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
1. Pain / tenderness over frontal sinus
3. Nasal obstruction
4. Purulent rhinorrhoea
6. Hyposmia / anosmia
Medical Treatment first
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.
Â Surgery is indicated in resistant cases which includes frontal sinus trephening and endoscopic decompression.