Edema in the frontal sinus
Evaluation of the x-ray of the frontal sinuses of the nose: signs of inflammation
Of all accessory nostrils the largest variety in size and shapediffer frontal sinuses. They begin to develop only in the first years of life and reach a certain value already in the period of cessation of body growth. There are cases of complete absence of both frontal sinuses; The frontal sinus can be developed only on one side. The bottom of the frontal sinus takes part in the formation of the orbital wall of the orbit.
Usually it forms front third of the upper wall and extends from the trochlear fossa to the incisurasupraorbitalis. Behind the bottom of the sinus ends at the border of the anterior and middle third of the orbit roof. In some cases, the frontal sinus can reach a significant value, so that its bottom forms almost the entire roof of the eye socket, reaching out to the zygomatic process of the frontal bone, and posteriorly to the small wing of the sphenoid bone.
With such a significant frontal sinus development sometimes separated from the optic nerve canalonly a thin bone plate. The walls of the frontal sinus have a different thickness, but the thinnest lower wall that takes part in the formation of the orbital wall of the orbit is thinner. The septum separating one frontal sinus from another is not always located in the middle plane, sometimes one sinus passes to the other side and, thus, the opposite eye socket can be involved in the pathological process.
As already mentioned, it is better total frontal sinuses are obtained on the roentgenogram when studying in the projections of the third and fourth schemes of VG Ginzburg. The idea of the depth of the frontal sinuses can also be obtained on an oblique picture of the skull.
In acute catarrhal frontal sinusitis clinical symptoms are manifested in pain in the foreheadroot of the nose, lachrymation and pain when pressing on the upper inner wall of the orbit. Often also more or less pronounced edema of the upper eyelid. X-ray symptoms in acute frontal sinus inflammation may be mild. At the same time, there is a slight decrease in transparency and a concealment of the corresponding sinus.
In bilateral disease it is sometimes difficult to draw a definite conclusion. When studying the radiographs, attention should be paid to the condition of the nasal concha, which can be increased on the side of the affected sinus due to edema and hyperemia of them, which is accompanied by a decrease in the transparency of the nasal passage.
Especially dangerous festering frontal sinusitis in the sense of transition of the process to the contents of the eye socket. In this case, there is rarely a disease of the frontal sinus alone, usually a latticed cavity is involved in the process. Radiographically, a rather pronounced darkening of the frontal sinus and cells of the latticed cavity is observed.
In chronic inflammation of the frontal sinus there is polyposis degeneration of the mucosashell. On the radiographs there is a non-uniform darkening. This symptom, according to VG Ginzburg, is not very convincing, since in the multi-chambered frontal sinus and the uneven depth of each chamber on the roentgenogram, uneven transparency of the sinus is also noted. With full polyposis degeneration of the mucosa, a diffuse rather intense darkening is noted, although it is never as intense as with a purulent sinusitis.
With prolonged chronic inflammation The periosteum and bone are sometimes involved in the process. On radiographs, this manifests itself in a more intensive darkening of the marginal zone. It is not easy in such cases to carry out differential diagnosis with a syphilitic process, which can also give an intense band of edge dimming.
Prolonged chronic frontal sinusitis can lead to resorptive processes. Every case of chronic sinusitis ends with bone resorption, especially in the thinnest places or where the vessels pass. In the frontal sinus, the most vulnerable point in this respect is the sinus floor, which forms the upper-inner wall of the orbit. If there is a bone defect, a fistula can form. When the fistula opens before septum orbitae, the diagnosis is not particularly difficult.
It should be borne in mind that when breakout of pus from fistula Transparency of the frontalsinuses, which sometimes leads to an erroneous conclusion. To avoid this, it is necessary to pay attention to the contours of the sinus. The streakiness of the contours and the compaction of the border zone provide in such cases a correct diagnosis.