Our recent studies of the human frontal sinus indicated that occurrence of naso-paranasal inflammation is greatly affected by the extent of sinus development. The authors studied 74 human frontal sinuses in 61 cases whose age ranged from fetus to 80 years old in order to study the process of pneumatization in the frontal sinus and the etiology of recurrent frontal sinusitis. The conclusions drawn may be summarized as follows: 1. Pneumatization activity of the frontal sinus is mainly dependent upon two major factors. One is proliferation of connective tissue between the mucous membrane and the periostium (submucous connective tissue), which plays an active role in pneumatization and the other is the size of marrow space in the frontal bone. The frontal sinus appeared to develop when the frontal bone has a well developed marrow space plus proliferation of the submucous connective tissue extending into the marrow space. The pneumatization process will be suppressed either when the frontal bone contains underdeveloped marrow space or when proliferation of the submucous connective tissue is depressed. Heredity, disposition, endocrine activity, local inflammation and local mechanical factors may affect the extent of pneumatization. 2. The authors studied the specimens in regards to the etiology of recurrent frontal sinusitis and deduced that postoperative derangement of the pneumatization process in the frontal bone could be responsible for the condition. Many specimens showed small ducts that communicated with the frontal sinus and the marrow space located above the frontal sinus. Submucous connective tissue was often seen to extend into the marrow space through these small ducts. Transformation of the bone at the roof of the frontal sinus for pneumatization seemed to be accomplished in this manner. Frontal sinusectomy with radical removal of the submucosal tissue may cause obstruction of those small ducts which could leads to recurrent frontal sinusitis provided pneumatization proceeds in the isolated marrow space.
A case of case of carcinoma originating in the frontal sinus was treated by a combination of Co60 irradiation, chemotherapy and surgery. The prognosis appeared favorable and the patient returned to his work ten months postoperatively without any sign of recurrence.
A case of sepsis developing after pansinusectomy is reported. The case was successfully treated by intensive chemotherapy. The authors discussed useful preventive measures for this rare but serious complication in regards to operative procedure, postoperative local treatment and systemic treatment.
A 70-year-old male who suffered from repeated massive nasal bleeding was successfully treated by ligation of the internal maxillary artery in the sphenopalatine fossa. This method which creates no visible scars can be used to control severe nasal bleeding due to operations or other causes. Bellocq's nasal pack can be removed right after this procedure is completed and patients can breathe comfortably through their nose.
A 12-year-old male underwent conchotomy and anterior ethmoidectomy because of various nasal symptoms due to chronic sinusitis. The patient complained of headache, abdominal pain, insomnia associated with fever and vomiting about five months after the operation. In spite of intensive treatment with antibiotics the patient died on the 6th day of the disease. Autopsy revealed suppurative inflammation of the meninges plus congestion of the lungs, kidneys, pancreas and suprarenal glands. Splenitis and hyaline degeneration of the liver were also recognized. The authors inferred that pansinusitis inclusive of sphenoid sinus gave rise to serious complications such as osteomyelitis of the roof of the sphenoid sinus, meningitis and sepsis. The authors discussed the pathology of fulminating rhinogenic meningitis and reviewed the literature for the last ten years.
Nasal hemorrhage from the paranasal sinus may be controlled by application of Bellocq's nasal pack or by ligation of the external carotid artery. The author describes technique of another method (Seiffert's method) which is characterized by ligation of the internal maxillary artery in the sphenopalatine fossa. Although this method is not commonly used in Japan, the author concludes, it is a very useful procedure as the nasal packing can be removed immediately after the ligation of the artery.