Frontoethmoidal
sinusitis
If treated promptly with antibiotics and
topical nasal decongestants this type of sinus infection is unlikely to be a
long-term problem. If allowed to persist chronic frontoethmoiditis gives rise to
mucopurulent catarrh, frontal headaches, pressure feeling between the eyes,
nasal obstruction and hyposmia. Nasal endoscopy will confirm pus issuing from
the middle meatus. The ethmoid sinuses can only be properly assessed
radiologically by CT scanning, including coronal as well as axial sections. If
frontoethmoiditis fails to settle with conservative treatment then frontal
drainage may be required. The frontal sinus is entered through its anterior wall
via a small incision below the medial end of the eyebrow. After pus is drained a
small sialastic tube is left in the wound to allow regular irrigation of the
sinus. Where the disease is more extensive intranasal endoscopic ethmoidectomy
may be required. Removal of the uncinate process provides access to the
osteomeatal complex, so that if necessary the entire ethmoid complex can be
cleared and the frontonasal recess opened. If endoscopic nasal equipment is not
available then the tried and tested radical external ethmoidectomy through a
Lynch—Howarth incision provides excellent access to the frontal, ethmoid and
sphenoid sinuses. Chronic frontal sinus disease can be cleared by means of an
osteoplastic flap procedure. Using an X-ray template, the boundaries of the
frontal sinus are marked out and a fissure burr is used to cut
Complications
of frontoethmoiditis
These are potentially extremely serious. Quite
often infection can spread to involve the other sinuses because of the close
proximity of their ostia. Orbital cellulitis is not an uncommon complication (Fig.
39.23) and may progress to an extra periosteal abscess, which typically
displaces the eyeball down forwards and laterally. If unrecognised and untreated
this can lead to blindness. Treatment consists of intravenous broad-spectrum
antibiotic and an orbital decompression by an external approach. Orbital
cellulitis may progress to cavernous sinus thrombosis and septicaemia. Spread of
infection by direct bone penetration or via the diploic veins can give rise to
either extradural, subdural or frontal lobe abscess formation.
Frontoethmoidal
sinusitis — summary
•
Chronic frontal sinusitis may require obliterative osteoplastic flap
procedure
•
Orbital complications may threaten sight
• Intracranial complications include cerebral abscess and cavernous sinus
thrombosis