The exact percentage
of persons developing frontal sinusitis is not known although roughly
3-6% of children with pansinusitis will have frontal disease.
Frontal sinus is a
pyramidal shaped structure with vertical and horizontal segments
in the frontal bone. It borders the anterior cranial fossa and the
roof of the orbit.
The frontal sinus,
not present at birth, develops from either the frontal recess or
from anterior ethmoidal cells. It is radiographically visible by
seven years of age and reaches full size by adulthood.
Frontal sinusitis stems
from blockage of the nasofrontal duct ostium. Mechanical obstruction
and local mucosal edema lead to symptoms of frontal headache, fever,
rhinorrhea and cough. Frontal sinusitis is a very serious condition
requiring aggressive medical management.
Acute sinusitis in
adults has been tied to non-typable H. influenza, S. pneumonia,
S. pyogenes, alpha hemolytic streptococcus, and neisseria. S. pneumonia,
B. catarrhalis, and H. influenza account for acute disease in children.
Medical treatment consists
of analgesics, topical decongestants, and antibiotics. Persistent
frontal pain, periorbital edema, and forehead edema indicate disease
progression mandating surgical intervention.
Though endoscopic enlargement
of the frontal sinus ostium is beginning to gain attention, endoscopic
frontal sinus approaches have not gained wide popularity in the
pediatric population. The removal of agar nasi cells and entrance
through the floor of the frontal sinus with silastic stenting provides
drainage without disfiguring skin incisions.
Complications of frontal
sinusitis include recurrent sinusitis, mucocele, pyocele, orbital
sequelae, and intracranial spread of infection. Intracranial spread
of infection leads to meningitis, subdural empyema, brain abscess,
and cavernous sinus thrombosis. The consortium of frontal osteomyelitis
and subperiosteal abscess has been termed Pott's Puffy Tumor. Signs
and symptoms include a soft and fluctuant forehead mass, headache,
photophobia and fever.
require evaluation by the neurosurgical service with a combined
surgical approach to remove infected tissues. The length of antibiotic
therapy is dictated by the seriousness of disease.