FRONTAL SINUSITIS

From Big Medical Encyclopedia

FRONTYT (Latin frons, frontis a forehead + - itis) — an inflammation of a mucous membrane of a frontal sinus.

Distinguish acute and chronic F. Ostry F. often arises during acute cold (see Rhinitis), at flu (see), measles (see) and others inf. diseases. Quite often the injury of a frontal bone, especially in the field of the frontonasal channel (see Paranasal sinuses) happens its reason. Owing to bystry edematization of a mucous membrane and obturation of the frontonasal channel there can be in a short space of time a deep ulceration of a mucous membrane of a frontal sinus. Transition of an acute frontal sinusitis to chronic is promoted by insufficient drainage of a frontal sinus that is more often caused by a hypertrophy of the front end of average - a nasal sink and a strong curvature of a partition of a nose (see the Nose). Decrease in body resistance is important. Chronic F., as a rule, is followed by damage of bosoms of a sievebone, preferential front, and also can proceed in a combination with an inflammation of other subordinate clauses (okolonosovy, T.) bosoms of a nose.

Wedge, picture acute F. begins with emergence of pain in a forehead, edges amplifies with a pressure (or percussion) on a front wall of a frontal sinus, and even more during the pressing on an upper wall of an eye-socket in the field of a medial corner of an eye. In addition, the headache of various localization, eye pain, a photophobia, dacryagogue is noted. Pains are accompanied difficulty of nasal breath and usually plentiful (in the beginning serous, then serous and purulent) by inodorous allocations from the corresponding half of a nose.

Body temperature increases to 38 — 39 ° in the beginning, then gradually falls, but can long remain subfebrile. Puffiness of soft tissues, especially at a medial corner of an eye is quite often observed. At a front rinoskopiya (see) under an average sink the mucopurulent discharge is found. At the closed empyema of a frontal sinus the discharge can be absent. The front end of an average sink is thickened and edematous, the mucous membrane is hyperemic.

Subjective symptoms chronic F. are expressed much more weakly, than acute. The headache has the aching or pressing character, is more often localized in the affected bosom; in case of the complicated outflow of exudate and supertension in a bosom pain amplifies, and during the pressing on an upper wall of an eye-socket and at its internal corner happens sharp. Pain in the field of a frontal sinus amplifies at alcohol intake, smoking, overfatigue, etc. Allocations from a nose are especially plentiful in the mornings and often have off-flavor; quite often during sleep allocations flow down in a nasopharynx and in the mornings the patient expectorates a large number of a phlegm. At a rinoskopiya the discharge from a frontal sinus best of all can be found in the morning upon transition of the patient to vertical position since the pus which accumulated in a night in a bosom flows down in the average nasal course easier. A mucous membrane of the front end of an average nasal sink at chronic F. polipozno it is changed, hyperemic, edematous. During an aggravation of the frontal sinusitis, at a delay separated at a medial corner of an eye moderate puffiness of soft tissues is quite often noted, and at a palpation — morbidity.

From complications F. transition of inflammatory process to a front bone wall of a frontal sinus with the subsequent its necrosis, sequestration and burrowing is sometimes observed. Less often process extends through the lower wall of a frontal sinus, causing a purulent inflammation of tissues of eye-socket, or through a back (cerebral) wall, leading in this case to intracranial complications — extradural abscess, abscess of a brain (see the Brain, diseases; Pachymeningitis) or to purulent meningitis (see). Development of sepsis is possible (see).

Diagnosis F. establish rather easily on subjective and objective signs. Rentgenol. the research of frontal sinuses (see Paranasal sinuses) allows to judge their form, availability in them of exudate, puffiness of a mucous membrane. From additional methods of a research sometimes use a diafanoskopiya (see), sounding of the frontonasal channel. In the absence of any changes in a nasal cavity there can be a need for differential diagnosis with neuralgia of the first branch of a trifacial (see). Unlike F. pain at neuralgia comes suddenly in the form of attacks; the greatest morbidity at a palpation is noted in the place of an exit of the first branch of a trifacial. Pain at F., as a rule, amplifies at a physical tension, cough, sneezing. Off-flavor of allocations specifies on hron. process.

Treatment of a frontal sinusitis in most cases conservative. Its main objective — to provide free outflow separated from a bosom that is reached by greasings repeated during the day, an instillation' or spraying in the field of the average nasal course of 2 — 3% of solution of cocaine of a hydrochloride from 0,1% solution of Adrenalinum hydrochloricum or from 2 — 3% solution of ephedrine of a hydrochloride. At introduction of drops to a nose the head of the patient is thrown back back and turned towards defeat.

At acute F. in the first days of a disease appoint a bed rest; for removal of pains give acetilsalicylic to - that with caffeine or analginum with caffeine. Several days later after the beginning of a disease on condition of sufficient passability of the frontonasal channel use the warming physiotherapeutic procedures. At hard proceeding acute F. use antibiotics after definition of sensitivity of microflora to them.

At chronic F. for reduction of hypostasis of a mucous membrane of the average nasal course it is greased (1 time in 2 — 3 days) by 2 — 5% with solution of silver nitrate. At secondary neuralgia of branches of a trifacial apply UVCh or dnedinamichesky currents, galvanization by means of Bergonye's mask, an electrophoresis of 2% of solution of potassium iodide, 2 — 5% of solution of novocaine. D'Arsonval's currents.

In modern a wedge, practice at purulent (both acute, and chronic) F. widely apply trepanopunktsyyu a frontal sinus through a front bone wall. In the next 5 — 10 days a bosom 2 times a day antiseptic solution with introduction of 10 — 15 mg 11 roteo wash out through a cannula l of itichesky enzyme (trypsin, chymotrypsin, hi-moisin) in 2 — 3 ml of isotonic solution of sodium chloride with addition of the corresponding antibiotic. In the absence of effect of washings the obstacle for outflow of contents of a bosom is eliminated by a resection of the hypertrophied front end of an average nasal sink (see the Turbinotomy) or resections of the bent partition of a nose, and also careful sounding of the frontonasal channel.

At inefficiency of the listed medical actions and the complicated current F. resort to opening of a frontal sinus, removal patholologically of the changed fabrics and to creation of a resistant anastomosis between a frontal sinus and a nasal cavity. As the absolute indication to this operation serve intra orbital or intracranial complications, osteomyelitis of a frontal bone, and also a septic state. Operational treatment can be also shown in those cases chronic F., when in the field of the average nasal course polyps are repeatedly formed, the severe headache breaking efficiency of the patient is observed.

Radical operation on a frontal sinus can be carried out by means of intranasal and vneno-sovy methods. Modern modification of intranasal opening of a frontal sinus was offered by Halle (J. Halle); D. M. Rutenburg and F. S. Bokstein brought a number of the receptions facilitating its performance and allowing to keep a mucous membrane of a nasal cavity in a technique of operation. Operation is technically difficult, and at nek-ry options of a structure of a frontal sinus is impracticable. There is a lot of methods of extra nasal radical operation of a frontal sinus. All it aim at formation of the wide message of a frontal sinus with a nasal cavity. The frontal sinus is opened at the same time through a front (front) or lower (orbital) wall, and at big bosoms — through both of these walls. The resection only of a front wall by methods K of an unt (1894) and Golovin (1897) in modern a wedge, practice is not applied. Jansen and Ritter (And. Jansen, G. Ritter, 1893 — 1896) offered a resection of an orbital wall of a frontal sinus, and Ridel (V. Riedel, 1898) — simultaneous full removal of front and orbital walls. At operation on Killian's way front and orbital walls are excised short — the put bone and periosteal bridge preventing for falling of soft tissues of a forehead remains horizontally races.

Majority sovr. specialists delete only the lower (orbital) bone wall in combination with removal of cells of front bosoms of a sievebone, and if necessary destroy and scrape out also cells of back bosoms. One of the main difficulties, to-rye meet at operation, creation of a reliable anastomosis between a frontal sinus and a nasal cavity is, without to-rogo it is impossible to count on permanent elimination of inflammatory process.


Considering that chronic F. it is, as a rule, combined with damage of bosoms of a sievebone, A. F. Ivanov developed the modification of operation called by it lobnoreshetchaty trepanation, at a cut the maximum shchazheniye of not changed or a little changed mucous membrane is reached.

In the postoperative period (see) the frontal sinus is washed out through a cannula and periodically grease an educated anastomosis of 2 — 5% with solution of silver nitrate.

The forecast at a frontal sinusitis in cases of an uncomplicated current, at timely and correct treatment of l and hop r and yatny.

Bibliography: Ivanov A. F, About lobno

trellised trepanation, Ezhemy. ears., throats, and nose. Bol., t. 6, No. 1, page 1, No. 2, page 62, 1911; The Multivolume guide to otorhinolaryngology, under the editorship of A. G. Likhachev, t. 4, page 7, M., 1963; Sweat

of p I. I. Troakar for a puncture of a frontal sinus, in book: Izbr. vopr. a wedge, from-rinolar., under the editorship of B. S. Preobrazhensky, page 107, M., 1959; H a j e k M. Pathologie und Therapie der entzimdlichen Erkrankungen der Nebenhohlen der Nase, Lpz. — Wien, 1926; T e of of and with - about 1 J. e t A u b of at M. Les maladies des cavites annexes des fosses nasales, P., 1964.

A. G. Likhachev.

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