Frontal sinus malignancies

Frontal sinus malignancies are rare tumors of the paranasal sinuses. They often present as late-stage diseases and are most often caused by secondary involvement from an inferiorly based paranasal sinus tumor. Primary frontal sinus malignancies represent 1% of paranasal sinus malignancies and are most commonly adenocarcinomas. A high index of suspicion must be maintained to diagnose these malignancies; advanced imaging is used for this purpose. These tumors rarely respond to nonsurgical therapy, and primary resection is the treatment method of choice.     

Limited CT scanning techniques of the paranasal sinuses

Computerized tomographic (CT) imaging provides detailed information on the paranasal sinuses and is now well established as an alternative to standard radiographs. The planning and safety of surgery to the paranasal sinuses is greatly improved by CT imaging. We describe a new CT protocol comprising a limited coronal and axial scan series, based on our experience with the previously described 'CT-Mini-series'.     

Benign nasal schwannoma.

Nerve sheath tumours of the head and neck region mainly involve the eighth cranial nerve with only 4 per cent occurring in the paranasal sinuses. Only 32 cases of benign schwannomas occurring in the paranasal sinuses have been reported. We present a further case, review the current literature, and discuss the clinical details and specific histological features.     

Thermographic and rhinorheographic parallels in clinical diagnosis of inflammatory diseases of paranasal sinuses

One hundred and thirty patients with inflammatory diseases of paranasal sinuses were examined using highly sensitive methods--thermography and rhinorheography. It is concluded that the combined application of these methods is highly efficient for early detection of inflammatory diseases of paranasal sinuses.     

History of rhinology: anatomy of the paranasal sinuses

The knowledge of the presence of the paranasal sinuses dates back to early mankind as well as attempts to treat their diseases. Apart from the sensory function of smell, however, little has been known about the function and especially the anatomy of the system till the end of the last century. Until the late middle ages sometimes obscure functions were attributed to the sinuses, like holding the "grease" for the movement of the eyeballs, or allowing the brain to "drain its bad spirits" to the outer world, bringing about names like "la cloaca del cerebro" by Sansovino in the 16th century. The old French expression of "rhume de cerveau" demonstrates these ideas having passed on into modern man's vocabulary. During the 17th and 18th century discussion was mainly about the function or purpose of the sinuses, and the rare anatomical studies were meant to support or prove one or the other "philosophies". Today's knowledge of the anatomy to a great deal goes back to the basic work of Emil Zuckerkandl of Austria, who starting from the 1870s described in subtile studies the anatomical and development details of the nose and the sinuses, opening an entire new field for scientific and surgical approach to the area. The decades around the turn of the century boost with studies on sectional and surgical anatomy, creating the specialty of rhinology and leading into our modern concepts of diagnosis and therapy of nasal and paranasal sinus diseases. Names like Grünwald, Onodi, Hajek and many others are closely linked with this creative period. Radiology, especially the development of conventional and computed tomography during the last two decades helped to "rediscover" the fascinating details and complex connections of the paranasal sinus system. Together with the development of the operating microscope and the endoscope this helped to open new ways for functional approaches and less radical microsurgery.     

Difficulties of diagnostic and therapeutic policy in association of purulent intracranial processes with inflammatory ENT diseases

The paper analyses treatment given to 125 patients with purulent intracranial processes combining with inflammatory diseases of the paranasal sinuses, ear and other diseases. Otorhinogenic genesis was diagnosed in 45.6% cases. Often, affections of the paranasal sinuses and ear mask the true reason of the intracranial pathology, making problems for diagnosis and choice of therapeutic policy. Differential-diagnostic features of the diseases which may complicate with purulent intracranial processes as well as urgent therapeutic measures are described.     

Sinusitis and carotid artery stroke

The relationship between sinusitis and ischemic stroke is unexplored. The anatomic proximity between the paranasal sinuses and the internal carotid artery suggests that inflammation of the sinuses could easily extend to the intracranial vasculature. We report 4 patients with acute ischemic stroke and extensive disease of the paranasal sinuses. All patients had large vessel stroke involving the internal carotid artery territory. All patients had extensive disease of the sphenoid and other sinuses. The sinus disease was demonstrated by magnetic resonance imaging. These case report observations suggest a relationship between inflammation of the paranasal sinuses, particularly sphenoid sinusitis, and ischemic stroke.     

Detection of sinus-induced orbital mycosis with standardized orbital ultrasonography: a case report

Fungal involvement of the paranasal sinuses is frequently observed in the immunocompromised host, and it can become life-threatening if it is not diagnosed. Although the definitive diagnosis is made by tissue biopsy and culture, imaging is of vital importance in the clinical workup and in planning treatment. We present a case of fulminant ethmoidal sinusitis caused by Aspergillus flavus with orbital involvement in an immunocompromised patient. Standard computed tomography of the paranasal sinuses was complemented by the use of standardized orbital ultrasonography, which was able to identify the intraorbital extension. We discuss the role of standardized orbital ultrasonography as a complementary imaging modality in the diagnosis of fungal sinusitis and in the assessment of local extension. To the best of our knowledge, the role of SOU in diagnosing an orbital extension of a fungal infection of the paranasal sinuses has not been previously discussed in the literature.     

Hyperaeration of the frontal sinus

The nasal cavity and paranasal sinuses constitute an anatomical and functional unit. Paranasal sinuses communicate with the nasal cavities, which are covered by the same mucosa, via small openings and narrow ducts that allow both aeration and sinus drainage. Anatomical variations of the paranasal sinuses and nasal cavity are important in sinus diseases. Computerized tomography (CT) plays a critical role in evaluation of the patients with paranasal sinus pathology and variations. A 38-year-old man admitted to our clinic with headache and postnasal dripping for 1 year. His paranasal CT scanning revealed that there is hyperaeration of the frontal sinus which is in continuity with the sphenoid sinus. Hyperaeration of the sinuses may be kept in mind in a patient complaining of headache.     

Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses

A prospective analysis of 666 patients was performed to examine the prevalence of radiologic abnormalities of the paranasal sinuses in asymptomatic adults. The initial sample group included 1000 patients who were referred for cranial computed tomographic scans for conditions such as head injuries and seizures. Patients in whom there was clinical suspicion of sinus disease were excluded from the study. A questionnaire was completed by each patient and cranial computed tomography, including magnetic resonance imaging of the paranasal sinuses, was performed. Abnormality of one or more of the paranasal sinuses was reported in 42.5% of scans. Mucosal thickening in the ethmoid sinus was the abnormality most often identified. The high frequency of reported radiologic abnormalities in asymptomatic patients highlights the importance of correlation with the clinical presentation when interpreting computed tomographic scans of the paranasal sinuses.     

Possibilities of treating nasal turbinates in the framework of endonasal microsurgery

Pathologic alterations of the turbinates are common in infectious diseases of the nose and paranasal sinuses. Over 300 patients were treated for paranasal sinuses disease from 1986 to 1989 by endonasal microsurgery. One-third of the patients were found intraoperatively to have alterations of the middle and inferior turbinate causing obstruction and functional disorders of the nose and sinuses. Our concept comprises a step-by-step microsurgical approach to the turbinates. The technique and the results are presented.     

Fungus balls of the paranasal sinuses: a review

In the past 30 years, thanks in part to the advance of both endoscopic technology and imaging possibilities, the classification, diagnosis, and management of rhinosinusitis caused by fungi have been better defined. These are basically divided into invasive and non-invasive forms based on the presence or absence of microscopic evidence of fungal hyphae within the tissues. Among the non-invasive fungal sinus diseases, fungus ball has been increasingly reported and large published series have allowed better characterization of the disease and the treatment strategies. Fungus ball of the paranasal sinuses is defined as the non-invasive accumulation of dense fungal concrements in sinusal cavities, most often the maxillary sinus. To describe this entity, confusing or misleading terms such as mycetoma, aspergilloma or aspergillosis would be best avoided. Clinical presentation is non-specific and the diagnosis is usually suspected on imaging studies. Surgical treatment, usually through an endonasal endoscopic approach, is curative. In this paper, we review the clinical, radiological, and pathological presentation of the fungus ball of the paranasal sinuses as well as the surgical management with emphasis on the transnasal endoscopic approach.     

Magnetic resonance imaging patterns of the development of the sphenoid sinus: a review of 800 patients.

Accurate knowledge of age-related development and pneumatisation of the paranasal sinuses has become an important issue in diagnosing paranasal sinus diseases in infants and young adults. Magnetic resonance imaging (MRI) has the potential to assess bone marrow conversion and pneumatisation of the paranasal sinuses. We retrospectively reviewed 800 children aged 0-14 years undergoing brain MRI for various indications. T1-weighted sagittal and T2-weighted axial scans were evaluated for bone marrow conversion and development of pneumatisation of the sphenoid sinus. The sphenoid sinus had a uniformly low signal intensity on T1-weighted images in all children less than four months old. Signal intensity began to change to hyperintense marrow at the age of four months. Onset of pneumatisation was observed in 19% at the age of 12-15 months. Pneumatisation was complete in all patients older than 10 years. In conclusion, these data can be used as baseline standards of normal age-related development of the sphenoid sinus and can be of great value for the diagnostic and therapeutic management of pathologic conditions of the child's sphenoid sinus and its surrounds.     

Magnetic resonance imaging of the paranasal sinuses: incidental abnormalities and their relationship to patient symptoms.

OBJECTIVES: Magnetic resonance imaging (MRI) is able to demonstrate a wide range of abnormalities in the paranasal sinuses, which are often reported as incidental findings on scans performed for indications other than the evaluation of paranasal sinus pathology. However, the clinical significance of these findings remains undefined. We present a prospective study that determines the prevalence of abnormalities in the paranasal sinuses in a population undergoing MRI scans for suspected intracranial disease. These findings are correlated with clinical data pertaining to nasal and sinus symptoms. STUDY DESIGN: Prospective, cross-sectional study. METHODS: Patients undergoing MRI scans for suspected intracranial pathology were asked to complete a questionnaire pertaining to symptoms of nasal/sinus pathology. The T2-weighted scans of 86 patients (mean age = 51 years) were then reviewed for evidence of paranasal sinus pathology using a standardized method for evaluation and reporting of results. These results were then correlated with those obtained from the patient questionnaire. RESULTS: Radiologic abnormalities were found in the paranasal sinuses of 33 (38%) patients. Abnormalities were most commonly seen in the ethmoid sinuses (44.8%) followed by the maxillary (38%), sphenoid (14%), and frontal (3%) sinuses. Analysis of the clinical data revealed no significant relationship between the presence of clinical symptoms of nasal and sinus pathology and abnormalities on MRI scan. CONCLUSION: The assessment of inflammatory sinus pathology remains controversial. Based on the results of this study, incidental abnormalities of the paranasal sinuses detected on MRI scan do not appear to be related to clinical symptoms.     

Sinusitis with contiguous abscess involvement of the clivus and petrous apices. Case report.

A wide spectrum of diseases may involve the clivus, such as primary neoplasms, metastatic disease, and inflammatory, vascular, hematopoietic, and infectious processes. Of these, osteomyelitis of the skull base and/or clival-petrous abscess are unusual, but may occur as a result of contiguous spread from the paranasal sinuses, namely, the posterior ethmoid and sphenoid, as was demonstrated by this patient. In this case report we discuss the pertinent anatomy, imaging studies, pathogenesis, and medical and surgical management of this case.     

Sinusitis as an emergency.

The manifestations of diseases of the paranasal sinuses that may present as acute emergency situations and the more common complications of these diseases are briefly reviewed with suggestions for initial evaluation therapy.     

Ventilation and drug delivery to the paranasal sinuses: studies in a nasal cast using pulsating airflow

BACKGROUND: Although there is a high incidence of nasal disorders including chronic sinusitis, there is limited success in the topical drug delivery to the nose and the paranasal sinuses. This is caused by the nose being an efficient filter for inhaled aerosol particles and the paranasal sinuses being virtually non ventilated METHOD: The objective of this study was to visualize the efficiency of sinus ventilation in a nasal cast using dynamic 81mKr-gas imaging in combination with pulsating airflows. Furthermore, the efficiency of the deposition of radiolabelled aerosol was assessed. RESULTS: Pulsation increased ventilation efficiency of the sinuses more than fivefold and aerosol deposition efficiency more than twentyfold, compared to delivery without pulsation. Furthermore pulsation increased aerosol deposition in the nasal airways by a factor of three. Using pulsating airflow Kr-gas ventilation and aerosol deposition efficiencies increased with increasing sinus volume. Pulsating airflow resulted in a deposition of up to 8% of the nebulized drug within the sinuses compared to 0.2% without pulsation. CONCLUSIONS: The study demonstrates the high efficiency of a pulsating airflow in paranasal sinus ventilation and aerosolized drug delivery. This proves that topical drug delivery to the paranasal sinuses in relevant quantities is possible.     

Clinical significance of incidental magnetic resonance image abnormalities in mastoid cavity and middle ear in children

OBJECTIVE: Magnetic resonance imaging of the head may reveal incidental findings in paranasal sinuses. The purpose of this study was to discover whether similar changes could be identified in the mastoid cavity and middle ear as well. METHODS: A group of 50 children undergoing magnetic resonance imaging of the head for suspected intracranial pathology were prospectively gathered. Their parents completed a questionnaire concerning each child's medical history connected with acute otitis media. Otoradiologists evaluated the pictures for mastoid cavity and middle ear and paranasal sinus abnormalities. RESULTS: In six (12%) children, magnetic resonance imaging detected abnormalities resembling acute inflammatory changes, although none had had acute otitis media during the preceding last 3 months. Abnormalities detected in the paranasal sinuses were not correlated with abnormalities in the mastoid cavity and middle ear. CONCLUSIONS: High signal intensity in magnetic resonance images from the mastoid cavity and middle ear may be incidental and without any clinical significance. These findings must be interpreted together with knowledge of the child's medical condition and clinical examination of the ears.     

Cause-effect relationship in combination of purulent intracranial processes with ENT diseases

36 case histories were analyzed. The patients had purulent intracranial processes combined with inflammation of the paranasal sinuses and ear. Cause-effect relationships in development of the above diseases are considered. It was found that paranasal and auricular inflammation combined with purulent intracranial processes do not cause always the latter. The ENT diseases may develop not only in parallel with purulent intracranial pathology, but also as its complication. It is shown that post-mortem hyperdiagnosis exists of ethmoidal and sphenoid inflammation as a cause of purulent intracranial processes.     

Microscope and endoscope-assisted surgery of inflammatory diseases of the paranasal sinuses. Value of the Messerklinger infundibulotomy

Insights into the importance of the infundibulum of the anterior ethmoid bone in the etiology and pathogenesis of chronic paranasal sinusitis, based above all on the studies of Messerklinger, have resulted in a fundamental change in our concept of therapy: the main objective of any treatment must be the restoration of ventilation and drainage of the paranasal sinuses in the region of the semilunar hiatus. Its function in the healing of paranasal sinus diseases parallels the significance of the Eustachian tube for the healing of inflammatory lesions of the middle ear. In many cases, the objective is attained by infundibulotomy, using Messerklinger's technique. Our technique differs from that described by Messerklinger and Wigand: we use the surgical microscope and a self-retaining nasal speculum. It is thus possible to operate with both hands, as in microsurgery of the ear and the larynx. Moreover, the operations can be taught and learned via an observation tube. Since the introduction of this technique which can be extended at any time to complete endonasal surgery of the maxillary, ethmoid and sphenoid sinuses, extranasal operations on the paranasal sinuses have become exceedingly rare. The results have been checked in a newly established paranasal sinus clinic.