All about frontal sinuses and their treatment. Paranasal sinuses Frontal sinuses where they are

The frontal sinuses are integral part systems of the paranasal air cavities and perform a number of functions related to the protection of the body, the organization of normal breathing and speech. They are located in close proximity to the meninges, so their diseases can threaten with serious complications.

The structure and functions of the front cameras

The frontal sinuses, like the maxillary sinuses, in their location belong to the anterior voids, which communicate with the nose through a long and tortuous middle frontonasal meatus. This anatomy predetermines much more frequent infectious diseases of the anterior cavities.

The frontal chambers are a paired organ, which is located in the thickness of the frontal bone.

Their size and configuration different people can vary markedly, but on average each frontal sinus has a volume of about 4.7 cubic centimeters. Most often, it looks like a triangle lined inside with a mucous membrane, with four walls:

• Orbital (lower) - the thinnest, most of its area is the upper wall of the orbit, with the exception of the edge adjacent to the ethmoid bone. On it there is an anastomosis of the canal 10-15 mm long and up to 4 mm in diameter, which opens into the nasal cavity.
• Facial (front) - the thickest, represented by the outer part of the frontal bone, having a thickness of 5 to 8 mm.
• Brain (posterior) - consists of a thin but strong compact bone, bordering on the anterior cranial fossa and the dura mater.
• The inner (medial) divides the two chambers, in its upper part it can deviate to the left or right.

A newborn child does not have frontal sinuses, they begin to form only at 3-4 years of age and finally develop after puberty.

They appear at the upper inner corner of the orbit, consist of cells of the ethmoid bone, the nasal mucosa grows into them. In parallel with this, the process of resorption of the spongy bone, which is located between the inner and outer plates of the frontal bone, occurs. In the vacated space, frontal voids are formed, which sometimes in the lumen may have niches, bays and internal partitions. Blood supply comes from the ophthalmic and maxillary arteries, innervation - from the ophthalmic nerve.

The cavities are most often not the same, since the bone plate separating them is usually not located exactly in the center, sometimes it may be absent, then the person has one large cavity. In rare cases, the dividing bone is located not vertically, but horizontally, and the chambers are located one over the other. According to various studies, 5-15% of people generally have no frontal sinuses.

The main functions of the front cameras today are:

• protection of the brain from injury and hypothermia (act as a "buffer");
• participation in the formation of sounds, increased voice resonance;
• regulation of the pressure level in the nasal passages;
• warming and humidifying the inhaled air;
• reduction in the mass of the skull in the process of its growth.

Acute frontal sinusitis: etiology and symptoms

Since the paranasal compartments are covered with mucous membranes inside, the main disease is the inflammatory process in them. If we are talking about the frontal sinuses, then their inflammation is called frontal sinusitis. Inflammation wears a wave-like course, can quickly move from an acute stage to a chronic one and then proceed asymptomatically or pass without treatment.

The main cause of the disease is usually an inflammatory process in the upper respiratory tract, from where it passes to the frontal compartments in an ascending way.

With untimely or insufficient treatment due to a change in the pH of the secretion, the immune barrier from the ciliated epithelium weakens, and the pathogenic microflora penetrates into the chambers, covering the mucous membranes. Many doctors are of the opinion that drops with a vasoconstrictive effect that are used for a long time can disrupt the acid-base balance of mucus.

The main prerequisites for the development of the disease:

• long runny nose;
• poorly cured or transferred "on the legs" colds;
• hypothermia of the body, in particular, the legs;
• stress;
• trauma to the anterior part of the head.

The inflammatory process is accompanied by hyperemia and swelling of the mucous membranes, resulting in increased secretion while hindering the outflow of fluid. The supply of oxygen is sharply limited or completely stopped. Gradually increasing internal pressure causes severe pain in the forehead area.

Symptoms of the disease are divided into general and local, which together give a characteristic clinical picture acute frontitis.

Local signs:

• complete absence or severe difficulty in nasal breathing;
• throbbing and pressing pain above the eyebrows, which is aggravated by tilting the head forward or pressing a hand on the forehead;
• copious purulent discharge from the nasal passages (one or both);
• secretion flowing into the oropharynx;
• swelling may spread to the upper eyelid or angle of the orbit of the eye.

Simultaneously with the local ones, general signs are also growing, indicating intoxication of the body:

• temperature rise to 37.5-39 degrees, chills are possible;
• blood reaction (increased ESR, leukocytosis);
• muscle weakness;
• diffuse headaches;
• hyperemia of the skin in the projection of the affected organ;
• aches in bones and joints;
• fast fatigue and drowsiness.

Diagnosis and conservative treatment of frontal sinusitis

To study the clinical picture and make the correct diagnosis, you need to contact an otolaryngologist. The ENT doctor interviews the patient, after which he performs a rhinoscopy - a visual examination of the nasal cavities and paranasal sinuses in order to determine the location of the discharge of pus and the condition of the mucous membranes. Palpation and percussion (tapping) help to reveal the soreness of the anterior wall of the forehead and the corner of the eye on the affected side.

To confirm the alleged diagnosis, the patient donates blood for analysis, in addition, radiography (in the lateral and direct projection) or computed tomography is performed.

These methods best allow to determine the lesion, the amount of accumulated pus, the depth and shape of the chambers, the presence of additional partitions in them. The secreted mucus passes microbiological research to determine the pathogen and prescribe adequate treatment.

In most cases, conservative treatment is used, including anti-inflammatory therapy, opening of the fronto-nasal canal and restoration of cavity drainage. In this case, such medicines are used:

• broad-spectrum antibiotics in the presence of high temperature (Klacid, Avelox, Augmentin) with subsequent correction if necessary;
• analgesics (ascofen, paracetamol);
• antihistamines (claritin, suprastin);
• drugs to reduce the secretion of mucous membranes by high adrenalization (sanorin, nazivin, galazolin, sinupret, naphthyzinum);
• means for strengthening the walls of blood vessels (vitamin C, rutin, ascorutin).

In the absence of severe intoxication of the body, physiotherapy is highly effective (laser therapy, UHF, compresses). The sinus catheter YAMIK is also used, which allows washing the chambers with medicinal substances.

In case of ineffectiveness of conservative treatment (preservation of high temperature, headache, impaired nasal breathing, secretion of thick mucus or pus) for three days, as well as when detected by X-ray or computed tomography pus in the cavities, trepanopuncture of the sinus is prescribed. Today it is very effective technique giving a high level of recovery. This is a fairly simple operation that is well tolerated by patients, regardless of their age.

The essence of the operation is to penetrate under the bone tissue mechanically in order to:

• removal of purulent contents;
• restoration of drainage through the connecting channel;
• reduction of swelling of the membranes;
• suppression of pathogens that caused inflammation.

For the implementation of surgical intervention, a manual drill no longer than 10 mm long with a penetration depth limiter and a set of plastic or metal cannulas for washing is used.

When determining the optimal entry point, special calculations are used, which are confirmed by x-rays in different projections.

Trepanopuncture is performed in the inpatient department of the hospital, while local infiltration anesthesia (ledocaine, novocaine) is mainly used. With the help of a drill, a hole is made in the thick anterior wall of the bone, through the opening of which the entire organ is probed. A special cannula is inserted and fixed into the hole, through which drugs are injected over the next few days. Besides, antiseptic solutions the sinus and the connecting canal are washed, followed by the evacuation of blood clots, polyps, cystic formations, granulation tissue.

Less often, otolaryngologists use the method of punching a bone with a chisel. The resulting vibration is contraindicated in:

• meningitis;
• abscesses;
• osteomyelitis of the cranial bones;
• thrombophlebitis.

There is also a method of puncturing the lower wall of the cavity with a sharpened special needle, which is much thinner than the anterior one, and is widely used in practice. At the same time, a thin subclavian catheter is inserted into the lumen of the needle, which is fixed on the skin after removal of the needle and serves as a passage for washing and delivering drugs into the chamber. However, this operation is considered less preferable and more difficult due to the presence of the orbit in the immediate vicinity.

Due to the location near the lesion of the meninges, delay in seeking medical attention or attempts at self-treatment can lead to serious consequences, even death. Complications of frontal sinusitis can be diseases such as purulent inflammation of the orbit, meningitis, osteomyelitis of the cranial bones, etc.

Folk methods of treatment and prevention of frontal sinusitis

Alternative recipes are mainly aimed at reducing edema and removing mucus, their use must be agreed with the attending physician:

• Boil bay leaves (5-10 pieces) in a saucepan, transfer to a small fire and breathe, covered with a towel, for five minutes. Repeat for several days in a row, this contributes to the outflow of pus.
• A teaspoon of salt, a little baking soda and three drops of tea tree oil are mixed in a glass of warm water. Clear the nose, then, tilting the head forward, using a small syringe under pressure, pour the solution into one nostril so that it flows out of the other. Repeat 2-3 times a day, then apply drops for a cold.

Prevention of the disease is as follows:

• timely treatment of rhinitis and sinusitis, if a runny nose has not passed in three days, you should contact the clinic;
• strengthening immunity through hardening and exercise;
• vitamin therapy in autumn and spring;
• control of the cleanliness of the nose and free nasal breathing.

Sources: medscape.com,

Inflammation of the frontal sinuses - acute or chronic frontal sinusitis, manifested by inflammation of the mucous membrane of the frontal sinus with the formation of serous or purulent exudate.

Swelling of the mucous membrane leads to a violation of the outflow of the contents of the sinus, the gradual formation of a fluid level, tissue edema.

Frontitis requires an early start of treatment, due to high risk the development of complications due to the spread of infection as a result of a breakthrough of the abscess. To the most dangerous complications include meningitis, purulent fusion of the bones of the facial skull, rhinogenic sepsis.

Paranasal paranasal sinuses- these are air cavities (sinuses) that are located in the bones of the facial skull. The paranasal sinuses (sinuses) are air cavities located in the bones of the skull. Paranasal sinuses maintain shape and density facial bones and reduce their weight.

There are the following sinuses:

• frontal (frontal);
• maxillary (maxillary);
• wedge-shaped;
• lattice labyrinth.

Diagnosis of inflammation of the frontal sinuses includes an examination by a general practitioner or therapist to identify common symptoms diseases, ENT examination, laboratory tests and x-rays of the sinuses.

Acute frontal sinusitis can be suspected by diagnostic signs:

• purulent discharge along the lateral wall of the nasal passage from the middle turbinate;
• thickening of the mucous membrane;
• bright hyperemia.

In addition, pain is determined on palpation and percussion in the region of the anterior wall of the frontal sinus, the medial angle of the eye on the side of the lesion.

X-ray examination is performed in frontal and lateral projections, allows you to assess the volume and depth of the sinus, to identify the presence of a pathological process in it. The causes of the development of inflammation of the frontal sinuses are the penetration of inflammatory exudate from the nasal cavity with a severe cold.

Frontitis are of bacterial, viral, fungal etiology, are complications of influenza, SARS. The frontal sinus becomes inflamed with certain childhood infections, such as severe diphtheria or scarlet fever.

Symptoms of inflammation of the frontal sinuses are divided into local and general manifestations.

Locals include:

• nasal congestion;
• serous or purulent discharge;
• pain in the affected area (forehead, bridge of the nose);
• swelling around the eyes;
• swelling of the bridge of the nose;
• pain when bending forward.

General symptoms:

• heat;
• chills;
• headache;
• loss of appetite;
• decrease in working capacity;
• fever.

When the infection spreads to the bones of the ethmoid labyrinth, ethmoiditis develops, a similar course of the disease in a patient indicates an aggressive flora, requires an emergency start of antibiotic therapy, possibly in a hospital setting. The defeat of the bones of the orbit leads to the penetration of bacteria to the outer meninges.

Treatment of drug-induced inflammation of the frontal sinuses includes the use of drugs:

• vasoconstrictor (sprays, drops) to facilitate breathing;
• solutions for washing the sinuses (in the form of a spray with sea ​​water or saline)
• antihistamines (especially if an allergic history is burdened, to relieve swelling);
• mucolytic (stimulation of the outflow of sinus contents, restoration of mucociliary clearance);
• antibiotics, antimycotics, antivirals (depending on the flora).

Treatment begins only after an examination by a specialist doctor, if there is evidence, the doctor will give a referral to physiotherapy procedures, some of which can be performed independently at home.

Warming up and UHF procedures are carried out only with a catarrhal course of the disease or a stage after a puncture, emptying the sinus from purulent contents.

After a puncture, physiotherapy is carried out only under the supervision of a specialist to exclude a re-exacerbation of the disease. In the chronic course of frontal sinusitis, physiotherapy reduces atrophic changes in the mucous membrane, destructive changes in the bone structures of the paranasal sinuses. With allergic frontal sinusitis against the background of a bacterial infection, warming up can aggravate the clinical picture due to increased edema.

Folk recipes for the treatment of inflammation of the frontal sinuses include wet steam inhalations, which can only be carried out in the initial phases of the development of the disease. When pus appears in the sinus, heating leads to stimulation of the growth of the bacterial flora and the development of life-threatening complications.

In the absence of contraindications, warming up can be performed:

• potato(mash boiled potatoes in a saucepan, holding your head over the steam under a terry towel, take deep breaths for 7-10 minutes);
• herbal(a decoction of chamomile, sage, mint herbs is boiled over high heat, after which inhalations are carried out for 15 minutes);
• garlic(5 cloves of garlic are crushed, a glass of boiling water is added, after 5 minutes they breathe over the resulting steam for up to 6 minutes);
• menthol(asterisk balm, eucalyptus oil pour a glass of boiling water, breathe for 10 to 20 minutes).

Before starting the preparation of the mixture, you should view photos and videos of the inhalation process to avoid the risk of overheating or burns. The face should not be brought close to the source of steam, not lower than 15 cm.

Home treatments for inflammation of the frontal sinuses:

• washing(self-washing is carried out without pressure using a conventional pipette or a soft spray bottle. Three full pipettes in each nostril over the sink 3-4 times a day will speed up the outflow of exudate);
• inhalation (folk recipes quite effective, you can diversify inhalations using essential oils and specialized products that are sold in pharmacies);
• warming up(local exposure through the skin with boiled eggs or hot salt bags increases the blood supply to the sinus);
• massage(to enhance blood flow and lymph flow, it is performed with boiled warm eggs, special massagers or fingertips in the form of light pinching and patting).

Prevention of inflammation of the frontal sinuses is aimed at early treatment of the common cold and acute rhinitis, especially if the disease is severe. With severe nasal congestion, you can not blow your nose with great effort, since the resulting turbulent mucus flows are thrown into the paranasal sinuses and the mouth of the Eustachian tube.

Prevention includes hardening, means to increase the body's immune properties. Taking eleutherococcus or echinacea, as one of the most affordable means, significantly increases a person's resistance to infection. After suffering a frontal sinus, you should drink a course of a vitamin-mineral complex to restore health.

The frontal sinuses are paranasal sinuses located in the frontal bone behind the superciliary arches. Their lower walls are represented by the anterior walls of the orbits, the rear walls protect the sinuses from the frontal lobes of the brain. The cavities are lined with mucous membranes from the inside. It is worth noting that such cavities are absent in young children, they begin to develop only by the age of 8, completing their formation by the age of 18-21. The height of the frontal sinuses in an adult reaches 30 mm, width 25 mm, depth 20-25 mm, volume does not exceed 8 ml.

The absence of the frontal sinuses is not a pathology, it is diagnosed in 5% of the population. The frontal sinuses are necessary to ensure the normal functioning of the body. Due to the fact that these cavities are absent in newborns and young children, doctors conclude that one of the main functions of such formations is to reduce the mass of the skull. In addition, the sinuses provide:

• protection of the brain from shock;
• in the cavities, the air comes into contact with the mucous membranes, while being moistened and warmed;
• participate in the formation of the human voice, enhance the response.

Do not forget that the frontal sinuses have unlimited access to the mucosa, respectively, these formations can be quite vulnerable. The possibility of developing inflammation that flares up against the background of the penetration of a virus or infection into the human body is not excluded. The determining factor for the onset of inflammation is the weakening of the immune system and its inability to destroy the virus.

Features of the structure of the frontal sinus

The frontal sinus is located in the frontal bone behind the superciliary arches. The cavities are presented in the form of paired formations having the shape of a pyramid with three faces. The septum of the frontal sinuses separates the right and left sinuses. In most cases, they are asymmetrical, this is due to the fact that the bone septum has an inclination in any direction. Their inner surface is lined with mucous membranes.

The cavities consist of the following walls:

• facial;
• back;
• bottom;
• intersinus.

The base of the sinus is the upper wall of the orbit. The front wall of the sinus is the most dense, it can be felt, it is located 1-2 cm above the eyebrows. The back and bottom walls are aligned at a right angle. It is worth remembering that deviations in the structure of the frontal sinuses are not uncommon, for example, in some patients, the internal septum is not located vertically, but horizontally. The cavities in this case are one above the other.

Diseases of the frontal sinuses

It is worth remembering that the frontal sinuses are hollow formations, the surface of which is lined with mucous membranes. Such formations are often affected by bacteria and viruses. Representatives of pathogenic microorganisms enter the human body with inhaled air, and if the immune system a person has failed, the following diseases occur:

• frontitis;
• sinus cysts.

With frontal inflammation, inflammation forms on the mucous membranes, after which it penetrates through the nasolacrimal canal to the frontal sinuses. As a result, edema occurs, the excretory channel is blocked, as a result, the outflow of mucous contents from the sinus is limited or blocked. It should be remembered that the treatment of such a disease should be comprehensive, it is impossible to cure frontal sinusitis without antibiotics.

The cyst is a rounded container small size having thin walls. It can have different sizes. The causes of cysts are similar to the prerequisites for the occurrence of frontal sinusitis. During the inflammatory process, fluid is constantly produced (possibly in an increased volume), and its outflow does not occur. Therefore, due to the accumulation of mucus, a cyst is formed. Medical treatment in this case it is ineffective, operation is shown.

Causes of inflammation

The bones of the skull, which have a porous structure, are lined with mucous membranes in order to provide a protective function of the body, which consists in preventing the penetration of various particles and microorganisms that can become a source of pathology. But it is worth remembering that with a decrease in immunity pathogenic microorganisms can easily enter the human body.

Due to the fact that the frontal sinuses are connected to the nasopharynx, with the development of a strong pathology, pathogens penetrate into them and become the cause of development - inflammation of all the paranasal sinuses, including the frontal ones. Hypothermia, violation of blowing technique, lack of proper treatment underlying disease, interruption antibiotic therapy, non-compliance with the treatment regimen.

Therapy Method

Drug treatment of frontal sinusitis does not differ from the treatment of inflammation of the paranasal sinuses, therefore it is carried out in the same directions:

1. Application antibacterial drugs macrolides, cephalosporins, penicillins.
2. The use of anti-inflammatory drugs.
3. Taking antiallergic drugs to relieve swelling.
4. Irrigation of the nasal cavity with saline solution.
5. The use of nasal drops and sprays of various effects.
6. Physiotherapy.
7. The use of immunostimulating drugs.

It should be remembered that only a doctor should prescribe treatment. Self-treatment is unacceptable, it can lead to a number of irreversible consequences.

Consequences and complications

Among possible complications inflammation of the frontal sinus of the nose is distinguished by:

1. Difficulty breathing, which leads to chronic hypoxia. This condition negatively affects the state of all organs and systems of the body. It is worth remembering that this complication is especially dangerous for children - it can cause developmental delays.
2. Respiratory failure during sleep. Against this background, there is constant drowsiness.
3. The development of blindness is not ruled out. On the background chronic inflammation develops photophobia, decreased visual acuity.
4. The development of inflammatory processes in the ENT organs.
5. Meningitis.
6. Encephalitis.
7. brain abscess.

At the very beginning of the inflammatory process, it is extremely important to consult a doctor and unquestioningly follow all his recommendations and instructions. It is worth remembering that only the correct and timely treatment will defeat the pathology and cope with the symptoms of inflammation. In the absence of therapy, the consequences may be irreversible.

Mucocele(pyocele) of the frontal sinus - a cystic expansion of the frontal sinus resulting from its stretching with accumulated serous fluid (mucocele) or pus (pyocele). Mucocele of the frontal sinus is accompanied by gradually increasing pain in the forehead, above the orbit and around the eye; the appearance of a protrusion in the inner corner of the eye; exophthalmos and downward displacement of the eyeball; impaired visual acuity and color perception; lacrimation and diplopia. In order to diagnose the mucocele of the frontal sinus, rhinoscopy, radiography, ultrasound, CT, MRI and diaphanoscopy, diagnostic puncture and probing of the frontal sinus are used. All patients with frontal sinus mucocele are subject to surgical treatment.

General information

The frontal sinus is located in the medial part of the frontal bone behind the superciliary arches. Its lower wall is at the same time upper wall orbit, the posterior wall separates the frontal sinus from the brain. The right and left frontal sinuses are located side by side and separated from each other by a thin septum. Through the fronto-nasal canal, the frontal sinus is connected to the middle nasal passage of the nasal cavity. Inside the frontal sinus is lined with a mucous membrane, the cells of which produce a special fluid. The outflow of this fluid is carried out through the fronto-nasal canal. Violation of the outflow leads to the accumulation of fluid in the sinus cavity and the formation of a mucocele of the frontal sinus. With suppuration of the accumulated secret, they speak of a pyocele.

Mucocele of the frontal sinus is most often observed at school age. Due to the fact that the formation of the frontal sinuses begins after the birth of a child and ends at the age of 6-7 years, in children preschool age Frontal sinus mucocele does not occur. The slow growth of the mucocele of the frontal sinus leads to the fact that the first clinical symptoms diseases may appear several years after the onset pathological changes in the frontal cavity. In otolaryngology, a case is known when a frontal sinus mucocele was diagnosed in an adult patient 15 years after the nose injury that provoked its development.

Causes of frontal sinus mucocele

The development of the mucocele of the frontal sinus is associated with complete obstruction or partial violation patency of the fronto-nasal canal. Curvature of the nasal septum, foreign bodies of the nose, exostoses and tumors, trauma to the nose, resulting in periostitis, can lead to the appearance of a mucocele of the frontal sinus. The fronto-nasal canal can be blocked by adhesions and scars resulting from sinusitis of the frontal sinus.

Infection of the fluid of the mucocele of the frontal sinus with the occurrence of a pyocele can occur when the infection spreads from the nasal cavity, as well as by the hematogenous or lymphogenous route. In this case, the source of infection is primarily infectious and inflammatory diseases of the nasopharynx: rhinitis, sinusitis, pharyngitis, tonsillitis, chronic tonsillitis, laryngitis.

Frontal sinus mucocele symptoms

Mucocele of the frontal sinus is characterized by a long asymptomatic course. Before the appearance of the first clinical signs Mucocele can exist for 1-2 years or longer. Mucocele of the frontal sinus begins to manifest itself with a gradually increasing headache in the frontal region. Then pain joins above the orbit and around the eyeball, a rounded protrusion appears in the inner corner of the eye. Pressing on this bulge is usually painless and produces a characteristic crackling or cracking sound. Strong pressure can cause the formation of a fistula, through which a viscous mucous (with mucocele) or purulent (with pyocele) liquid begins to come out.

Over time, with the mucocele of the frontal sinus, the lower wall of the frontal sinus occurs, and therefore there is a displacement of the eyeball down and out. Often there is double vision (diplopia), a violation of the perception of colors, a decrease in visual acuity. With compression of the lacrimal ducts in patients with mucocele of the frontal sinus, lacrimation is observed.

The accumulation of a large amount of fluid in the mucocele of the frontal sinus can cause its breakthrough with the formation of a fistula in one of the walls of the frontal sinus. The outflow of pus through the fistula into structures adjacent to the frontal sinus leads to the development purulent complications.

Complications of frontal sinus mucocele

The complications arising from the mucocele of the frontal sinus are associated with the suppuration of its contents and the spread of the purulent process to the anatomical structures adjacent to the sinus. Most often, a breakthrough of pus occurs through the lower wall of the frontal sinus. The introduction of a purulent infection into the cavity of the orbit can lead to the development of panophthalmitis, endophthalmitis and phlegmon of the orbit. In rare cases of frontal sinus mucocele, a fistula has formed in the posterior wall of the sinus, resulting in meningitis.

Diagnostics of the mucocele of the frontal sinus

Frontal sinus mucocele is diagnosed by an otolaryngologist. If there are complications from the eye, an ophthalmologist's consultation is necessary, and if meningitis is suspected, a neurologist should be consulted. Diagnosis of the mucocele of the frontal sinus is based on the patient's complaints, his examination, rhinoscopy and examination of the paranasal sinuses. Rhinoscopy in patients with frontal sinus mucocele may not reveal any pathological changes. Sometimes during rhinoscopy in the region of the middle nasal passage a small smooth protrusion is visualized.

An X-ray examination with a mucocele of the frontal sinus determines an increase in the size of the sinus, stretching of its bottom, and a decrease in transparency. Possible protrusion of the septum between the frontal sinuses in a healthy direction. Discontinuity in the contours of the frontal sinus may indicate the presence of a fistula. A more accurate and informative study is CT of the frontal sinus. Ultrasound and frontotomy can be used) is performed after a skin incision along the length of the eyebrow. Then the sinus cavity is cleaned of mucus and pus, drainage is established. In adults and older children, surgery can be performed under local anesthesia. Postoperative drainage of the sinus is carried out for a long time (within 2-3 weeks) until scarring. This is necessary to create a stable communication between the frontal sinus and the nasal cavity.

Simultaneously with the surgical treatment, drug treatment of the mucocele of the frontal sinus is carried out. The patient is prescribed antibiotics, anti-inflammatory and decongestants.

Forecast and prevention of frontal sinus mucocele

With timely surgical treatment, the frontal sinus mucocele has a favorable prognosis. The development of complications worsens the prognosis. Prevention of the mucocele of the frontal sinus consists in effective treatment infectious and inflammatory diseases of the nasopharynx, prevention of injury to the nose and hypothermia, correction of the nasal septum in case of its curvature, removal of tumors and foreign bodies of the nose.

Frontit(frontal sinusitis) - inflammation of the frontal paranasal sinus. For the past decade, sinusitis (inflammation of the sinuses) has been considered one of the most common diseases in the world. Today they affect about 10-15% of the population. One tenth of patients with sinusitis is diagnosed with acute or chronic frontal sinusitis. Over the past 5 years, the incidence of sinusitis has tripled and continues to increase. In Russia, the number of people suffering from manifestations of frontal sinusitis reaches 1 million people a year. Among those hospitalized, there are more males, and among those who are treated on an outpatient basis, women are more common.

Anatomy of the frontal sinuses

Adjacent to the nasal cavity are the paranasal sinuses:

• two maxillary (maxillary)
• two frontal
• two lattice labyrinths
• one wedge-shaped (main)

• humidify and warm the inhaled air
• make the bones of the skull lighter
• isolate the roots of teeth and eyeballs from temperature fluctuations
• act as a buffer for facial injuries
• act as a vocal resonator

There are four walls of the frontal sinus:

1. lower (orbital)- the thinnest
2. anterior- strongest and thickest
3. rear- separates the sinus from the cranial fossa
4. internal, she is a partition- divides the cavity into right and left halves

The frontal sinus (like the rest of the sinuses) is lined from the inside with a mucous membrane, which is a continuation of the nasal mucosa. But it is much thinner and does not contain cavernous tissue. The sinus is connected to the nasal cavity by a narrow convoluted tubule, which opens with a small opening in the anterior part of the nasal passage.

Causes of frontitis

Infection

The most common causative agents of viral frontal sinusitis are:

• adenoviruses
• coronaviruses
• rhinoviruses
• respiratory syncytial viruses

• Streptococcus pneumoniae
• haemophilus influenzae
• Pyogenes
• Staphylococcus aureus

The cause of inflammation of the frontal sinus can also be a fungal infection. In some cases, infection with bacteria and fungi can occur through the blood (hematogenous). This happens if there are foci of infection in the human body: carious teeth, abscesses.

Allergy

nasal polyps

Injuries of the nose and paranasal sinuses

Deviated septum and turbinate hypertrophy

Foreign bodies

Symptoms and signs of frontitis

Acute sinusitis

• sharp pains in the forehead, aggravated by tapping or pressing on the anterior wall of the frontal sinus (forehead area above the bridge of the nose)
• discomfort in the area of ​​​​the inner corner of the eye
• eye pain, lacrimation, photophobia
• nasal congestion and difficulty in breathing
• copious discharge from the nose, at first they are transparent, mucous, over time they can turn into purulent
• with right-sided or left-sided frontal discharge from the corresponding half of the nose;
• swelling of the face, especially at the inner corner of the eye
• may change the color of the skin over the sinus
• an increase in temperature to 39 °, but in some cases the temperature may be low;
• feeling of weakness, weakness as a result of general intoxication of the body
• ENT examination reveals mucopurulent discharge, redness and swelling of the nasal mucosa

Pain in acute frontal sinusitis is cyclical. During periods when the outflow of mucus from the frontal sinus is disturbed, the pain intensifies. Such stagnation causes deterioration in the morning hours. The pain becomes severe, gives to the eye, temple, and the corresponding half of the head. After the sinus is freed from the contents, the pain subsides.

Chronic sinusitis

Symptoms of chronic frontal sinusitis are somewhat less pronounced than acute:

• aching or pressing pain in the frontal sinus, which is aggravated by tapping
• sharp pain in the inner corner of the eye when pressed
• copious purulent discharge from the nose in the morning, having an unpleasant odor
• a large amount of purulent sputum in the morning

Diagnosis of frontal sinusitis

Frontite types

Classification according to the form of the course of the inflammatory process

Frontitis treatment

Folk methods of treatment of frontal sinusitis

There is an indicator that this method of treatment suits you. If, after the procedure, tapping on the central region of the forehead does not cause pain, this means that the frontal sinus has been freed from mucous contents and microorganisms.

There is only one limitation: it must be remembered that in no case should you warm your forehead with purulent frontal sinusitis. This can lead to the spread of pus into the surrounding tissues.

Inhalations for the treatment of frontal sinusitis

1. Boil potatoes in their skins, drain the water. Mash the potatoes and breathe its steam over the pan. For greater effect, cover your head with a terry towel.
2. Brew chamomile flowers, add a few drops of tea tree or eucalyptus essential oil to the hot broth. Breathe the vapor over the mixture.
3. Bring one and a half liters of water to a boil, throw 7-10 bay leaves there. Make a small fire and breathe steam over the pan for five minutes.
4. Grind 4 cloves of garlic, add half a glass of apple cider vinegar and half a glass of boiling water. Breathe over the solution for 15 minutes, 3 times a day, covered with a towel. Add hot water as it cools.
5. Boil water in a saucepan and add a small amount of Asterisk balm or dry menthol to it. Remove from heat and breathe in the steam for five minutes, covering your head with a towel.

Solutions for washing the nose with frontal sinusitis

Using a small rubber bulb or a special bottle, the liquid is poured under pressure into one nostril. The flushing solution, together with the mucus from the sinuses, is poured out of the other nostril. After this procedure, there is significant relief.

1. Grind one medium onion on a grater or in a blender and pour a glass of boiling water. When the mixture has cooled, dilute a teaspoon of honey in it. Strain and rinse the nose with this composition three to four times a day. This tool kills bacteria, helps relieve inflammation and increase local immunity. Not suitable for frontitis caused by allergic reaction.


2. In one glass of warm boiled water, you need to dissolve one teaspoon of salt, a pinch of soda and three drops of tea tree oil. Use for washing 3-4 times a day. This composition disinfects the nasal cavity, has a strong antiviral and anti-inflammatory effect.


3. Prepare a decoction of chamomile flowers, it is a strong antiseptic and antimicrobial agent. Cool, strain and use for washing every two hours.


4. Dissolve in half a liter of warm boiled water a tablespoon of an alcohol solution of chlorophyllipt. It has an antibacterial effect and fights even those microorganisms that have developed resistance to antibiotics. The solution is used for washing 3-4 times a day.


5. It is also effective to rinse the nose with saline solution. You can make it yourself (one teaspoon of salt per liter of boiled water) or buy it ready-made in a pharmacy. Such a tool cleans well from mucus, microbes and allergens, without irritating the mucous membrane.

Drops for the treatment of frontitis

1. Take a black radish, peel and grate. Squeeze out the juice and use for instillation 3-4 times a day. The juice contains a large amount of essential oils and helps to cleanse the sinuses of mucus.


2. Thoroughly wash the cyclamen tubers, chop them and squeeze the juice. It must be diluted with water (one part juice to four parts water) and strain well. At night, instill two drops in each nostril and massage the sinuses well. Cyclamen is considered a remedy that helps to defeat the disease at any stage.


3. Pick large leaves of Kalanchoe and hold for three days in the refrigerator. After that, grind them and squeeze out the juice with gauze. Dilute the liquid with water twice and instill into the nose 2-3 times a day. Kalanchoe contributes to the liquefaction of the contents of the nose and its rapid removal.


4. Put a small piece of propolis in the freezer for several hours. After that, it is quickly crushed in a mortar and poured with refined vegetable oil. Let it brew for three days in a dark place. The tool helps fight inflammation and soothes the nasal mucosa. Do not use for allergic rhinitis.


5. Take 10 g of chamomile flowers, 10 g of marsh cudweed, 15 g of St. John's wort. Brew the components separately with a glass of boiling water, cool and strain. Bury 5 drops in each nostril 3 times a day. This composition helps to relieve inflammation and open clogged frontal sinuses.


6. Mix equal parts of celandine juice and chamomile juice. Bury 1-2 drops in each nostril. Such a composition effectively fights frontal sinusitis caused by polyps.

Ointments for frontitis

1. Take 4 parts of lard and one part of kerosene. Mix and store in the refrigerator. Rub the ointment into the forehead and wings of the nose several times a day. You can insert cotton swabs soaked in this ointment into your nose. The procedure lasts 3 hours once a day. The product disinfects and dissolves adhesions.


2. In a water bath, melt the crushed laundry soap(1/2 piece), teaspoonful vegetable oil, 70% alcohol, honey and milk. Cool and soak cotton flagella with ointment. Lay 3 times a day for 15 minutes. The course of treatment is two weeks. If necessary, repeat the course after 10 days. The ointment disinfects, cleanses and relieves inflammation.


3. Prepare an ointment from equal parts of honey, aloe juice, onion juice, cyclamen juice, Vishnevsky ointment. Mix all ingredients thoroughly until smooth and store in the refrigerator. The turundas soaked in ointment are placed in the nose for 30 minutes. The course of treatment is three weeks.


4. Crush the garlic clove and mix with an equal amount of butter. Store this ointment in the refrigerator and lubricate the forehead before going to bed. Phytoncides of garlic penetrate deeply into tissues and help get rid of the disease.

For these purposes, medical white clay is suitable. It must be diluted with water or a decoction of chamomile to the consistency of a thick dough. The cake should be warm, about 1 cm thick. Apply such a compress in the evening, lying in bed, for two hours. Repeat 14 days.

It should be noted that the treatment of frontitis folk remedies should complement the measures prescribed by the doctor. This will protect against re-inflammation in the frontal sinus and the transition of the disease to chronic form. At the first sign of an allergy, it is worth stopping the use of funds. traditional medicine and replace them with others.

Dry heat treatment

1. Heat 3-5 tablespoons of sand or salt in a frying pan. Pour into a cloth bag and apply to the forehead in the area of ​​the frontal sinus. The duration of the procedure is 20-30 minutes.
2. Boil an egg and apply to the forehead. As long as it is too hot, it can be wrapped in a handkerchief. Keep until cool.
3. Wear a bandage of wool on your forehead. This heating can take several hours. After the procedure, it is important to avoid hypothermia on the street.

Medical treatment

When should you start taking antibiotics?

Indications for the use of antibiotics for frontal sinusitis are purulent discharge. They mean that bacteria have settled in the sinus. The doctor should take a sample of the discharge for laboratory analysis. With the help of this, it is possible to determine which microorganisms caused the inflammation and their sensitivity to antibiotics. This is the key to successful treatment. With chronic frontitis, such a procedure is required.

Indications for the use of antibiotics for frontal sinusitis are: severe general state the patient and a severe headache, as well as if a more gentle treatment did not work.

What antibiotics are usually prescribed for frontal sinusitis?

In acute frontal sinusitis, broad-spectrum antibiotics are prescribed, for example, Sumamed 500 mg per day.
In the treatment of chronic frontal sinusitis, when the sensitivity of bacteria to antibiotics is determined necessarily, narrowly targeted agents are prescribed. If the cause is Haemophilus influenzae, then Ampicillin, Amoxiclav are prescribed.

Enter intramuscularly or intravenously in a daily dose of 200-400 mg. Against pneumococcus, tetracycline antibiotics are used: Abadox, Biocyclind, Medomycin, Doxacin, Doxilin, Extracycline, Isodox, Lampodox. Daily dose for adults is 0.2 g.

The course of antibiotic treatment should be at least 7-10 days.

What other drugs are taken to treat frontal sinusitis?

In the case when it is necessary to remove thick pus from the frontal sinus, ACC-long (600 mg) is prescribed, 1 tablet 1 time per day.

To maintain the intestinal microflora, probiotics are taken: Lactobacterin, Probiovit, Bifikol, Lineks. They help maintain a balance of beneficial microorganisms and support immunity.

Homeopathic remedies. Sinuforte - has an anti-inflammatory effect and promotes the opening and ventilation of the sinuses. Cinnabsin - facilitates nasal breathing, relieves swelling, improves immunity. Sinupret - liquefies the thick contents of the sinuses, relieves inflammation.

To fight infection without antibiotics, sulfanilamide drugs Sulfadimezin, Norsulfazol, Etazol are also used.

To reduce the headache prescribed: Analgin, Amidopyrin, Nurofen.

Physiotherapy procedures

To speed up recovery, the following physiotherapeutic procedures are prescribed: electrophoresis with 2% potassium iodide, laser therapy, solux, UHF therapy. They are aimed at warming the frontal cavity, ensuring the free outflow of its contents, relieving inflammation, and improving blood circulation.

When is a puncture made with frontitis?

Pus in the sinus, severe headaches and lack of outflow, cysts in the sinus cavity - these are signs that indicate the need for a puncture with frontal sinusitis.

In preparation for a puncture, the most important stage is an x-ray study of the structure of the frontal sinuses. This is necessary to accurately determine the puncture site with frontal sinusitis.

There are several techniques for piercing:

• through the lower thin wall of the frontal sinus (through the nasal cavity)
• through the anterior wall of the frontal sinus (through the forehead)

Complications with frontitis

• The inflammatory process can spread to neighboring paranasal sinuses. This leads to the occurrence of sinusitis, ethmoiditis, sphenoiditis
• Intraorbital complications (edema of the eyelids and orbital tissue, orbital phlegmon, eyelid abscess)
• Intracranial complications (meningitis, brain abscesses)
• In severe cases, blood poisoning is possible - sepsis

Prevention of frontal sinusitis

It is also necessary to take care of strengthening the immune system and hardening the body, avoid hypothermia and lead an active lifestyle. Compliance with these simple recommendations is the key to your health.

What is the difference between frontal sinusitis, sinusitis, ethmoiditis, sphenoiditis, sinusitis?

At neuralgia of the first branch trigeminal nerve disturbed by headache attacks, there is pain when pressed in the area of ​​​​the eyebrow, where the specified branch of the nerve goes to the face.

What is this procedure - "cuckoo"?

During the procedure, the patient lies on a couch with their head hanging down and tilted back by about 45°. A warm antiseptic solution is poured into one nostril, and it is pumped out through the other along with pus. In the nose of the patient, as it were, a "bubbling stream" is created.

While washing the nose, the patient must constantly say: “cuckoo”, due to which the method got its name. While pronouncing these syllables soft sky pressed against the back wall of the pharynx, due to which the communication between the nose and throat is closed.

Due to the constant flow of antiseptic and the pronunciation of the syllables "ku-ku", negative pressure is created in the nasal cavity. Pus and other pathological contents come out of the paranasal sinuses into the nasal cavity.

Typically, washing continues for 10-15 minutes. It can be carried out in a clinic or hospital setting. After the procedure, it is not recommended to go outside for 30 minutes in the warm season, and for 1-2 hours in the cold season.

Possible complications of the procedure:

• sneezing due to irritation of the nasal mucosa;
• nose bleed;
• slight headache;
• burning in the nose;
• redness of the eyes.