A histoanatomical study of the frontal bone was undertaken using a total of 61 human frontal bones (74 sides) obtained from widely scattered ages ranged from 5 months to 80 years of age in order to investigate the process of pneumatization in the frontal sinus and causes of recurrent frontal sinusitis.
1. Although no frontal sinus was seen to be present in the fetal frontal bones, there observed extensions of submucous connective tissue into the medullary space, which wasconsidered as a preparatory state for the formation of the frontal sinus.
When the rudiment of the frontal sinus contacts the anterior table of the frontal bone, it created a shallow pit which later developed to a sinus.
The author observed the shallow pit first in a 2-year-old girl and a completed frontal sinus fi rst in a 4-year-old girl.
2. The process of development of the frontal sinus is characterized by a boneabsorption on the mucosal side and the formation of bone on the opposite side.
The bony plate at the roof of the frontal sinus has many small ducts in it communicating the sinus cavity to the marrow space. Through the small ducts extends the submucous connective tissue as far as the marrow space. Transformation of the bone tissue is takenplace under the mucosa and the epthelial layer. Development of the frontal sinus is usually seen, accordingly, toward the direction of the bone marrow.
3. Anterior development of the frontal sinus is usually seen between the age of 25 and 35. So-called frontal pneumosinus seems to be produced by unusually active anterior development of the sinus.
4. Development of the frontal sinus after middle age was characterized by proliferation of submucous connective tissue into the small ducts toward the marrow space thenfollowed by absorption of the bony tissue.
It is not certain that how the proliferation of the connective tissue induce bony absorption in the frontal bone.
Development of the frontal sinus appeared not to cease at about the age of 20as previously considered.
The author observed osteoclasts in a 29-year-old female with moderate frontalsinus development at the roof of the frontal sinus, in a 38-year-old male with a well developed frontal sinus and in a 70-year-old male at the wall of the small ducts.
These findings would indicate that the development of the frontal sinus although very slow continue to one's life.
5. In two frontal bones with well developed frontal sinuses, a small cavity that connecting the frontal sinus to the marrow space was found.
This small cavity had a similar anatomical relation to that of the antrum which communicate the middle ear to the mastoid. Proliferation of submucous connective tissue was also seen extending from the frontal sinus to the medullary space in these cases. Such findings may be considered as one of the characteristics of a well developed frontal sinus.
In routine frontal sinusectomy, these connective tissues in the small cavity and small ducts are unable to be removed radically the remaining tissue may proliferate to create finally so-called regenerated sinus.
6. Three of the frontal bones with underdeveloped sinuses showed arborescent type development of the frontal sinus. In those bones small ducts extended into the medullary space through which submucous connective tissue was seen to reach the marrow sapce.
Frontal sinusectomy if performed on such sinuses the nasofrontal duct will inevitably obstructed to produce various symptoms including unexplained headache, or in some cases recurrent frontal sinusitis, muco or pyocele of the frontal sinus.
7. The author discussed other causative factors of the recurrent frontal sinusitis.
8. Discussion was made about the six cases of osteoma encountered in the frontal sinus.
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