Acute Frontal Sinusitis: Treatment and Complications

Acute frontal sinusitis usually occurs in association with ethmoid or maxillary sinusitis. The front nasal duct is tortuous and easily obstructed by mucosal edema after a viral URTI. Early diagnosis and management of acute frontal sinusitis will go a long way in preventing development of complications.

Predisposing factors are any abnormality that interferes with drainage of the frontal sinus, for example:

and Deviated nasal septum

and Nasal polyps

and large middle turbinate-Concha bullosa

Symptoms

1. Pain / tenderness over frontal sinus

2. Head ache showing classic periodicity (More during early morning hours and gets better as the day progresses). This is due to the gravitational effects of frontal sinus drainage.

3. Nasal obstruction

4. Purulent rhinorrhoea

5. Fever

6. Hyposmia / anosmia

Medical Treatment first

Treatment of infection:

Antibiotics should be prescribed routinely because only 30-40% of patients with clinically suspected sinusitis have a bacterial infection, and over two thirds of patients experience improvement or resolution of symptoms with antibiotic treatment.

Decongestants – e.g. Intra Nasal Topical Oxymetazoline nasal drops or spray

Analgesics may be used to relieve pain and fever.

Complications should be suspected in patients with:

• Protracted symptoms with increasing severity

• Periorbital edema due to preseptal cellulites

• Painful and restricted eye movements (orbital cellulitis)

• Neurological signs and symptoms indicate intracranial complications

• Meningitis is one of the important intracranial complications of acute frontal sinusitis. Signs and symptoms of meningitis include: High fever, photophobia, neck pain, neck stiffness, severe headache and altered mental status.

• Osteomyelitis is one of the complications of acute frontal sinusitis. This is caused by direct extension of infection or by thrombophlebitis involving the diploic veins. In patients with osteomyelitis of anterior table of frontal bone may lead to formation of subperiosteal abscess which present as swelling over the forehead. This is also known as the “Pott\’s puffy tumor”.

• Cavernous sinus thrombosis is a complication of acute frontal sinusitis. Thrombophlebitis involves the diploic veins which are valveless. The infection spreads to cavernous sinus causing thrombophlebitis. Patients with cavernous sinus thrombosis present with ophthalmoplegia, proptosis, visual loss, trigeminal nerve deficits.

 Surgery is indicated in resistant cases which includes frontal sinus trephening and endoscopic decompression.