individual structure of the bones of the skull. In 10 percent of people, frontal sinusitis is completely absent - this pathology is hereditary. The volume of the frontal sinus can range from 3 to 5 cm3.

The inside of the frontal sinuses is lined with mucous membrane (a continuation of the nasal mucosa), which does not contain cavernous tissue. If we compare the thickness of the mucous membranes of the sinuses and nose, then in the former it is thinner. The frontal sinuses are connected to the nasal cavity through a narrow convoluted canaliculus and open with a small opening in the front of the nasal passages.

Etiology of the disease

Frontal sinusitis is characterized by inflammation of the mucous membrane that lines the frontal sinuses. The severity and form of the disease directly depend on the causative agent of the disease. Most often, frontal sinusitis is provoked by:

infections;
allergic reactions;
nasal polyps;
foreign bodies;
pathology in the structure of the nose;
injuries of the paranasal sinuses and nose.

Infection

Penetrating into the human body, pathogenic microorganisms provoke inflammation of the mucous membrane of the nasopharynx, which can spread to the mucous membrane of the frontal sinuses

Frontal sinusitis is most often provoked by infections that enter the frontal sinuses from the nasal cavity. Inflammation of the mucous membrane can develop not only in the frontal sinuses, but also in the maxillary sinuses, in which case the patient is diagnosed with two diseases - frontal sinusitis and sinusitis. The causes of infection in the human body are respiratory diseases of the upper respiratory tract (sore throat, ARVI, influenza), as well as diseases such as diphtheria, measles, scarlet fever and others.

As for the causative agents of the disease, they differ depending on the form of frontal sinusitis (viral and bacterial). For the viral form, the causative agents are rhino-, adeno- and coronoviruses, as well as respiratory sensitial viruses. The bacterial form is provoked by microorganisms such as staphylococci, streptococci and pneumococci.

Pathogenic fungi can also provoke frontal sinusitis. If there are foci of fungal infection in the body, for example, an abscess, carious teeth and others, the fungi enter the blood hematogenously (through the blood), provoking inflammation of the mucous membrane.

Allergic reactions

Diseases such as bronchial asthma or vasomotor rhinitis (allergic rhinitis, especially its chronic form) can provoke swelling and inflammatory processes in the mucous membrane of the frontal sinuses. When the mucous membrane swells, the hole through which fluid exits the frontal sinus is blocked.

The cause of frontal sinusitis is allergic reactions, namely vasomotor rhinitis

Nasal polyps

Benign formations that have a round shape and are caused by degeneration of the mucous membrane are called polyps. When nasal polyps occur, the patient experiences swelling of the mucous membrane, which, in turn, impedes the outflow of fluid from the frontal sinuses and leads to its stagnation, as well as difficulty breathing, which can negatively affect the functioning of the cardiovascular system and the functioning of the respiratory system. As a result of fluid stagnation in the frontal sinuses, inflammation of the mucous membrane occurs, which is called frontal sinusitis.

Foreign bodies

The entry of foreign bodies and their prolonged stay in the nasal passages also causes inflammation of the mucous membrane of the paranasal sinuses. Most often, foreign bodies cause frontal sinusitis in young children.

Nasal polyps, as well as foreign bodies in the nasal passages, complicate the natural ventilation of the nasopharynx

Pathology of the structure of the nasal structures

Pathological changes (acquired or congenital), for example, a deviated nasal septum, can also disrupt the outflow of fluid, and with it pathogenic microflora, from the paranasal sinuses, resulting in an inflammatory process. Frontal sinusitis, which is caused by pathological changes in the nasal structures, can only be completely cured through surgery.

Injuries

Facial injuries accompanied by severe bruises or damage to the bones of the skull can also provoke frontal sinusitis, since the bruise causes swelling of the tissues, as a result of which their blood supply is disrupted, which causes inflammation of the mucous membrane of both the nasal passages and the frontal sinuses. Due to edema, the outflow of fluid from the paranasal sinuses is disrupted, and some injuries can provoke pathological changes in the nasal structures.

Congenital or acquired curvature of the nasal septum disrupts the natural circulation of air in the nasal cavity. thereby provokes the occurrence of inflammatory processes both in the nasal passages themselves and in the paranasal sinuses

Symptoms of frontal sinusitis

Depending on the course of the disease, frontal sinusitis can be of two types: acute and chronic. The disease is much more severe than other sinusitis and can cause serious complications.

Signs of an acute form of frontal sinusitis are:

severe and sharp pain in the forehead, which intensifies with pressure or palpation;
discomfort in the inner corner of the eye;
photophobia, lacrimation;
stinging and pain in the eyes;
difficulty breathing through the nose and congestion of the nasal passages;
copious mucous discharge from the nose (if treatment is not started in time, then over time the discharge becomes purulent in nature);
if right-sided or left-sided frontal sinusitis develops, then discharge will be observed in the corresponding half of the nose;
in some cases, the patient’s skin color changes directly above the frontal sinuses;
as a rule, there is an increase in body temperature (38-39 degrees), but in some cases the patient’s body temperature may have only minor deviations from the norm;
the patient experiences general intoxication of the body, as a result of which the patient is characterized by a feeling of lethargy and drowsiness;
During rhinoscopy, the patient experiences swelling of the mucous membrane, its inflammation, as well as mucopurulent discharge.

The following symptoms are characteristic of chronic sinusitis:

pressing or aching pain in the frontal region;
when pressing, a sharp pain is felt in the inner corner of the eye;
purulent discharge from the nasal passages with an unpleasant odor;
in the morning, a large amount of purulent sputum is released.

The chronic form of the disease develops 4-8 weeks after the onset of frontal sinusitis, and the causes of its occurrence are inadequate treatment or complete neglect of the acute form of sinusitis.

With frontal sinusitis, the patient experiences sharp pain in the frontal region

Diagnosis of the disease

To determine an accurate diagnosis, an otolaryngologist can use the following types of diagnostics:

rhinoscopy;
taking anamnesis;
nasal endoscopy;
ultraviolet examination of the paranasal sinuses;
transillumination (diaphanoscopy);
thermography;
bacteriological examination of discharge from the nasal passages;
X-ray of the paranasal sinuses;
computer studies (tomogram);
cytological studies of discharge.

Radiography makes it possible to assess the volume of accumulated fluid in the frontal sinus, the size and structural features of the nasal sinuses

The general goal of diagnosis is a detailed collection of patient complaints and clarification of the symptoms of the disease. By performing rhinoscopy, it is possible to determine the presence of an inflammatory process, notice redness and swelling of the mucous membrane, and also identify the presence of polyps or pathological changes in the nasal structures, which, in turn, can provoke or complicate the course of frontal sinusitis. To identify the extent of inflammation, as well as monitor the effectiveness of therapy, ultrasound of the frontal sinuses is prescribed.

To determine the microorganisms that provoke frontal sinusitis, a bacteriological examination of the contents of the nasal cavity is carried out. Together with cytology, bacterial culture makes it possible not only to determine not only the pathogen, but also its sensitivity to antibiotics. Thanks to these laboratory tests, the otolaryngologist can prescribe the most effective treatment. Instead of lengthy clinical studies, the patient is often offered to undergo a rapid test for pathogenic microflora and its sensitivity to antibiotics. A special feature of this research method is the ability to obtain results within a few minutes after taking the secretion released from the nasal passages.

Types of frontal sinusitis

Frontitis is divided depending on the form of the course, localization and type of inflammatory process.

According to the flow form:

spicy;
chronic.

By localization:

one-sided (left- or right-sided);
double-sided

By type of inflammatory process:

catarrhal;
purulent;
cystic, polypous;
parietal-hyperplastic.

Depending on the localization of the inflammatory process, the course and cause of the disease, different types of frontal sinusitis are classified

Acute frontal sinusitis

The causes of the disease are allergic rhinitis, facial injuries, and infectious diseases. The symptoms are pronounced. Antibiotics, vasoconstrictors, painkillers and antipyretics are used for treatment.

Chronic frontal sinusitis

The diseases are caused by prolonged acute frontal sinusitis or its reoccurrence, acute rhinitis, previous influenza, nasal polyps, pathological changes in nasal structures, for example, a deviated nasal septum, a foreign body in the nasal passages, weakening of local immunity. The symptoms are not as pronounced as those of acute frontal sinusitis, but they bring the patient not only physical, but also emotional discomfort (especially purulent discharge).

For treatment, decongestants, vasoconstrictors and homeopathic drugs, antibiotics, electrophoresis, lavages, expansion of the frontonasal valve, and sinus puncture are used.

Unilateral form of the disease

The unilateral form of the disease is characterized by the presence of discharge from only one nasal passage (right or left), headache, and an increase in body temperature up to 39 degrees. The cause may be bacteria, viruses, allergens, decreased local immunity, or facial injuries. For treatment, decongestants, antihistamines, painkillers, antipyretic and anti-inflammatory drugs, as well as antibiotics are used, and if conservative treatment is ineffective, surgical intervention is used.

Bilateral form of the disease

The bilateral form has the same symptoms and causes as unilateral frontal sinusitis, only discharge is observed from both nasal passages. For therapy, conservative treatment is used, and if it is ineffective, frontal sinusitis is treated surgically.

With inflammation of the frontal sinuses, the patient feels pain in the frontal region. Depending on the form of the course and localization of inflammation, the pain can be equally strong or periodically intensify

Catarrhal form

Characterized by severe headache, increased body temperature and swelling under the eyes. The disease occurs as a consequence of inflammatory and infectious processes in the nasal mucosa. For treatment, rinses of the nasal cavity, vasoconstrictors, anti-allergenic drugs, antibiotics, and drugs that normalize the microflora are used.

Purulent frontal sinusitis

The disease is characterized by purulent discharge from the nasal cavity, intoxication of the body, weakness, severe headaches, high fever, and difficulty breathing. The disease is caused by bacteria, as well as polyps or pathological changes in the nasal structures. The presence of a focus of infection in the body can also provoke frontal sinusitis. Treatment uses antibiotics, painkillers and anti-inflammatory drugs, decongestants, and a puncture to remove pus.

Polypous form

The main symptoms are aching pain in the frontal region, difficulty breathing, and mucous discharge. The causes are pathological growth of the nasal mucosa and the formation of cysts. Treatment is carried out only surgically: the frontal sinus is opened and these formations are removed.

Parietal-hyperplastic form of the disease

This form of the disease is also characterized by aching pain, copious discharge, difficulty breathing and proliferation of the mucous membrane of the paranasal sinuses. The disease is caused by bacterial infections, individual reactions of the immune system to inflammation, and increased division of cells of the mucous membrane. Antibiotics and vasoconstrictors are used for treatment.

Drug treatment of the disease

Drug therapy for frontal sinusitis should only be prescribed by the attending physician, since self-medication can lead to serious complications. Some forms of frontal sinusitis do not require antibiotics: viral or allergic frontal sinusitis. Taking antibiotics for these forms of the disease leads to a deterioration in the general condition of the patient, decreased immunity and dysbacteriosis. Other forms of the disease are treated comprehensively, including taking antibiotics.

Treatment of frontal sinusitis is conservative. If it is ineffective, they resort to surgical intervention.

To treat the disease, it is extremely important to rinse the nasal cavity, as they help clear the nasal passages of secretions. To speed up recovery, in addition to rinsing, electrophoresis, UHF therapy, laser therapy, and Sollux are prescribed.

If conservative treatment is ineffective, they resort to surgical intervention; the patient is punctured in the frontal sinus, through which its contents are removed. The procedure is carried out under local anesthesia using a special device - a trephine. Surgical intervention is also extremely important in the treatment of frontal sinusitis caused by pathological changes in the nasal structures (deviated septum, proliferation of the mucous membrane, formation of cysts and polyps).

Therapy during pregnancy

During pregnancy, as well as during lactation, taking antibiotics can have a negative effect on the child, therefore antimicrobial agents are prescribed in minimally effective doses, and the treatment process itself should be monitored by a qualified otolaryngologist and gynecologist.

Traditional medicine methods

Treatment of frontal sinusitis at home is allowed for mild forms of the disease. Treatment prescribed by a doctor can be supplemented with inhalations, ointments and warming agents. Traditional methods can help cope with the disease more effectively and quickly. However, it is necessary that the results of treatment are monitored by an ENT specialist.

There is an indication that this treatment method is right for you. If after the procedure tapping on the central area of the forehead does not cause pain, this means that the frontal sinus has been freed of mucous contents and microorganisms.

There is only one limitation: you must remember that under no circumstances should you heat your forehead if you have purulent frontal sinusitis. This can lead to the spread of pus into surrounding tissues.

Traditional medicine for the treatment of frontal sinusitis can only be used after consultation with the attending physician

Possible complications

With inadequate or untimely treatment, the likelihood of the inflammatory process spreading to other paranasal sinuses increases, resulting in sphenoiditis, sinusitis, and ethmoiditis. Frontitis causes eye complications such as eyelid abscess, swelling of the orbital tissue, orbital phlegmon and others. The most severe complications of frontal sinusitis are sepsis, brain abscess and meningitis.

Prevention of frontal sinusitis

As preventive measures, it is recommended to strengthen local and general immunity, take vitamin complexes and immunostimulating drugs, harden yourself, avoid communicating with people with respiratory diseases of the upper respiratory tract and contact with allergens.

Timely treatment of colds is also considered a preventive measure against frontal sinusitis.

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The paranasal sinuses are air cavities located around the nasal cavity and connected to it through narrow openings (Fig. 34).

They are named after the bones in which they are located.

All sinuses are paired, divided into anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone).

Rice. 34. Frontal section through the nasal cavity and paranasal sinuses: 1 - frontal sinuses; 2 - cells of the ethmoid labyrinth; 3 - middle turbinate; 4 - inferior nasal concha; 5 - nasal septum; 6 - maxillary sinus

The maxillary, or maxillary, sinus (sinus maxillaris) is the largest. Its average size is 10-12 cm3. It looks like an irregular quadrangular pyramid. On the front wall there is a depression - a dog's fossa (fossa canina). Here the bone is thinnest, so when performing surgery on the maxillary sinus it is opened in this place. In addition, from here you can always get into the sinus, regardless of its volume and configuration.

The medial wall borders the lower and middle nasal passages; the nasolacrimal duct passes through its anterior section. The sinus opening (ostium maxillare) is located under the orbital margin - the highest point of the sinus behind the protrusion of the nasolacrimal duct. Disruption of the function of this opening leads to the accumulation of secretions from the sinus, contributing to the development of an inflammatory process in it. The upper wall of the sinus is also the lower wall of the orbit. She is very thin. It contains the canal of the inferior orbital nerve and the vessels of the same name. Sometimes there are dehiscences covered only by the mucous membrane.

A thinned wall, along with defects in it, can contribute to the spread of the inflammatory process to the contents of the orbit, which requires caution during surgery. The lower wall is the alveolar process of the maxillary bone. In most cases, the bottom of the sinus lies below the bottom of the nasal cavity, which promotes close contact of the teeth with the sinus. The second premolar and the first molar are located closest to the bottom of the sinus. The posterior wall is represented by the maxillary tubercle, behind which are located the maxillary nerve, pterygopalatine ganglion, internal maxillary artery, and pterygopalatine venous plexus. The maxillary sinus is in close contact with the ethmoidal labyrinth, with which it shares a common wall.

The frontal sinus (sinus frontalis) is located in the scales and orbital region of the frontal bone. The following walls of the sinus are distinguished: anterior (facial); posterior (cerebral), bordering the anterior cranial fossa; lower (orbital), bordering the orbit and cells of the ethmoidal labyrinth; medial - intersinus septum. The anterior wall is the thickest. The thinnest is the orbital wall. The rear wall occupies a middle place relative to thickness.

The intersinus septum may be deviated in one direction or another. On the lower wall, on the border with the septum and closer to the posterior wall, there is an opening of the frontonasal canal. The dimensions of the frontal sinuses vary widely, up to their complete absence on one or both sides. The anatomical proximity of the frontal sinuses to the contents of the anterior cranial fossa and orbit determines their pathogenetic relationship.

Ethmoidal cells (celhdae ethmoidales) are represented by air cells located between the frontal and sphenoid sinuses. The number, volume and placement of ethmoid cells vary significantly. On each side there are on average 8-12 of them. These cells are delimited externally by a paper plate (lamina papyracea), which approaches the lacrimal bone in front, the sphenoid sinus in the back, borders the frontal bone above and the maxillary and palatine bones below.

Based on their location, the ethmoidal cells are divided into anterior and middle, which connect to the middle nasal meatus in the anterior section of the semilunar fissure (hiatus semilunaris), and posterior, which open into the upper nasal meatus. From the individual cells of the ethmoidal labyrinth it is necessary to distinguish: 1) the ethmoidal vesicle (bulla ethmoidalis) - behind, above the iolunate fissure, it laterally borders the paper plate, and medially, sometimes reaching significant sizes, it can push the middle concha towards the nasal septum; 2) frontal bladder (bulla frontalis) - protrudes into the opening of the frontal sinus; 3) fronto-orbital cells - located along the upper wall of the orbit; 4) bulla conchae - located in the anterior section of the middle turbinate.

It should be noted that the cribriform plate (lamina cribrosa) most often lies below the roof of the nasal cavity, therefore, when opening the cells of the ethmoidal labyrinth, it is necessary to strictly adhere to the lateral direction so as not to penetrate into the cranial cavity.

The sphenoid sinus (sinus sphenoidalis) is located in the body of the sphenoid bone. The partition divides it into two (usually unequal) parts. The opening (ostium sphenoidale) is located on its front wall, just under the roof of the nasal cavity.

The lower wall of the sinus forms part of the arch of the nasal throat, the upper wall is represented by the lower surface of the sella turcica, on which the pituitary gland is located. The lateral wall of the sinus is very thin, bordered by the internal carotid artery, cavernous sinus (sinus cavernosas), the first branch of the trigeminal nerve, oculomotor, trochlear and abducens (III, IV, V and VI pairs of cranial nerves) nerves.

The mucous membrane of the paranasal sinuses is a continuation of the mucous membrane of the nasal cavity, but it is much thinner, instead of 5-6 layers of cells it has only 2. It is poor in blood vessels and glands and at the same time acts as periosteum. The movement of the cilia of the ciliated epithelium is directed towards the outlet openings of the sinuses.

Newborns have two sinuses: the maxillary and the ethmoidal labyrinth, represented by the rudiments. At the age of 6 years, the maxillary sinus takes on a normal shape, but its size remains small. By the age of 8, the bottom of the sinus descends to the level of the bottom of the nasal cavity, and by 12, below its bottom. By the time the child is born, the cells of the ethmoidal labyrinth are formed, but their number and size increase with age, especially in children from 3 to 5 years old. Frontal and sphenoid sinuses are absent in newborns; their formation begins by the age of 4 and ends at 16-20 years.

DI. Zabolotny, Yu.V. Mitin, S.B. Bezshapochny, Yu.V. Deeva

The frontal sinuses are two cavities in the frontal bone of the skull, located to the left and right of the midline. Their size and configuration vary individually among different people. Frontal sinusitis in children, especially small ones, is quite rare, since their frontal sinuses are not yet formed.

The frontal sinus is limited by four walls. The lower wall separates it from the orbit, the back wall is adjacent to the anterior cranial fossa, the middle wall is the wall between the right and left frontal sinuses. The front thick wall is the human forehead. Inside, the frontal sinuses can be relatively “smooth”, or they can be divided by bony projections and septa into many cells.

In the lower wall of the cavity there is a hole leading into a canal connecting the sinus with the middle nasal passage. The downward frontonasal canal should provide free outflow of the contents of the frontal sinus. But it is quite long (from 15 to 25 mm) and narrow (from 1 to 4 mm), so with the slightest swelling of the mucous membrane, the outflow from the sinus sharply worsens. And the lack of drainage is a direct path to the development of the inflammatory process.

Frontit is an inflammation of the mucous membrane lining the inside of the paranasal frontal sinuses. Depending on the nature of the disease, it can be acute or chronic.

Acute frontal sinusitis

Etiology of the disease

As a rule, the causative agents of acute frontal sinusitis are bacteria, which are normally sown during bacteriological examination of nasopharyngeal material taken from healthy people. Weakened immunity and poor ecology, abnormalities in the structure of the nasopharynx and chronic diseases, frequent acute respiratory viral infections and occupational hazards - all this contributes to the activation of microbes, often causing acute frontal sinusitis. Pneumococcus is the leader; staphylococcus, Haemophilus influenzae and Moraxella are somewhat inferior to it in terms of frequency of inoculation.

Clinical signs and possible complications

The clinical picture of acute purulent frontal sinusitis consists of general and local symptoms. In addition to an increase in body temperature (sometimes up to 39 °C), weakness and general malaise are noted. Local signs of frontal sinusitis are headache, difficulty in nasal breathing combined with nasal discharge, impaired sense of smell.

Painful sensations usually occur in the morning, intensify towards noon and disappear in the afternoon. The intensity of the pain varies from a feeling of pressure in the forehead to sharp, unbearable attacks of pain throughout the head.

With bilateral inflammation, “the whole forehead hurts,” and sometimes the whole head. Breathing through the nose is difficult on both sides. Serous-purulent or purulent discharge is noted from both nasal passages. The sense of smell may be completely absent.

With a unilateral process, pain in the forehead is concentrated in one half of it, at the site of the projection of the inflamed sinus, with the epicenter at the inner edge of the eyebrow. On the same side, nasal congestion and discharge from it are noted. The sense of smell may be partially preserved.

Another symptom characteristic of frontal sinusitis is inflammatory swelling and redness of the soft tissues in the area of the eyebrow, inner corner of the eye and upper eyelid.

The clinical forms of modern frontal sinusitis are often erased forms, in which the clinical signs of the disease include only a local headache above one or both eyebrows. At the same time, additional examination methods also do not give clear results.

Due to the proximity of the frontal sinuses to the eye sockets, and due to the anatomical features of the vascular network of the head, purulent inflammation of the frontal sinuses is often accompanied by complications. Pathogenic microbes can penetrate into the cavity of the skull and orbit by contact (when bone melts) or along the course of blood vessels and nerves.

When inflammation spreads to the bone elements that form the sinus, periostitis (inflammation of the periosteum) or subperiosteal abscess can become a complication of acute purulent sinusitis. Possible orbital complications of frontal sinusitis are swelling of the tissue or phlegmon of the orbit and thrombosis of the veins of the tissue of the orbit.

In terms of the frequency of intracranial complications (meningitis, abscess, etc.), frontal sinusitis ranks second, second only to inflammation of the ethmoidal labyrinth. They can be caused by melting of the posterior wall of the frontal sinus, as a result of which the infection penetrates into the anterior cranial fossa and affects the meninges.

A complication of purulent frontal sinusitis involving the brain or orbit in the inflammatory process is always an indication for emergency surgery. It is carried out in a specialized ENT department with the participation of neurosurgeons and ophthalmologists.

How does a doctor diagnose acute frontal sinusitis?

The diagnostic process consists of the following stages:

After listening to the patient’s complaints and asking him about the onset of the disease, the ENT doctor conducts an examination. In addition to the external signs of frontal sinusitis described above, it reveals pain when tapping on the frontal bone and pressing on the area of the inner corner of the eye. The doctor detects that the patient has an increase in headache when bending the head forward.
When examining the nasal cavity, inflammation of the frontal sinus is indicated by thickening and redness of the mucous membrane of the middle nasal passage and purulent discharge flowing from under the middle turbinate. To simplify diagnosis, optical rhinoscopy is used - an endoscopic method. To visually confirm the diagnosis of frontal sinusitis, the otolaryngologist prescribes radiography, ultrasound or CT scan of the paranasal sinuses.
The variability in size and different structure (described above) of the frontal sinuses are the main reasons for the variety of clinical symptoms of frontal sinuses and the development of atypical forms of the disease. Computed tomography helps the doctor understand the anatomical structure of the sinuses in a particular patient.
In a clinical analysis of blood in a typical acute frontal sinusitis, there are signs of a purulent-inflammatory process: a significant increase in the number of leukocytes with corresponding changes in the leukocyte formula, a pronounced increase in ESR. If even after this the diagnosis of acute purulent frontal sinusitis is in doubt, the doctor performs a diagnostic trephine puncture of the frontal sinus.
In doubtful cases, flowometry, thermography, rheofrontography and digital diaphanoscopy help.

Treatment of acute sinusitis

In most cases, the otolaryngologist begins treatment of an acute purulent-inflammatory process in the frontal sinuses with conservative treatment methods. They are aimed at restoring the patency of the frontonasal canal, at “extinguishing” the inflammatory process and at combating microorganisms that have become the causative agents of the disease.

Means for the conservative treatment of acute frontal sinusitis are as follows:

To combat swelling of the mucous membrane, vasoconstrictors (anemia) are used in the form of nasal drops or nasal sprays. Sometimes they resort to lubricating the mucous membrane of the middle nasal passage with anemic drugs;
to evacuate the contents of the frontal sinuses and subsequently wash them with medicinal solutions, the YAMIK sinus catheter is used with high efficiency;
To eliminate the pathogen and in case of severe intoxication (fever, chills, weakness), antibacterial drugs are prescribed. The ideal option is to use an antibiotic to which the infectious agent that caused the disease is sensitive. But in some situations (severe disease, frontal sinusitis in pregnant women, frontal sinusitis in children, etc.) you cannot risk wasting time waiting for the results of a bacteriological examination. Therefore, broad-spectrum antibiotics become the drugs of choice;
according to indications, mucolytics, painkillers and antihistamines are prescribed;
if frontal sinusitis in adults and children occurs without intoxication, physiotherapy is carried out (EF in the nose, UHF in the sinus area, etc.), local warming procedures are recommended.

Frontitis on an x-ray:

Before treating frontal sinusitis at home, for example, using traditional medicine, be sure to visit an ENT doctor. Believe me, he will not convince you that, for example, apitherapy or homeopathy is ineffective or miraculous. The doctor will guide you in the right direction and tell you what means in your particular case are best to treat frontal sinusitis at home.

If, against the background of conservative treatment of purulent frontal sinusitis, confirmed by radiography or CT, after three days the condition has not improved (headaches and fever persist), the ENT doctor performs trephine puncture of the frontal sinus. Its result is the evacuation of the purulent contents of the sinus, the ability to rinse the cavity and introduce medications into it. Sometimes the frontal sinus is punctured with a thin needle through the inferior orbital wall.

There is no need to be afraid of trephine puncture - it is performed in a hospital setting, is always performed under local anesthesia and is the most effective way to remove pus from the frontal sinuses.

Using a special instrument, the doctor drills a hole in the front wall of the frontal bone, inserts a metal cannula (tube) into it and leaves it there. Every day for 2-7 days, the sinus is washed through the cannula and medications are injected into it.

If the clinical signs of acute frontal sinusitis persist for 3-4 weeks, and the patency of the frontonasal canal is not restored, surgical endoscopic intervention is performed on the frontal sinus with access through the nasal cavity. But in 20% of cases, doctors have to resort to radical operations with external access to the frontal sinus. The goal of all interventions is to restore the patency of the frontonasal canal.

Chronic frontal sinusitis

Causes of development of chronic sinusitis

An ENT doctor makes a diagnosis of chronic frontal sinusitis if the acute process has dragged on for a month or more.

The most common cause of chronic inflammation in the frontal sinuses is an untreated acute process. Anatomical anomalies, a long-term absence of normal sinus drainage, and polypous processes in the adjacent sinuses and in the nasal cavity contribute to the development of chronic frontal sinusitis.

Very often, chronic frontal sinusitis is caused by associations of microbes, including: streptococci, Haemophilus influenzae, staphylococci and moraxella. The incidence of fungal frontitis, candidiasis and actinomycosis has increased. They are often very severe and malignant. Fungi often destroy the bone walls of the sinuses, which leads to the development of complications.

Clinical picture of the disease

All clinical signs typical for frontal sinusitis also occur in the chronic course of the disease. But they are not expressed so clearly and are characterized by inconstancy.

Chronic frontal sinusitis rarely occurs in isolation: the cells of the ethmoid bone are involved in the pathological process. Intracranial and orbital complications are frequent companions of chronic inflammation of the frontal sinuses. They manifest themselves as protrusion of the eyeball, pain in the orbit, blurred vision and other symptoms.

Diagnosis and treatment of chronic sinusitis

The diagnosis of chronic frontal sinusitis is made by an ENT doctor based on the history of the disease and clinical symptoms. The results of instrumental examination, laboratory and other examination methods (endoscopy, radiography, CT, etc.) play an important role.

To formulate an accurate clinical diagnosis of chronic sinusitis, doctors use a classification common to all sinusitis, distinguishing productive, exudative, alterative and mixed forms of the disease, as well as vasomotor and allergic sinusitis.

The treatment tactics for the disease are determined by its form. Allergic, catarrhal and serous chronic frontal sinuses are treated with conservative methods, including:

applications and instillations of vasoconstrictors;
YAMIK procedures;
antibiotic therapy;
probing of the sinuses.

You can treat chronic sinusitis at home using a variety of traditional medicine methods. But do not hesitate to consult an ENT doctor. He will tell you when and what means can be used, and when even the most popular and simple procedures are contraindicated.

Surgical treatment is indicated for alterative, productive and mixed forms of chronic frontal sinusitis. Thus, aspergillus sinusitis is treated only surgically: the sinus is opened, the fungal body is removed from it and the anastomosis with the nasal cavity is expanded. If gentle methods are ineffective, radical operations with external access are resorted to. They are indicated for chronic frontal sinusitis with frequent relapses, and for complicated forms of the disease.

Another treatment method is balloon dilatation (expansion) of the frontonasal canal. A balloon filled with air presses on the bone walls of the anastomosis, causing microfractures of the bones, compressing the surrounding tissues and thereby expanding the canal. A catheter is inserted into the expanded channel, through which the sinus is then washed. This is a relatively safe method of treating chronic sinusitis.

In some cases, doctors use the method of obliteration (fusion, closure) of the frontal sinuses, using tissue from the patient himself or synthetic materials.

The frontal sinuses are an integral part of the system of paranasal air cavities and perform a number of functions related to the protection of the body, the organization of normal breathing and speech. They are located in close proximity to the brain membrane, so their diseases can lead to serious complications.

Structure and functions of front cameras

The frontal sinuses, like the maxillary sinuses, in their location belong to the anterior voids, which communicate with the nose through the tortuous and long middle frontonasal passage. This anatomy predetermines much more frequent infectious diseases of the anterior cavities.

The frontal chambers are a paired organ located deep in the frontal bone.

Their size and configuration can vary markedly from person to person, but on average each frontal sinus has a volume of about 4.7 cubic centimeters. Most often, it looks like a triangle, lined inside with mucous membrane, with four walls:

The orbital (lower) is the thinnest, most of its area is the upper wall of the orbit, with the exception of the edge adjacent to the ethmoid bone. On it there is a canal anastomosis 10-15 mm long and up to 4 mm in diameter, opening into the nasal cavity.
The facial (front) is the thickest, represented by the outer part of the frontal bone, which has a thickness of 5 to 8 mm.
Medullary (posterior) - consists of a thin but strong compact bone, bordered by the anterior cranial fossa and the dura mater.
The inner (medial) divides the two chambers; in its upper part it can deviate to the left or to the right.

A newborn child does not have frontal sinuses; they begin to form only at 3-4 years of age and finally develop after puberty.

They appear at the upper inner corner of the orbit, consist of cells of the ethmoid bone, and the nasal mucosa grows into them. In parallel with this, the process of resorption of the spongy bone, which is located between the inner and outer plates of the frontal bone, occurs. In the vacated space, frontal voids are formed, which can sometimes have niches, bays and internal partitions in the lumen. The blood supply comes from the ophthalmic and maxillary arteries, and the innervation comes from the ophthalmic nerve.

The cavities are most often unequal, since the bone plate separating them is usually not located exactly in the center, sometimes it may be absent, then the person has one large cavity. In rare cases, the dividing bone is not located vertically, but horizontally, and the chambers are located one over the other. According to various studies, 5-15% of people have no frontal sinuses at all.

The main functions of front cameras today are:

protecting the brain from injury and hypothermia (acting as a “buffer”);
participation in the formation of sounds, enhancing vocal resonance;
regulation of pressure levels in the nasal passages;
warming and humidification of inhaled air;
reduction in the mass of the skull during its growth.

Acute frontal sinusitis: etiology and symptoms

Since the paranasal compartments are covered inside with mucous membranes, the main disease is the inflammatory process in them. If we are talking about the frontal sinuses, then their inflammation is called frontal sinusitis. The inflammation has a wave-like course, can quickly move from the acute stage to the chronic stage and then be asymptomatic or go away without treatment.

The main cause of the disease, as a rule, is an inflammatory process in the upper respiratory tract, from where it spreads to the frontal compartments in an ascending manner.

If treatment is untimely or insufficient due to changes in the pH of the secretion, the immune barrier from the ciliated epithelium weakens, and pathogenic microflora penetrates into the chambers, covering the mucous membranes. Many doctors are of the opinion that the acid-base balance of mucus can be disrupted by drops with a vasoconstrictor effect, which are used for a long time.

The main prerequisites for the development of the disease:

long lasting runny nose;
colds that have been poorly treated or suffered “on your feet”;
hypothermia of the body, in particular the legs;
stress;
injuries to the front of the head.

The inflammatory process is accompanied by hyperemia and swelling of the mucous membranes, resulting in increased secretion while simultaneously impeding the outflow of fluid. The supply of oxygen is sharply limited or completely stopped. Gradually increasing internal pressure is the cause of severe pain in the forehead area.

Symptoms of the disease are divided into general and local, which together give a characteristic clinical picture of acute frontal sinusitis.

Local signs:

complete absence or severe difficulty in nasal breathing;
throbbing and pressing pain above the eyebrows, which intensifies when you tilt your head forward or press your hand on your forehead;
copious purulent discharge from the nasal passages (one or both);
secretion flowing into the oropharynx;
Swelling may spread to the upper eyelid or the corner of the orbit of the eye.

Simultaneously with the local ones, general signs indicating intoxication of the body also increase:

temperature rise to 37.5-39 degrees, chills are possible;
blood reaction (increased ESR, leukocytosis);
muscle weakness;
diffuse headaches;
hyperemia of the skin in the projection of the affected organ;
aches in bones and joints;
fatigue and drowsiness.

Diagnosis and conservative treatment of frontal sinusitis

To study the clinical picture and make the correct diagnosis, you need to contact an otolaryngologist. The ENT doctor interviews the patient, after which he performs rhinoscopy - a visual examination of the nasal cavities and paranasal sinuses in order to determine the location of pus and the condition of the mucous membranes. Palpation and percussion (tapping) help to identify pain in the anterior wall of the forehead and the corner of the eye on the affected side.

To confirm the suspected diagnosis, the patient donates blood for analysis, and also undergoes radiography (in lateral and direct projections) or computed tomography.

These methods best allow us to determine the lesion, the amount of accumulated pus, the depth and shape of the chambers, and the presence of additional partitions in them. The mucus released undergoes microbiological examination to determine the pathogen and prescribe adequate treatment.

In most cases, conservative treatment is used, including anti-inflammatory therapy, unblocking of the frontonasal canal and restoration of drainage of the cavity. The following medications are used:

broad-spectrum antibiotics in the presence of high temperature (Klacid, Avelox, Augmentin) with subsequent correction if necessary;
analgesics (askofen, paracetamol);
antihistamines (claritin, suprastin);
drugs to reduce mucous secretion through high adrenalization (sanorin, nazivin, galazolin, sinupret, naphthyzin);
means for strengthening the walls of blood vessels (vitamin C, rutin, ascorutin).

In the absence of severe intoxication of the body, physiotherapy (laser therapy, UHF, compresses) is highly effective. A YAMIK sinus catheter is also used, which allows the chambers to be flushed with medicinal substances.

If conservative treatment is ineffective (persistence of high fever, headache, impaired nasal breathing, secretion of thick mucus or pus) for three days, as well as if pus in the cavities is detected using X-rays or computed tomography, sinus trephine puncture is prescribed. Today this is a very effective technique that provides a high level of recovery. This is a fairly simple operation that is well tolerated by patients, regardless of their age.

The essence of the operation is to penetrate the bone tissue mechanically in order to:

removal of purulent contents;
restoration of drainage through the connecting channel;
reducing swelling of the membranes;
suppression of pathogens that cause inflammation.

To carry out surgical intervention, a hand drill no more than 10 mm long with a penetration depth limiter and a set of plastic or metal cannulas for rinsing are used.

When determining the optimal entry point, special calculations are used, which are confirmed by x-rays in different projections.

Trepanopuncture is performed in the inpatient department of the hospital, and local infiltration anesthesia (ledocaine, novocaine) is mainly used. Using a drill, a hole is made in the thick anterior wall of the bone, through which the entire organ is probed. A special cannula is inserted and secured into the hole, through which medications are administered over the next few days. In addition, the sinus and connecting canal are washed with antiseptic solutions, followed by the evacuation of blood clots, polyps, cystic formations, and granulation tissue.

Less commonly, otolaryngologists use the method of punching the bone with a chisel. The resulting vibration is contraindicated for:

meningitis;
abscesses;
osteomyelitis of the cranial bones;
thrombophlebitis.

There is also a technique that is widely used in practice for puncturing the lower wall of the cavity, which is much thinner than the front, with a sharpened special needle. In this case, a thin subclavian catheter is inserted into the lumen of the needle, which is fixed to the skin after the needle is removed and serves as a passage for washing and delivering medications into the chamber. However, this operation is considered less preferable and more difficult due to the presence of the orbit in close proximity.

Due to the location of the meninges near the lesion, delaying contact with a doctor or attempting self-medication can lead to serious consequences, including death. Complications of frontal sinusitis can include diseases such as purulent inflammation of the orbit, meningitis, osteomyelitis of the cranial bones, etc.

Traditional methods of treatment and prevention of frontal sinusitis

Traditional recipes are mainly aimed at reducing swelling and removing mucus; their use should be coordinated with your doctor:

Boil bay leaves (5-10 pcs.) in a saucepan, transfer to low heat and breathe, covered with a towel, for five minutes. Repeat for several days in a row, this promotes the outflow of pus.
A teaspoon of salt, a little baking soda and three drops of tea tree oil are mixed in a glass of warm water. Clean your nose, then, tilting your head forward, use a small syringe to pour the solution under pressure into one nostril so that it flows out of the other. Repeat 2-3 times a day, then apply drops for a runny nose.

Prevention of the disease is as follows:

timely treatment of rhinitis and sinusitis; if the runny nose does not go away within three days, you should contact the clinic;
strengthening the immune system through hardening and physical exercise;
vitamin therapy in autumn and spring;
control of cleanliness of the nose and free nasal breathing.

Sources: medscape.com,

If, after suffering from a cold, a constant headache appears, aggravated by changing body position and bending, the body temperature rises, and pus with a characteristic odor begins to be released from the nose, this means that frontal sinusitis is developing - inflammation of the frontal sinuses.

The facial part of the skull consists of porous bones and has several sinuses communicating with the nasal cavity. This allows you to prevent small mechanical particles inhaled along with the air from entering the body, as well as most pathogens of various diseases. But if immunity decreases, the protective function of the sinuses decreases, and microbes easily enter the body.

Since the nasal and frontal sinuses have a direct connection with the nasopharynx, in the event of inflammation, the microorganisms that caused it easily enter the sinuses. Their penetration leads to the development of sinusitis, sinusitis or sinusitis.

There are 2 main causes of frontal sinusitis - infection by viruses or bacteria.

In the first case, the most typical are:

adenoviruses;
coronaviruses;
rhinoviruses.

In case of bacterial inflammation, streptococci, polyps or allergies can provoke it. It is also possible that inflammation may develop due to injuries to the nose or sinus area, a deviated septum, or the entry of a foreign body during inhalation.

Signs of frontal sinusitis

The most characteristic signs of frontal sinusitis are:

headache that gets worse when bending over;
general weakness;
a sharp increase in body temperature.

During the process in which inflammation of the frontal sinus occurs, yellow-green pus or mucus begins to be released from the nose. A headache causing severe discomfort appears, accompanied by dizziness and spasms, which intensify with changes in body position.

A person who develops frontal sinusitis will complain of throbbing pain radiating to the temples in the forehead area. In the absence of proper treatment, frontal sinusitis can lead to complications in the form of sinusitis or otitis media. Its most dangerous consequence is. This is because the facial bones have a thin, porous structure, through which infection can easily penetrate the brain.

Externally, frontal sinusitis can manifest as swelling on the outside of the frontal sinuses. Moreover, it will be more pronounced from the side of the inflamed sinus. Such swelling may spread to the orbital part or corner of the eye.

Diagnostic process

Swelling becomes noticeable to the naked eye. In addition, upon palpation the patient experiences pain. And tapping or pressing in the sinus area worsens the headache.

Accurate information about the condition of the sinuses can be obtained by doing tomography, frontal or lateral x-rays. Rhinoscopy can help detect large amounts of pus, as well as severe thickening and swelling of the mucous membranes.

An increased ESR, leukocytosis and a shift in the blood count to the left, revealed during the analysis, also indicate acute inflammation occurring in the body. When the data collected by such methods is insufficient, trephine puncture of the frontal sinuses is performed.

Drug treatment

If frontal sinusitis occurs in a mild form, then conservative treatment would be more appropriate. To reduce swelling of the mucous membranes, it is necessary to adrenalize them. For this purpose, the following drugs are used in the form of nasal drops:

Galazolin;
Naphthyzin;
Oxemethazaline.

These vasoconstrictors reduce swelling and looseness of the nasal and sinus mucosa, and also reduce mucus production. This can significantly alleviate the patient's condition.

In addition, you must take the following medications in tablets:

antibiotics with a broad spectrum of action (Sumamed, Augmentin, Claforan, Duracef, Rovamycin and others);
painkillers that can reduce pain caused by inflammation;
various antihistamines (Diazolin, Tavegil, Suprasin, and others).

Physiotherapy is also very helpful in the treatment of frontal sinusitis. But you should prescribe procedures with caution, after making sure that they will not aggravate the course of the disease.

If conservative methods of therapy are unsuccessful, and drug treatment does not justify the expected positive effect, you need to resort to surgery. To do this, it is necessary to perform trephine puncture, in which the frontal sinus is pierced, pus is pumped out of it, after which it is washed.

Nasal rinsing

Rinsing the nose can very effectively remove pus mixed with mucus and reduce the intensity of the inflammatory process. Effective treatment solutions are made based on:

sea salt, which does a good job of killing bacteria;
alkaline still mineral water;
chamomile

Antibiotics

A severe inflammatory process caused by infection is characterized by a large amount of pus. Only potent broad-spectrum antibiotics can cope with it. In this case, it is highly advisable to test the susceptibility of the infection to the action of the drugs before using them. It will allow you to determine the specific group of bacteria that led to inflammation and select the antibiotic necessary to combat these bacteria specifically.

The test requires a long period of time, from 3 days to a week. And with severe frontal sinusitis, it may not be there. Therefore, broad-spectrum antibiotics, which can act on several types of bacteria at once, are often prescribed without analysis.

Traditional methods of treatment

Most folk methods boil down to warming up the sinuses. For the first treatment method, you need to take a boiled egg. It is wrapped in natural fabric and applied to the inflamed area of the forehead. When the egg begins to cool, take it out and roll it for 2-3 minutes in the area of the frontal sinuses.

For the second method, bags made of natural fabric filled with highly heated salt or sand are used. Such a “compress” should be placed on the inflamed area and warm the sinus with it. Since salt and sand retain heat for a long time, the procedure will be quite lengthy.

Surgery

In the case when all of the above methods did not lead to positive dynamics, the need for surgical intervention arises. Trepanopuncture surgery can be performed using two methods: through the anterior surface of the frontal bone or from the side, through the orbital wall of the frontal sinus. The second method is used less frequently, when the first is technically impossible, as it is characterized by a high risk for the patient.

To perform trepanopuncture, it is necessary to make a special marking on the forehead. It is performed using an x-ray of the skull, and its goal is to identify the thinnest part of the frontal bone. It is in this place that a hole will be made, where the cannula will subsequently be immersed. Through it, pus is removed from the sinus, after which the cavity is washed and medications are administered. This therapy lasts from 3 days to a week, depending on the patient’s condition and the dynamics of the treatment.