Primary frontal sinus aspergillosis: an uncommon occurrence

Primary frontal sinus aspergillosis is extremely uncommon with only few cases reported in the English literature. Isolated frontal sinus aspergillosis is usually asymptomatic and produces symptoms due to orbital or intracranial involvement. We report two cases of primary frontal sinus aspergillosis, presenting as frontoethmoidal mucocele and mimicking a 'Pott's puffy tumor,' respectively. Forehead swelling produced by frontal sinus aspergillosis will be the first to be reported in the English literature.     

Selecting the Best Approach to the Frontal Sinus

The Messerklinger technique is an endoscopic approach to sinus surgery designed to be minimally invasive and preserve mucosa and hence physiological function. More recently there have been advocates for more radical endoscopic approaches to the frontal sinus such as the Modified Lothrop. This review discusses different approaches to frontal sinus surgery including any advantages and disadvantages to each approach. After examining the evidence from the literature, meticulously performed endoscopic frontal sinusotomy with or without computer guidance appears to be the most effective minimally invasive procedure for treating chronic frontal sinusitis secondary to outflow tract obstruction. Properly performed, it is almost always effective in dealing with even the most diseased frontal sinus. It offers clear advantages in reducing complications and recurrence rates in frontal sinus disease, even for revision cases.     

Complication of frontal sinusitis-Not amenable to endoscopic surgery

Endoscopic sinus surgery has brought a change in the concept of treatment of sinus disease. Frontal sinusitis, however, still gives rise to intra and extracranial complication often musked by antibiotic intake. Where endoscopic surgery may fail to completely eradicate disease or even not be feasible due to various anatomic factors and other limitation. It is here that the tried and trusted external approach to the frontal sinus finds a role even today. Four such cases of various complication not amenable to endoscopic sinus surgery are presented here with the view of maintaining the necessity of keeping the external approach within the present day surgical palette when treating complication of frontal sinus disease.     

Radiation-induced osteosarcomas after treatment for frontal gliomas: a report of two cases

Most radiation-induced osteosarcomas of the skull are reported to arise in the facial bone or paranasal sinus after radiotherapy for retinoblastoma and/or pituitary adenoma. Here we report two cases of radiation-induced osteosarcoma in the paranasal sinus after treatment for frontal glioma. Case 1 was a 56-year-old woman who underwent surgical resection of a left frontal tumor in October 1990. The histological diagnosis was a low-grade glioma, and radiotherapy of 54 Gy was administered. Sixteen years later, in September 2006, the patient noted an enlarging subcutaneous mass in the right frontal region. CT showed an osteolytic mass in the right frontal sinus. An open biopsy established the histopathological diagnosis of osteosarcoma, and the patient subsequently died of rapid tumor regrowth. Case 2 was a 58-year-old man who underwent partial removal of a bifrontal tumor in May 1996. The histological diagnosis was anaplastic oligoastrocytoma, and radiotherapy of 56 Gy was administered. Twelve years later, in March 2008, the patient was readmitted to our hospital for reasons of marked deterioration in general physical condition. Tumor recurrence was suspected in the left frontal lobe, and CT demonstrated an osteolytic mass in the left frontal and ethmoid sinus. A secondary operation was performed, and the pathological specimens were diagnosed as osteosarcoma. Radiotherapy was readministered, but the subject died of rapid tumor regrowth. From these clinicopathological findings, both cases were diagnosed as radiation-induced osteosarcoma. Radiation-induced osteosarcomas appeared 16 and 12 years after radiotherapy in cases 1 and 2, respectively. As the prognosis of radiationinduced osteosarcoma is poorer than that of primary osteo-sarcoma, careful attention is required for consideration of the long-term survival of patients with glioma.     

Frontal sinus osteomyelitis with midline fistula

Chronic osteomyelitis of frontal sinus is a rare complication of recurrent sinusitis. The pent-up secretions in the sinus may result in pressure necrosis of the containing wall of frontal sinus resulting in persistently discharging fistula. Here we present a case of chronic osteomyelitis of frontal sinus with persistent midline fistula over forehead in a 30 year old male managed surgically by osteoplastic flap procedure and frontal sinus obliteration with abdominal fat.     

嗅神经母细胞瘤的CT表现

目的探讨CT在嗅神经母细胞瘤的诊断和分期中的价值。方法回顾性分析15例嗅神经母细胞瘤的CT表现。男10例,女5例。平扫8例,增强扫描7例。结果肿瘤中心位于筛窦10例,鼻腔5例;9例呈膨胀性生长,6例浸润性生长,侵犯范围为鼻腔及筛窦各14例,眼眶及上颌窦各9例,蝶窦、额窦、脑实质及鼻咽各3例,海绵窦及颞下窝各1例。14例伴有相邻骨质破坏。7例增强扫描中,轻度强化4例,中度强化3例,1例出现钙化。结论CT扫描可清楚显示肿瘤大小与部位,冠状面及矢状面扫描能更好地显示侵犯范围,具有重要意义。     

Non-hodgkin’s lymphoma of the frontal sinus

Non-Hodgkin’s lymphoma (NHL) of the head and neck area is rare, and constitutes 0.4%–2% of all extranodal lymphomas and 6.4%–13% of extranodal lymphomas of the head and neck area^1–6. The maxillary antrum, nasal cavity and ethmoid sinus are the most common sites for this tumor³. Prognosis of the NHL affecting the paranasal sinuses and nasal cavity is poor with 33% of survival at 5 years^5–7. Failure of the treatment is local and with distant metastasis. Radiotherapy permits disease-free survival at 5 years in T1–T2 of 78% and in T3–T4 of 18%⁷. Only three cases in the literature have been described affecting the frontal sinus, in two cases there was infiltration of the other paranasal sinuses and in one case there was an isolated primary non-Hodgkin’s lymphoma of the frontal sinus^3,4 (Medline from 1966 to 2001). We present the second case reported in the literature of NHL exclusively affecting the frontal sinus showing local control 5 years after diagnosis.     

Endoscopic Transseptal Approach to Frontal Sinus Disease

This paper describes an endoscopic transseptal approach to identify and access the frontal sinus and reviews the clinical cases. Between May 2004 and July 2010, endoscopic modified Lothrop procedure (EMLP) with transseptal approach was performed on sixteen patients. The indications for EMLP were complicated frontal sinusitis or cyst, revision surgery for failed frontal sinusotomy or Lynch procedure, or trauma cases. The first step of this procedure was to open a window in the bilateral anterior portion of the middle turbinates and nasal septum. The nasal septum, which could be observed through the window, should be the landmark of the midline during the surgery. A drill bur was raised up just behind the nasal bone along the midline of the nose. After the bilateral frontal sinuses and their posterior walls were confirmed, the interfrontal septum was removed superiorly. We reviewed the clinical records of patients who underwent the EMLP with transseptal approach. We have managed sixteen patients in this fashion. Neither intracranial nor orbital complications were encountered during or after surgery. Endoscopic transseptal frontal sinus surgery is simple to perform, and does not cause severe complications.     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的　研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法　对 2 5例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术 ,术中配合使用电动吸切器切除肿瘤 ,术后随访 12～ 60个月。结果　全部 2 5例均在鼻内窥镜下一次完整切除肿瘤 ,2 5例中 2例分别于术后 12个月和 16个月内复发 ,其余 2 3例在随访期内未见复发。结论　使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效 ,对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

Intracranial leiomyosarcoma: A neuro-oncological consequence of acquired immunodeficiency syndrome

We describe a case of glioblastoma treated with chemoradiotherapy that spread to the dura mater with direct invasion of the skull base, protrusion into the homolateral nasal fossa, and penetrated of the frontal sinus, the orbital wall and the ethmoidal sinuses. Only eight cases of glioblastoma showing this development have been described in the literature; one of these, however, had a sarcomatous component which was absent in our case.     

螺旋ＣＴ在鼻腔鼻窦骨化纤维瘤诊断中的应用

目的：探讨螺旋ＣＴ诊断鼻腔鼻窦骨化纤维瘤的价值。方法：回顾性分析２０００年７月～２００８年５月我院手术治疗病理确诊的鼻腔鼻窦骨化纤维瘤患者２４例的临床资料及ＣＴ特征。结果：侵犯单个鼻窦肿瘤１２例,其中筛窦８例,上颌窦４例,伴有鼻腔侵犯６例。肿瘤同时侵犯多个鼻窦和鼻腔１２例,其中上颌窦和筛窦８例,筛窦和额窦４例,均有鼻腔侵犯。鼻腔鼻窦骨化纤维瘤的ＣＴ表现为鼻腔鼻窦内单发类圆形或不规则性高密度肿块,部分区域可见低密度影,其周边出现完整骨性包壳,呈膨胀性生长,周边组织受压变形但分界清楚。结论：螺旋ＣＴ扫描是诊断鼻腔鼻窦骨化纤维瘤最常用和有价值的影像检查手段。     

A forgotten foreign body in the frontal sinus

A 46-year-old female patient presented with a discharging wound over the nasal bridge, near the medial end of the right eyebrow of 2 months duration. She did not give any history of trauma or surgery in the past. Wound exploration showed a glass piece in the floor of the right frontal sinus. After showing the glass piece, patient remembered road traffic accident she had at the age of 18 years. Patient was asymptomatic for 28 years. To our knowledge, this is the longest retained case of asymptomatic foreign body in the frontal sinus reported in the world literature. Case report and a review of literature concerning foreign body in the frontal sinus are presented.     

Verrucous carcinoma of the frontal sinus: A case report and review of the literature

Carcinoma of the frontal sinus is rare. Treatment is controversial, and prognosis is poor, The etiology is unknown, although some risk factors for other paranasal sinus carcinomas have been identified. A 70-year-old male presented with proptosis and x-ray findings consistent with a mucocele of the frontal sinus. At operation the patient was felt to have a cholesteatoma. Pathologic diagnosis was verrucous carcinoma of the frontal sinus. The case is discussed and the literature is reviewed.     

Efficacy of the Modified Endoscopic Frontal Sinus Surgery for Recurrent Chronic Frontal Sinusitis

To modify the endoscopic frontal sinus surgery and improve the therapeutic effect of recurrent chronic frontal sinusitis (RCFS). Eighty-five patients with RCFS were divided into two groups. Endoscopic frontal sinus surgery through an approach of Frontomaxillary Process-Agger Nasi, a modified Draf IIb procedure, was carried out in 51 patients (Group A), and conservative medication was applied in 34 patients as control (Group B). The therapeutic effect was prospectively evaluated with statistically validated measures of sinusitis-specific quality of life, sino-nasal outcome test-20 questionnaire (SNOT-20). Compared with pre-treatment, the average total score of SNOT-20 in RCFS patients was significantly decreased at the time of 6, 12 months after modified endoscopic frontal sinus surgery and medical treatments (p < 0.05). However, the total score of SNOT20 was significantly lower in group A than group B at the same period of the follow-up after treatments (p < 0.05). The overall efficacy evaluated by patients’ self showed that the rate of “much improved” and “improved” was respectively 68.6 and 17.6 % in group A, and significantly better than group B (p < 0.001). Furthermore, the frontal sinus patency rate in group A was 85 %, and significantly higher than group B (p < 0.001). Endoscopic frontal sinus surgery through an approach of Frontomaxillary Process-Agger Nasi, a modified Draf IIb procedure, is an effective procedure to treat the RCFS.     

CT and MRI features in Bipolaris fungal sinusitis

Bipolaris is an increasingly recognized cause of fungal sinusitis. Reports of imaging features are sparse. Our purpose was to review the imaging features in patients with Bipolaris fungal sinusitis. A review of our data showed seven patients with culture‐proven Bipolaris fungal sinusitis. Computed tomography of the paranasal sinuses in all the patients and MRI in five patients were analysed for the location, nature, extent of the disease and density/signal characteristics on CT/MRI. The sphenoid and posterior ethmoid sinuses were most often involved (six of seven), followed by the anterior ethmoid sinus (five of seven), frontal sinus (four of seven) and maxillary sinus (three of seven) involvement. Five of seven cases had bilateral disease. Secretions were seen to fill the sinus and were expansile in nature in six of seven cases. Bony erosion was noted in all the patients. Air–fluid levels and bony sclerosis were rarely seen. Computed tomography showed central hyperdensity in all the cases. In the corresponding MR images (n = 5), the sinus contents appeared hyperintense on T1‐weighted images and hypointense on T2‐weighted images. Extension into the nasal cavity was found in six of seven cases. Five of seven cases had intracranial (extradural) spread. Intraorbital extension was seen in three of seven cases, with associated optic nerve compression in two. All the patients responded to surgical debridement, and systemic antifungal therapy was not required. Bipolaris fungal sinusitis typically presents with an allergic fungal sinusitis picture with expansile sinus opacification and bony erosions. There is central hyperdensity on CT scan, which appears hyperintense on T1‐weighted and hypointense on T2‐weighted MR images.     

嗅神经母细胞瘤的CT应用评价

目的 探讨ＣＴ在 嗅神经母细胞瘤诊断,分期与疗后随访中的价值。方法 对１３例经病理证实的嗅神经母细胞瘤ＣＴ资料结合文献进行回顾性分析。结果 １３例中,１１例行术前ＣＴ检查,按Ｋａｄｌｉｓｈ标准分期：Ｂ期４例,Ｃ期７例。全组病灶平扫呈软组织密度,３例内部要见钙化灶,４例平扫＋增强病残暴球均匀明显强化;６便直接增强扫描病灶密度明显高于周转软组织。４例行术后复查者,在３个月至２年内均有复发。病灶侵犯鼻腔     

Inferior Turbinate osteoma — rare cause of nasal obstruction

Osteomas are common benign tumors of the paranasal sinus, with a predilection for the frontal sinus. We report a rare case of inferior turbinate osteoma in a 54 year old lady. The osteoma was resected completely by endoscopic sinus surgery and the patient was relieved of symptoms.     

Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIII: Meningiomas

Twelve cases of meningiomas involving the nasal cavity and paranasal sinuses are reported. Meningiomas only rarely involve the upper respiratory tract; these 12 cases were found among the 566,000 surgical pathology cases that have been studied in this laboratory. In this series, five meningiomas probably arose in the cranial cavity and secondarily extended into the nasal cavity and paranasal sinuses. Because radiographs demonstrated hyperostosis or bone destruction, three other tumors could have involved the cranial cavity, but this was never proven. In two other cases, the meningiomas appeared to involve only extracranial tissues and thus probably were primary extracranial lesions. (The data available in two other cases were insufficient to assess the possibility of intracranial involvement). These patients clinically had nonspecific signs and symptoms similar to those produced by other types of neoplasms growing in the upper respiratory tract. The tumor involved the sphenoid area in seven cases, the nasal cavity in six, the maxilla in five, the ethmoid sinus in four, and the frontal sinus in one. The diagnosis was first established when biopsy material was examined, although in several cases the presence of meningioma was first suggested on radiographic examination. Treatment depended upon the size and location of the tumor. In some cases, surgical resection appeared to control the lesion. These tumors did not appear to respond well to radiotherapy. The histologic differential diagnosis is discussed.     

Combined Aplasia of Frontal and Sphenoid Sinuses with Hypoplasia of Ethmoid and Maxillary Sinuses

The paranasal sinuses are air filled spaces. The process of development of paranasal sinuses begins prenatally. The agenesis of paranasal sinuses in an unusual clinical condition and that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses is extremely rare along with hypoplasia of other sinuses. Agenesis of sphenoid sinus is also rare in incidence. We report a case of a 54 years old female, who presented with complains of persistent headache with nasal blockage and found to have combined aplasia of bilateral frontal and sphenoid sinus with hypoplasia of bilateral maxillary and ethmoid sinus with unusual age of presentation. The findings were confirmed on non-contrast computed tomography scan of paranasal sinuses.     

Management protocols of Allergic Fungal Sinusitis

Controversy surrounds the appropriate surgical approach and the appropriate medical therapy for Allergic Fungal Sinusitis. The present prospective study aims to assess the impact of these factors on the treatment outcome of Allergic Fungal Sinusitis. In the present study 34 cases with AFS were randomized into one of 3 methods of post operative therapy i.e. systemic itraconazole (group A, n=11), topical steroids (group B, n=12) and nasal alkaline douches only (group C, n=11). Outcome was assessed at 6 months post-operative by the Kupferberg grading system for assessment of nasal and sinus mucosa. Grade ‘3’ mucosal disease was defined as recurrence. Complete pre-operative opacification of sphenoid and frontal sinus was a predictor of poorer outcome. Postoperative systemic itraconazole therapy demonstrated a trend towards a better outcome but was not statistically significant. Larger trials are required to conclusively evaluate the merit of various post-operative treatment regimens for AFS.