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Complications of Frontal Sinusitis

  • Shiayin F. Yang
  • Chirag Rajan Patel
  • James A. Stankiewicz
Chapter

Abstract

Complications of frontal sinusitis occur when infection extends outside of the frontal sinus and into the surrounding tissue. The most commonly affected structures are the skull, brain, and orbit, which surround the frontal sinus. The anatomic proximity of the frontal sinus to these structures allows the spread of infection by both direct extension and retrograde thrombophlebitis of shared venous drainage pathways. Presenting signs and symptoms vary and depend on the location of the complication. Symptoms can range from headache, fever, and forehead or orbital swelling to decreased visual acuity and focal neurologic deficits. Work-up includes thorough history and physical examination including nasal endoscopy. Imaging with contrast is important for diagnosis and surgical planning. There should be a low threshold to obtain imaging of the orbit or brain if history or physical exam suggests involvement of these structures. MRI is the best imaging modality to evaluate intracranial pathology. Neurosurgery and ophthalmology consults are warranted in patients with intracranial and orbital complications, respectively. Prompt treatment is vital as complications of frontal sinusitis can have significant morbidity and mortality. Treatment is often a combination of culture-directed intravenous antibiotics and surgical intervention addressing the affected sinuses and associated complications.

Keywords

Frontal sinus complications Orbital complications Intracranial complications Osteomyelitis Pott’s puffy tumor Chandler’s classification Subdural empyema Intraparenchymal abscess Venous sinus thrombosis 

References

  1. 1.
    Dhepnorrarat RC, Subramaniam S, Sethi DS. Endoscopic surgery for frontoethmoidal mucoceles: a 15-year experience. Otolaryngol Head Neck Surg. 2012;47:345–35.CrossRefGoogle Scholar
  2. 2.
    Har-El G. Endoscopic management of 108 sinus mucoceles. Laryngoscope. 2001;111(12):2131–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Stankiewicz JA, Park AA, Newell DJ. Complications of sinusitis. Curr Opin Otolaryngol. 1996;4:17–20.CrossRefGoogle Scholar
  4. 4.
    Lee TJ, Li SP, Fu CH, et al. Extensive paranasal sinus mucoceles: a 15-year review of 82 cases. Am J Otolaryngol. 2009;30(4):234–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Goldberg AN, Oroszlan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngol Clin N Am. 2001;34:211–25.CrossRefGoogle Scholar
  6. 6.
    Karaman E, Hacizade Y, Isildak H, et al. Pott’s puffy tumor. J Craniofac Surg. 2008;19:1694–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Akiyama K, Karaki M, Mori N. Evaluation of adult Pott’s puffy tumor: our five cases and 27 literature cases. Laryngoscope. 2012;122:2382–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Ketenci I, Unlu Y, Tucer B, et al. The Pott’s puffy tumor: a dangerous sign for intracranial complications. Eur Arch Otorhinolaryngol. 2011;268:1755–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Jackson K, Baker SR. Clinical implications of orbital cellulitis. Laryngoscope. 1986;96(5):568–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Schramm VL, Myers EN, Kennerdell JS. Orbital complications of acute sinusitis: evaluation, management, and outcome. Otolaryngology. 1978;86(2):ORL221–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80:1414.CrossRefPubMedGoogle Scholar
  12. 12.
    Botting AM, McIntosh D, Mahadevan M. Paediatric pre- and post-septal peri-orbital infections are different diseases: a retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol. 2007;72:377–83.CrossRefGoogle Scholar
  13. 13.
    Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol. 2006;70:1853–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Blumfield E, Misra M. Pott’s puffy tumor, intracranial, and orbital complications as the initial presentation of sinusitis in healthy adolescents, a case series. Emerg Radiol. 2011;18(3):203–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Herrmann BW, Chung JC, Eisenbeis JF, et al. Intracranial complications of pediatric frontal rhinosinusitis. Am J Rhinol. 2006;c20(3):320–4.CrossRefGoogle Scholar
  16. 16.
    Morgan PR, Morrison WV. Complications of frontal and ethmoid sinusitis. Laryngoscope. 1980;90:661–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Germiller JA, Monin DL, Sparano AM, et al. Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg. 2006;132(9):969–76.CrossRefPubMedGoogle Scholar
  18. 18.
    Clayman GL, Adams GL, Paugh DR, et al. Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope. 1991;101:234–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Weing BL, Goldstein MN, Abramson AL. Frontal sinusitis and its intracranial complications. Int J Pediatr Otorhinolaryngol. 1983;5:285.CrossRefGoogle Scholar
  20. 20.
    Hicks CW, Wever JG, Reid JR, et al. Identifying and managing intracranial complication of sinusitis in children: a retrospective series. Pediatr Infect Dis J. 2011;30(3):222–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Giannoni CM, Stewart MG, Alford EL. Intracranial complications of sinusitis. Laryngoscope. 1997;107:863–7.CrossRefPubMedGoogle Scholar
  22. 22.
    DelGaudio JM, Evans SH, Sobol SE, et al. Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010;31(1):25–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Mafee MF, Tran BH, Chapa AR. Imaging of rhinosinusitis and its complications: plain film, CT, and MRI. Clin Rev Allergy Immunol. 2006;30(3):165–86.CrossRefPubMedGoogle Scholar
  24. 24.
    Singh B, Dellen Van J, Ramjettan S, et al. Sinogenic intracranial complications. J Laryngol Otol. 1995;109:945.PubMedGoogle Scholar
  25. 25.
    Brook I, Friedman EM, Rodriguez WJ, et al. Complications of sinusitis in children. Pediatrics. 1980;66:568–72.PubMedGoogle Scholar
  26. 26.
    Remmler D, Boles R. Intracranial complications of frontal sinusitis. Laryngoscope. 1980;90:1814–24.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Shiayin F. Yang
    • 1
  • Chirag Rajan Patel
    • 1
  • James A. Stankiewicz
    • 1
  1. 1.Department of Otolaryngology – Head and Neck SurgeryLoyola University Medical CenterMaywoodUSA

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