The sphenoid sinus (sinusphenoidalis) is located in the body of the sphenoid bone above the choanae and the vault of the nasal pharynx. It is divided into right and left by a partition. The sphenoid sinus has six walls. The upper wall faces the anterior and middle cranial fossae and corresponds to the sella turcica (selloturcica). On the lateral wall there are the internal carotid artery, cavernous venous sinus, oculomotor, trochlear, abducens nerves and the first branch of the trigeminal nerve. The lower wall of the sphenoid sinus is involved in the formation of the posterior arch of the nose and the nasal part of the pharynx. The posterior wall corresponds to the slope (clivus). The anterior sinus borders the posterior sinuses of the ethmoid bone. In the anterior wall there is an opening (ostium sphenoidale), connecting the sinuses with the upper nasal passage.

4. Anatomy and topography of the frontal sinus.

The frontal sinus (sinus frontalis) is located in the thickness of the frontal bone. In the frontal sinus, the walls are distinguished: outer, or anterior, posterior, or cerebral, inferior, or orbital, and median. The thickest is the anterior wall, the thinnest is the orbital wall. The frontal sinus communicates with the nose through the nasofrontal canal (ductus nasofrontalis), which opens in the anterior part of the middle nasal passage. Development of the frontal sinuses is usually completed by age 25. They come in various sizes. In 12-25% of cases, the frontal sinuses may be absent, usually on one side.

5. Anatomy and topography of the maxillary sinus.

The maxillary sinus (sinus maxillaris) is the largest of the paranasal sinuses: its capacity is from 3-5 to 30 cm3, on average 10-12 cm3. The inner, or nasal, wall of this sinus corresponds to most of the lower and middle nasal passages.

In the middle meatus there is an opening connecting the maxillary sinus with the nasal cavity (ostium maxillare). It is located under the very bottom of the eye socket. The upper (orbital) wall, corresponding to the lower wall of the orbit, is the thinnest. The canal of the infraorbital nerve passes through its thickness. The anterior wall corresponds to the canine buccal, or canine, fossa and is the thinnest part. At the upper edge of the canine fossa there is an infraorbital foramen for the exit of the infraorbital nerve. The posterior wall of the sinus, corresponding to the maxillary tubercle, faces its surface towards the pterygopalatine fossa. The lower wall (bottom) of the maxillary sinus lies close to the posterior part of the alveolar process of the upper jaw and corresponds to the alveoli of the four, three or two posterior upper teeth. The following types of relationships between the bottom of the maxillary sinus and the teeth are distinguished: 1) the bottom of the maxillary sinus lies at the level of the bottom of the nasal cavity; 2) the bottom of this sinus is located below the bottom of the nasal cavity, then the roots of the upper teeth lie freely in the cavity, which is important in the spread of the inflammatory process into the said sinus; 3) the bottom of the maxillary sinus is located above the bottom of the nasal cavity. The medial (nasal) wall of the maxillary sinus is identical to the lateral wall of the nasal cavity. In the very anterior part of the wall there passes the nasolacrimal canal (canalis nasolacrimalis). Under the orbital edge, posterior to the protrusion of the nasolacrimal canal, is the opening of the maxillary sinus.

6. Anat. and topographical Smell the analyzer.

Smell - is phylogenetically one of the most ancient sense organs, and its study is extremely necessary for both physiology and clinical medicine, especially neuropathology. Clinicians are interested in the possibility of determining the site of damage to the olfactory analyzer by the nature of the disturbance of olfactory function. Studying olfactory disorders in the clinic of large brain tumors, we were convinced that data from a thorough study of olfactory function have great diagnostic value. As you know, the olfactory region is located in the upper part of the nasal cavity, the so-called olfactory fissure. The space delimiting this area is the septum, the superior and middle conchae, and the cribriform plate. The mucous membrane covering this area differs from the rest of the mucous membrane of the nasal cavity by brown spots, which receive their color from the pigment contained in the olfactory cells: these spots or islands generally occupy 250 mm2 of area and have an irregular shape. There is no exact determination of the area of ​​distribution of the olfactory part of the nasal mucosa containing pigment; this area varies among individuals, sometimes occupying part of the superior turbinate and nasal septum, sometimes moving to the middle turbinate. The olfactory pigment is apparently similar to the pigment of the retina, and its disappearance leads to a loss of smell, which is observed in old people, in people with a disease of the epithelium of the olfactory fissure itself. The olfactory epithelium consists of three types of cells: 1) the olfactory cells themselves; 2) cylindrical olfactory cells; 3) small basal cells. Sensitive cells of the olfactory epithelium are bipolar. One free end of such a cell faces the olfactory cavity and has hairs at the end, which together form a fringed tissue called the border olfactory septum. But unlike other receptors, olfactory cells, like the cells of the retina, are areas of the central nervous system located on the periphery. The process of the olfactory cell protrudes through the hole in the marginal olfactory septum and here expands into a vesicle from which the cilia extend. These ciliated olfactory vesicles are the true receptors of the olfactory sense. Embryologically, they originate from centrosomes and their surrounding centrospheres. The olfactory vesicles are immersed in a semi-liquid outer membrane secreted by supporting cells (membranalimitans). The other end of the sensitive cell is directed into the cranial cavity and, connecting with other similar processes of sensitive cells, forms olfactory fibers. These latter, passing through the cribriform plate into the cranial cavity, are immersed in the olfactory bulb. Olfactory fibers are accompanied by fibers of the trigeminal nerve. Having plunged into the olfactory bulb, the fibers of the sensory cells branch in a tree-like manner and, intertwining with the same branches of the mitral cells, form the olfactory glomeruli. Olfactory glomeruli, the so-called glomeruli, are spherical particles sitting on a layer of olfactory fibers. These spherical formations essentially represent a ball of entangled inseparable two bundles of fibers going one to another. One of these bundles, the ascending one, is a cylindrical process of the bipolar cell of the olfactory epithelium branched into a bouquet; the descending bundle coming towards it is also a branched protoplasmic main process of the mitral cell. In humans, each glomerulus receives branching from only one mitral cell and the cylindrical processes of many bipolar cells of the olfactory epithelium. The microscopic structure of the olfactory bulbs consists of five layers: 1) a layer of nerve fibers; 2) layer of glomeruli; 3) molecular layer with brush cells; 4) a layer of mitral cells, which serve for further transmission of olfactory impulses to the brain; 5) granular layer, poorly developed in humans, consisting of granule cells and Golgi cells. Thus, the olfactory bulb is like an intercalary ganglion. This is where the peripheral olfactory pathway ends and the central olfactory pathway begins. The first neuron of the central olfactory pathway will be the olfactory tract. The olfactory tract consists of ganglion cells, nerve fibers, remnants of the ventricular ependyma, cells and blood vessels. All these elements form the olfactory tubercle, which is a pyramidal eminence on the lower edge of the olfactory sulcus. The base of this pyramid is the olfactory tubercle. In more detail, the human olfactory tract, together with the bulb, represents the underdeveloped olfactory gyrus of macrosmatic animals. The olfactory tract consists of three layers : 1) a layer of olfactory fibers, the most superficial to the thinnest, covering the bulb with a very thin cingulate layer (described above as a layer of nerve fibers); 2) a layer of mitral fibers, consisting of three zones: a) superficial, b) deep, formed by a layer of cells called mitral, and c) lower, formed by a layer of simple or double glomeruli; 3) layer of central fibers. The cells, called mitral cells, are shaped like a pyramid or miter. The top of the pyramid faces upward. A long thin axon departs from it, which penetrates the layer of central fibers, bends and goes along the tract to the olfactory triangle. Throughout its path, this axon releases collaterals. Some of them descend between the mitral cells, others approach the cells of the central layer or go to the cells of the cortex. The lateral angles of the mitral cells give rise to protoplasmic processes, generously branching in the plane of the parent cell, except for one, called the main one, which extends from the base of the mitral cell. This most powerful process of all descends in a straight line down to the glomerulus. Everywhere in the deep zone of the second layer there are small cells scattered near the mitral and having the same significance as the mitral, giving processes to the glomeruli and into the layer of central fibers. The layer of central fibers is very dense and consists of centronetal and centrifugal fibers: the first are the axons of mitral cells and their equivalents, the second are fibers coming from the anterior commissure of the brain, and corticofugal fibers penetrating into the deep zone, the significance of which is currently still unknown . The fibers of the tract go in four directions: 1) through the lateral olfactory bundle - into the hook of its side; these fibers end in the ammon's horn, in its tonsil nucleus; 2) through the anterior commissure - into the tract of the opposite side and ends in its cortical layer; 3) from the olfactory triangle - to the gray matter of the transparent septum (septumpellucidum); 4) finally, from the olfactory triangle - to the anterior perforated substance. The anterior part of the perforated space in macrosmatic animals is highly developed and is designated as the olfactory tubercle. The paths of the second central neuroma are as follows: 1) from the gray matter of the transparent septum in the fornix to the horn of Ammon; 2) from the anterior perforated space through a semicircular strap around the caudate nucleus, separating it from the optic thalamus, among the terminal stripes and further along the bottom of the lateral ventricle into the horn of Ammon and to the hook; 3) from the olfactory triangle in the Wallenberg bundle to the mammillary body. The third central neuron consists of the following formations and pathways coming from the mammillary body as part of bundles. The olfactory system also includes systems of fibers that go: 1) from the anterior nucleus of the visual thalamus and the gray matter of the transparent septum, the so-called terminal stripes of the visual thalamus, and reach the leash node; 2) from the leash knot, in the form of a Meynert bundle, to the interpeduncular nucleus; 3) from the interpeduncular nuclei to the deep dorsal tegmental ganglion. Along with the systems just mentioned, there are the following formations classified as the olfactory sphere: 1) paths from the nucleus of the amygdala, which go along the fornix in the opposite direction to the mammillary body; 2) a bundle from the posterior deep node of the tegmentum, running along the back of the bottom of the Sylvian aqueduct and the tegmentum of the medulla oblongata, the so-called longitudinal dorsal fasciculus of Schütz, which ends in all nuclei of the tegmentum of the pons and medulla oblongata. There is a close connection between the primary olfactory centers (olfactory triangle, olfactory bulb) and the nuclei of the trigeminal nerve. This close anatomical connection of the olfactory centers with the trigeminal and other cranial nerves (vagus, vestibule) probably explains many phenomena caused by the olfactory act, in addition to the purely olfactory sensation - a change in the rhythm of breathing and pulse with pleasant and unpleasant olfactory sensations, a decrease and increase in muscle tone , the appearance of dizziness due to the perception of certain odors. Thus, we distinguish the paths and centers of the primary order - the first olfactory neuron (olfactory cells located in the olfactory fissure, the central processes of olfactory cells in the form of filaments, penetrating through the perforated plate of the ethmoid bone and ending in the area of ​​the olfactory bulbs). Pathways and centers of secondary order - II neuron of the olfactory system - fibers from the olfactory bulbs go in the olfactory tracts and end in an extension - the olfactory triangle. The third neuron of the olfactory analyzer begins here. The anterior commissure connects the primary olfactory centers. The secondary olfactory formations are connected by the hypocampal commissure or commissure of the lyre of David and the posterior part of the anterior commissure, which also connects the gynocampal gyrus. All third-order neurons are projection, association and commissural fibers. The olfactory pathways are mostly uncrossed. In the area of ​​the anterior commissure there is an anastomosis of the olfactory tracts, in the area of ​​the middle commissure there is an anastomosis of the fibers entering the ammonian horn. The cortical ends of the olfactory analyzer are also connected to each other by a large white commissure. The olfactory pathways have connections with various parts of the brain. From the olfactory triangles there are paths to the papillary bodies at the base of the brain. These formations are involved in the regulation of autonomic functions. From here the vegetotropic effect of smell (vasodilation, increased heart rate, etc.) becomes clear. Through the mamillary bodies, the olfactory pathways are connected to the visual thalamus. In the area of ​​the visual thalamus there is a connection between the olfactory and vestibular analyzers. Clinically, this connection is confirmed by the influence of olfactory stimulation on vestibular chronaxy and other observations. Olfactory connections with the visual thalamus and mamillary bodies have a double direction (in one direction or the other), that is, impulses can be conducted in both directions. The connections between the olfactory formations and the tegmentum of the brainstem and the varoli are described. pons and medulla oblongata (via the descending tracts of the posterior longitudinal fasciculus). Along these pathways, unconditioned motor reflexes to olfactory stimuli (facial movements, as well as general motor reactions, etc.) are carried out. There is a rich anatomical and physiological connection between the I and V cranial nerves, as well as with the autonomic nervous system.

Frontal sinusitis or frontal sinusitis is an inflammation of the frontal paranasal sinus. In the modern world, this disease is one of the most common. Frontal sinusitis affects about 10-15 percent of the entire world population. About 10 percent of all patients suffer from a chronic form of this disease.

Recently, the incidence of this disease not only does not decrease, but also gradually progresses. Among the population of the Russian Federation, about 1 million people a year suffer from frontal sinusitis. To understand the etiology and causes of the disease, it is necessary to know the anatomy of the frontal sinuses.

A distinctive feature of the frontal sinuses is their absence at the time of birth.

The paranasal sinuses adjacent to the nasal cavity are divided into:

• maxillary or maxillary;
• wedge-shaped;
• frontal;
• lattice labyrinth.

They are small cavities located in the bones of the skull, thanks to which the nasal passages open. According to the norm, the sinuses should contain air.

The sinuses perform important functions, namely:

• lighten the bones of the skull;
• moisturize and warm the air that enters the human body;
• play a buffer role in various facial injuries;
• protect eyeballs and tooth roots from temperature fluctuations;
• act as a vocal resonator.

In the frontal bone of the skull there are two frontal sinuses, which have a pyramidal shape, with the pyramid located base down and divided into two parts by a bony septum.

Each frontal sinus has 4 walls: orbital or inferior, anterior, internal and posterior. The thickest is the anterior septum of the sinus, and the thinnest is the lower one. As for the size of the sinus, they can vary depending on the individual structure of the bones of the skull. In 10 percent of people, frontal sinusitis is completely absent - this pathology is hereditary. The volume of the frontal sinus can be from 3 to 5 cm3.

The inside of the frontal sinuses is lined with mucous membrane (a continuation of the nasal mucosa), which does not contain cavernous tissue. If we compare the thickness of the mucous membranes of the sinuses and nose, then in the former it is thinner. The frontal sinuses are connected to the nasal cavity through a narrow convoluted canaliculus and open with a small opening in the front of the nasal passages.

Etiology of the disease

Frontal sinusitis is characterized by inflammation of the mucous membrane that lines the frontal sinuses. The severity and form of the disease directly depend on the causative agent of the disease. Most often, frontal sinusitis is provoked by:

• infections;
• allergic reactions;
• nasal polyps;
• foreign bodies;
• pathology in the structure of the nose;
• injuries of the paranasal sinuses and nose.

Infection

Penetrating into the human body, pathogenic microorganisms provoke inflammation of the mucous membrane of the nasopharynx, which can spread to the mucous membrane of the frontal sinuses

Frontal sinusitis is most often provoked by infections that enter the frontal sinuses from the nasal cavity. Inflammation of the mucous membrane can develop not only in the frontal sinuses, but also in the maxillary sinuses, in which case the patient is diagnosed with two diseases - frontal sinusitis and sinusitis. The causes of infection in the human body are respiratory diseases of the upper respiratory tract (sore throat, ARVI, influenza), as well as diseases such as diphtheria, measles, scarlet fever and others.

As for the causative agents of the disease, they differ depending on the form of frontal sinusitis (viral and bacterial). For the viral form, the causative agents are rhino-, adeno- and coronoviruses, as well as respiratory sensitial viruses. The bacterial form is provoked by microorganisms such as staphylococci, streptococci and pneumococci.

Pathogenic fungi can also provoke frontal sinusitis. If there are foci of fungal infection in the body, for example, an abscess, carious teeth and others, the fungi enter the blood hematogenously (through the blood), provoking inflammation of the mucous membrane.

Allergic reactions

Diseases such as bronchial asthma or vasomotor rhinitis (allergic rhinitis, especially its chronic form) can provoke swelling and inflammatory processes in the mucous membrane of the frontal sinuses. When the mucous membrane swells, the hole through which fluid exits the frontal sinus is blocked.

The cause of frontal sinusitis is allergic reactions, namely vasomotor rhinitis

Nasal polyps

Benign formations that have a round shape and are caused by degeneration of the mucous membrane are called polyps. When nasal polyps occur, the patient experiences swelling of the mucous membrane, which, in turn, impedes the outflow of fluid from the frontal sinuses and leads to its stagnation, as well as difficulty breathing, which can negatively affect the functioning of the cardiovascular system and the functioning of the respiratory system. As a result of fluid stagnation in the frontal sinuses, inflammation of the mucous membrane occurs, which is called frontal sinusitis.

Foreign bodies

The entry of foreign bodies and their prolonged stay in the nasal passages also causes inflammation of the mucous membrane of the paranasal sinuses. Most often, foreign bodies cause frontal sinusitis in young children.

Nasal polyps, as well as foreign bodies in the nasal passages, complicate the natural ventilation of the nasopharynx

Pathology of the structure of the nasal structures

Pathological changes (acquired or congenital), for example, a deviated nasal septum, can also disrupt the outflow of fluid, and with it pathogenic microflora, from the paranasal sinuses, as a result of which the inflammatory process begins. Frontal sinusitis, which is caused by pathological changes in the nasal structures, can only be completely cured through surgery.

Injuries

Facial injuries accompanied by severe bruises or damage to the bones of the skull can also provoke frontal sinusitis, since the bruise causes swelling of the tissues, as a result of which their blood supply is disrupted, which causes inflammation of the mucous membrane of both the nasal passages and the frontal sinuses. Due to edema, the outflow of fluid from the paranasal sinuses is disrupted, and some injuries can provoke pathological changes in the nasal structures.

Congenital or acquired curvature of the nasal septum disrupts the natural circulation of air in the nasal cavity. thereby provokes the occurrence of inflammatory processes both in the nasal passages themselves and in the paranasal sinuses

Symptoms of frontal sinusitis

Depending on the course of the disease, frontal sinusitis can be of two types: acute and chronic. The disease is much more severe than other sinusitis and can cause serious complications.

Signs of an acute form of frontal sinusitis are:

• severe and sharp pain in the forehead, which intensifies with pressure or palpation;
• discomfort in the inner corner of the eye;
• photophobia, lacrimation;
• stinging and pain in the eyes;
• difficulty breathing through the nose and congestion of the nasal passages;
• copious mucous discharge from the nose (if treatment is not started in time, then over time the discharge becomes purulent in nature);
• if right-sided or left-sided frontal sinusitis develops, then discharge will be observed in the corresponding half of the nose;
• in some cases, the patient’s skin color changes directly above the frontal sinuses;
• as a rule, there is an increase in body temperature (38-39 degrees), but in some cases the patient’s body temperature may have only minor deviations from the norm;
• the patient experiences general intoxication of the body, as a result of which the patient is characterized by a feeling of lethargy and drowsiness;
• During rhinoscopy, the patient experiences swelling of the mucous membrane, its inflammation, as well as mucopurulent discharge.

The following symptoms are characteristic of chronic sinusitis:

• pressing or aching pain in the frontal region;
• when pressing, a sharp pain is felt in the inner corner of the eye;
• purulent discharge from the nasal passages with an unpleasant odor;
• in the morning, a large amount of purulent sputum is released.

The chronic form of the disease develops 4-8 weeks after the onset of frontal sinusitis, and the causes of its occurrence are inadequate treatment or complete ignorance of the acute form of sinusitis.

With frontal sinusitis, the patient experiences sharp pain in the frontal region

Diagnosis of the disease

To determine an accurate diagnosis, an otolaryngologist can use the following types of diagnostics:

• rhinoscopy;
• taking anamnesis;
• nasal endoscopy;
• ultraviolet examination of the paranasal sinuses;
• transillumination (diaphanoscopy);
• thermography;
• bacteriological examination of discharge from the nasal passages;
• X-ray of the paranasal sinuses;
• computer studies (tomogram);
• cytological studies of discharge.

Radiography makes it possible to assess the volume of accumulated fluid in the frontal sinus, the size and structural features of the nasal sinuses

The general goal of diagnosis is a detailed collection of patient complaints and clarification of the symptoms of the disease. By performing rhinoscopy, it is possible to determine the presence of an inflammatory process, notice redness and swelling of the mucous membrane, and also identify the presence of polyps or pathological changes in the nasal structures, which, in turn, can provoke or complicate the course of frontal sinusitis. To identify the extent of inflammation, as well as monitor the effectiveness of therapy, ultrasound of the frontal sinuses is prescribed.

To determine the microorganisms that provoke frontal sinusitis, a bacteriological examination of the contents of the nasal cavity is carried out. Together with cytology, bacterial culture makes it possible not only to determine not only the pathogen, but also its sensitivity to antibiotics. Thanks to these laboratory tests, the otolaryngologist can prescribe the most effective treatment. Instead of lengthy clinical studies, the patient is often offered to undergo a rapid test for pathogenic microflora and its sensitivity to antibiotics. A special feature of this research method is the ability to obtain results within a few minutes after taking the secretion released from the nasal passages.

Types of frontal sinusitis

Frontitis is divided depending on the form of the course, localization and type of inflammatory process.

According to the flow form:

• spicy;
• chronic.

By localization:

• one-sided (left- or right-sided);
• double-sided

By type of inflammatory process:

• catarrhal;
• purulent;
• cystic, polypous;
• parietal-hyperplastic.

Depending on the localization of the inflammatory process, the course and cause of the disease, different types of frontal sinusitis are classified

Acute frontal sinusitis

The causes of the disease are allergic rhinitis, facial injuries, and infectious diseases. The symptoms are pronounced. Antibiotics, vasoconstrictors, painkillers and antipyretics are used for treatment.

Chronic frontal sinusitis

The diseases are caused by prolonged acute frontal sinusitis or its reoccurrence, acute rhinitis, previous influenza, nasal polyps, pathological changes in nasal structures, for example, a deviated nasal septum, a foreign body in the nasal passages, weakening of local immunity. The symptoms are not as pronounced as those of acute frontal sinusitis, but they bring the patient not only physical, but also emotional discomfort (especially purulent discharge).

For treatment, decongestants, vasoconstrictors and homeopathic drugs, antibiotics, electrophoresis, lavages, expansion of the frontonasal valve, and sinus puncture are used.

Unilateral form of the disease

The unilateral form of the disease is characterized by the presence of discharge from only one nasal passage (right or left), headache, and an increase in body temperature up to 39 degrees. The cause may be bacteria, viruses, allergens, decreased local immunity, or facial injuries. For treatment, decongestants, antihistamines, painkillers, antipyretic and anti-inflammatory drugs, as well as antibiotics are used, and if conservative treatment is ineffective, surgical intervention is used.

Bilateral form of the disease

The bilateral form has the same symptoms and causes as unilateral frontal sinusitis, only discharge is observed from both nasal passages. For therapy, conservative treatment is used, and if it is ineffective, frontal sinusitis is treated surgically.

With inflammation of the frontal sinuses, the patient feels pain in the frontal region. Depending on the form of the course and localization of inflammation, the pain can be equally strong or periodically intensify

Catarrhal form

Characterized by severe headache, increased body temperature and swelling under the eyes. The disease occurs as a consequence of inflammatory and infectious processes in the nasal mucosa. For treatment, rinses of the nasal cavity, vasoconstrictors, anti-allergenic drugs, antibiotics, and drugs that normalize the microflora are used.

Purulent frontal sinusitis

The disease is characterized by purulent discharge from the nasal cavity, intoxication of the body, weakness, severe headaches, high fever, and difficulty breathing. The disease is caused by bacteria, as well as polyps or pathological changes in the nasal structures. The presence of a focus of infection in the body can also provoke frontal sinusitis. Treatment uses antibiotics, painkillers and anti-inflammatory drugs, decongestants, and a puncture to remove pus.

Polypous form

The main symptoms are aching pain in the frontal region, difficulty breathing, and mucous discharge. The causes are pathological growth of the nasal mucosa and the formation of cysts. Treatment is carried out only surgically: the frontal sinus is opened and these formations are removed.

Parietal-hyperplastic form of the disease

This form of the disease is also characterized by aching pain, copious discharge, difficulty breathing and proliferation of the mucous membrane of the paranasal sinuses. The disease is caused by bacterial infections, individual reactions of the immune system to inflammation, and increased division of cells of the mucous membrane. Antibiotics and vasoconstrictors are used for treatment.

Drug treatment of the disease

Drug therapy for frontal sinusitis should only be prescribed by the attending physician, since self-medication can lead to serious complications. Some forms of frontal sinusitis do not require antibiotics: viral or allergic frontal sinusitis. Taking antibiotics for these forms of the disease leads to a deterioration in the general condition of the patient, decreased immunity and dysbacteriosis. Other forms of the disease are treated comprehensively, including taking antibiotics.

Treatment of frontal sinusitis is conservative. If it is ineffective, they resort to surgical intervention.

To treat the disease, it is extremely important to rinse the nasal cavity, as they help clear the nasal passages of secretions. To speed up recovery, in addition to rinsing, electrophoresis, UHF therapy, laser therapy, and Sollux are prescribed.

If conservative treatment is ineffective, they resort to surgical intervention; the patient is punctured in the frontal sinus, through which its contents are removed. The procedure is carried out under local anesthesia using a special device - a trephine. Surgical intervention is also extremely important in the treatment of frontal sinusitis caused by pathological changes in the nasal structures (deviated septum, proliferation of the mucous membrane, formation of cysts and polyps).

Therapy during pregnancy

During pregnancy, as well as during lactation, taking antibiotics can have a negative effect on the child, therefore antimicrobial agents are prescribed in minimally effective doses, and the treatment process itself should be monitored by a qualified otolaryngologist and gynecologist.

Traditional medicine methods

Treatment of frontal sinusitis at home is allowed for mild forms of the disease. Treatment prescribed by a doctor can be supplemented with inhalations, ointments and warming agents. Traditional methods can help cope with the disease more effectively and quickly. However, it is necessary that the results of treatment are monitored by an ENT specialist.

There is an indication that this treatment method is right for you. If after the procedure tapping on the central area of ​​the forehead does not cause pain, this means that the frontal sinus has been freed of mucous contents and microorganisms.

There is only one limitation: you must remember that under no circumstances should you heat your forehead if you have purulent frontal sinusitis. This can lead to the spread of pus into surrounding tissues.

Traditional medicine for the treatment of frontal sinusitis can only be used after consultation with the attending physician

Possible complications

With inadequate or untimely treatment, the likelihood of the inflammatory process spreading to other paranasal sinuses increases, resulting in sphenoiditis, sinusitis, and ethmoiditis. Frontitis causes eye complications such as eyelid abscess, swelling of the orbital tissue, orbital phlegmon and others. The most severe complications of frontal sinusitis are sepsis, brain abscess and meningitis.

Prevention of frontal sinusitis

As preventive measures, it is recommended to strengthen local and general immunity, take vitamin complexes and immunostimulating drugs, harden yourself, avoid communicating with people with respiratory diseases of the upper respiratory tract and contact with allergens.

Timely treatment of colds is also considered a preventive measure against frontal sinusitis.

The nasal cavity has paranasal sinuses, which communicate with various nasal passages (Fig. 50). Thus, the body cavity of the main bone and the posterior cells of the ethmoid bone open into the upper nasal meatus, the frontal and maxillary sinuses, the anterior and middle cells of the ethmoid bone open into the middle nasal meatus. The lacrimal duct drains into the lower nasal meatus.

Rice. 50.
A - the outer wall of the nasal cavity with openings into the paranasal sinuses: 1 - frontal sinus; 3 - opening of the frontal sinus; 3 - opening of the anterior cells of the ethmoid bone; 4 - opening of the maxillary sinus; 5 - openings of the posterior cells of the ethmoid bone; 6 - main sinus and its opening; 7 - pharyngeal opening of the auditory tube; 8 - opening of the nasolacrimal duct. B - nasal septum: 1 - crista galli; 2 - lamina cribrosa; 3 - lamina perpendicularis ossis ethmoidalis; 4 - opener; 5 - hard palate; 5 - cartilago septi nasi.

Maxillary sinus(sinus maxillaris Highmori) is located in the body of the upper jaw. It begins to be created from the 10th week of embryonic life and develops until 12-13 years. In an adult, the volume of the cavity ranges from 4.2-30 cm 3, it depends on the thickness of its walls and less on its position. The shape of the sinus is irregular and has four main walls. The anterior (in 1/3 of cases) or anterior outer (in 2/3 of cases) wall is represented by a thin plate corresponding to fossa canina. On this wall there is n. infraorbitalis along with the blood vessels of the same name.

The upper wall of the sinus is also the lower wall of the orbit. In the thickness of the wall there is a canalis infraorbitalis, containing the mentioned neurovascular bundle. At the site of the latter, the bone may be thinned or have a gap. In the presence of a gap, the nerve and vessels are separated from the sinus only by the mucous membrane, which leads to inflammation of the lower orbital nerve during sinusitis. Typically, the upper wall of the sinus is located at the same level as the upper part of the middle meatus. N. N. Rezanov points to a rare variant when this wall of the sinus is low and the middle nasal meatus is adjacent to the inner surface of the orbit. This determines the possibility of a needle penetrating into the orbit during puncture of the maxillary sinus through the nasal cavity. Often the dome of the sinus extends into the thickness of the inner wall of the orbit, pushing the ethmoid sinuses upward and backward.

The lower wall of the maxillary sinus is represented by the alveolar process of the jaw and corresponds to the roots of the 2nd small and anterior large molars. The area where the roots of the teeth are located can protrude into the cavity in the form of an elevation. The bone plate separating the cavity from the root is often thinned and sometimes has a gap. These conditions favor the spread of infection from the affected tooth roots to the maxillary sinus and explain cases of tooth penetration into the sinus at the time of its extirpation. The bottom of the sinus may be 1-2 mm above the bottom of the nasal cavity, at the level of this bottom, or below it as a result of the development of the alveolar bay. The maxillary cavity rarely extends under the bottom of the nasal cavity, forming a small depression (buchta palatina) (Fig. 51).

Rice. 51. Paranasal sinuses, maxillary sinus.
A - sagittal cut: B - frontal cut; B - structural options - high and low position of the lower wall: 1 - canalis infraorbitalis; 2 - fissura orbitalis Inferior; 3 - fossa pterygopalatina; 4 - maxillary sinus; 5- cells of the ethmoid bone; 6 - eye socket; 7 - processus alveolaris; 8 - inferior nasal concha; 9 - nasal cavity; 10 - buchta prelacrimalis; 11 - canalis infraorbitalis (devoid of a lower wall); 12 - buchta palatina; 13 - buchta alveolaris; G - frontal sinus on a sagittal section; D - variants of the structure of the frontal sinus.

The inner wall of the maxillary sinus is adjacent to the middle and lower nasal passages. The wall of the lower nasal passage is solid, but thin. Here it is relatively easy to puncture the maxillary sinus. The wall of the middle nasal passage has a membranous structure over a considerable extent and an opening connecting the sinus with the nasal cavity. Hole length 3-19 mm, width 3-6 mm.

The posterior wall of the maxillary sinus is represented by the maxillary tubercle, which is in contact with the pterygopalatine fossa, where n. infraorbitalis, ganglion sphenopalatinum, a. maxillaris with its branches. Through this wall you can approach the pterygopalatine fossa.

Frontal sinuses(sinus frontalis) are located in the thickness of the frontal bone, corresponding to the superciliary arches. They look like triangular pyramids with the base pointing down. The sinuses develop from 5-6 to 18-20 years. In adults, their volume reaches 8 cm3. The sinus extends upward slightly beyond the superciliary arches, outward to the outer third of the upper edge of the orbit or to the superior orbital notch and descends down into the nasal part of the bone. The anterior wall of the sinus is represented by the superciliary tubercle, the posterior one is relatively thin and separates the sinus from the anterior cranial fossa, the lower wall is part of the upper wall of the orbit and at the midline of the body is part of the nasal cavity, the inner wall is a septum separating the right and left sinuses. The top and side walls are absent, since its front and rear walls meet at an acute angle. There is no cavity in approximately 7% of cases. The septum separating the cavities from each other does not occupy a median position in 51.2% (M. V. Miloslavsky). A cavity opens through a canal (canalis nasofrontalis) extending up to 5 mm into the middle nasal passage, in front of the opening of the maxillary sinus. In the frontal sinus, the canalis nasofrontalis is formed at the bottom by a funnel. This helps drain mucus from the sinuses. Tillo points out that the frontal sinus can sometimes open into the maxillary sinus.

Ethmoid sinuses(sinus ethmoidalis) are represented by cells corresponding to the level of the superior and middle nasal conchae; they constitute the upper part of the lateral wall of the nasal cavity. These cells communicate with each other. On the outside, the cavities are delimited from the orbit by a very thin bone plate (lamina papyrocea). If this wall is damaged, air from the cells of the cavity can penetrate into the fiber of the periorbital space. The resulting emphysema causes protrusion of the eyeball - exophthalmos. From above, the sinus cells are delimited by a thin bone septum from the anterior cranial fossa. The anterior group of cells opens into the middle nasal meatus, the posterior group into the upper nasal meatus.

Main sinus(sinus sphenoidalis) is located in the body of the main bone. It develops between the ages of 2 and 20 years. The septum along the midline divides the sinus into right and left. The sinus opens into the upper nasal meatus. The hole lies 7 cm from the nostril along a line running through the middle of the middle turbinate. The position of the sinus made it possible to recommend that surgeons approach the pituitary gland through the nasal cavity and nasopharynx. The main sinus may be absent.

Nasolacrimal duct(canalis nasolacrimalis) is located in the area of ​​the lateral border of the nose (Fig. 52). It opens into the lower nasal meatus. The opening of the canal is located under the anterior edge of the inferior turbinate on the outer wall of the nasal passage. It is 2.5-4 cm from the posterior edge of the nostril. The length of the nasolacrimal canal is 2.25-3.25 cm (N. I. Pirogov). The canal passes through the thickness of the outer wall of the nasal cavity. In the lower segment it is limited by bone tissue only on the outer side, on the other sides it is covered with the mucous membrane of the nasal cavity.

Rice. 52. Topography of the lacrimal ducts.
1 - fornix sacci lacrimalis; 2 - ductus lacrimalis superior; 3 - papilla et punctum lacrimale superior; 5 - caruncula lacrimalis; 6 - ductus et ampula lacrimalis Inferior; 7 - saccus lacrimalis; 8 - m. orbicularis oculi; 9 - m. obliquus oculi inferior; 10 - sinus maxillaris; 11 - ductus nasolacrimalis.
A - cross section: 1 - lig. palpebrale medialis; 2 - pars lacrimalis m. orbicularis oculi; 3 - septum orbitale; 4 - f. lacrimalis; 5 - saccus lacrimalis; 6 - periosteum

Inflammation of the frontal sinuses - acute or chronic 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 disruption of the outflow of sinus contents, the gradual formation of a fluid level, and swelling of the tissue.

Frontitis requires early treatment, which is due to the high risk of complications due to the spread of infection as a result of a breakthrough of the abscess. The most dangerous complications include meningitis, purulent melting of the facial bones, and rhinogenic sepsis.

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

The following sinuses are distinguished:

• 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 general symptoms of the disease, an ENT examination, laboratory tests and x-rays of the nasal 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 detected during palpation and percussion in the area of ​​the anterior wall of the frontal sinus, the medial corner of the eye on the affected side.

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

Frontitis can be of bacterial, viral, fungal etiology, and are complications of influenza and ARVI. The frontal sinus becomes inflamed during some childhood infections, for example, during severe diphtheria or scarlet fever.

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

Local 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:

• high temperature;
• chills;
• headache;
• decreased appetite;
• decreased performance;
• fever.

When the infection spreads to the bones of the ethmoid labyrinth, ethmoiditis develops; such a course of the disease in the patient indicates an aggressive flora and requires emergency initiation of antibiotic therapy, possibly in a hospital setting. Damage to the bones of the orbit leads to the penetration of bacteria into the outer meninges.

Treatment of medicinal inflammation of the frontal sinuses includes the use of drugs:

• vasoconstrictors (sprays, drops) to ease breathing;
• solutions for rinsing the sinuses (in the form of a spray with sea water or saline);
• antihistamines (especially if you have a history of allergies, 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 examination by a medical specialist; if indicated, the doctor will give a referral for physiotherapeutic procedures, some of which can be performed independently at home.

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

After a puncture, physical procedures are carried out only under the supervision of a specialist to prevent re-exacerbation of the disease. In the chronic course of frontal sinusitis, physiotherapy reduces atrophic changes in the mucous membrane and destructive changes in the bone structures of the paranasal sinuses. In case of allergic frontal sinusitis against the background of a bacterial infection, heating can aggravate the clinical picture due to increased swelling.

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

In the absence of contraindications, warming can be performed:

• potato(mash the boiled potatoes in a saucepan, holding your head above the steam under a terry towel and 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, breathe over the resulting steam for up to 6 minutes);
• menthol(star balm, eucalyptus oil, pour a glass of boiling water, breathe for 10 to 20 minutes).

Before starting to prepare 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, no lower than 15 cm.

Home treatments for inflammation of the frontal sinuses:

• washing(washing is carried out independently without pressure using a regular pipette or a soft spray bottle. Three full pipettes in each nostril over the sink 3-4 times a day will speed up the process of exudate outflow);
• inhalation(folk recipes are 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 blood supply to the sinuses);
• massage(to enhance blood 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 runny nose and acute rhinitis, especially if the disease is severe. With severe nasal congestion, you should not blow your nose with great effort, since the resulting turbulent streams of mucus are thrown into the paranasal sinuses and the mouth of the Eustachian tube.

Prevention includes hardening and means to increase the body’s immune properties. Taking Eleutherococcus or Echinacea, as one of the most accessible remedies, significantly increases a person’s resistance to infection. After suffering from frontal sinusitis, you should take a course of a vitamin-mineral complex to restore your health.

- This is an integral part of the paranasal cavities. This area is responsible for several functions, but the main task is to protect the body and normalize the pressure of the respiratory tract.

It is important to know that the frontal sinuses are located in close proximity to the brain, so inflammation in this area is especially dangerous. It is known that almost fifteen percent of people suffer from diseases in this area.

Unfortunately, it is impossible to prevent this side from the penetration of microbes, cyanobacteria, shigella, enterobacteria, enterococci and other numerous harmful elements, therefore, if an infection enters the body, in which the temperature rises and inflammation of the respiratory tract is characterized, as well as pain in the ears or head, the frontal area should be checked.

Sometimes the frontal sinuses are undeveloped or completely absent. With this anatomical structure, a person often complains of headaches.

Paranasal sinuses, localized in the forehead area, located just above the nose and in their structure are voids, and are connected to the area of ​​the nasal sinuses using a certain frontonasal fold. Penetration of harmful elements into the head area occurs precisely through this element. When microbes enter the nasal fold, the patient experiences severe discomfort and other unpleasant symptoms.

Note that the depression in the forehead is a paired organ and therefore the disease always occurs on both sides.

This side resembles a triangle measuring five centimeters, but the cubic size may vary depending on the individual structure of the patient’s body. Inside the sinus there is a mucous part that envelops all four parts of the frontal sinus:

1. Front side.
2. The lower part.
3. Medial region.
4. The back.

All four parts help protect the brain from the penetration of viruses and bacteria, as well as changes in atmospheric pressure, trauma to the skull, and the body’s adaptation to weather changes. In addition, this part is responsible for the following functions:

• transmission of sound impulses;
• increasing air temperature and adapting it for subsequent processing;
• moisturizing the mucous area;
• regulation of pressure in the nasal sinus;
• As the skull develops, this side reduces its mass.

The frontal sinuses are not developed - what does this mean?

It is known that at birth in newborns the frontal recess is not fully developed or is completely absent. Accessory cavities begin their formation in the mother's belly, but complete their formation only closer to 18 years or during puberty.

If, upon examination by a doctor, it was diagnosed that the child’s frontal sinus is not developed, there is no need to be afraid. The largest region, called the maxillary region, is formed only at adulthood, and before that time, each section of the frontal sinus can be.

If there is a suspicion of undeveloped frontal sinuses in an adult, the doctor may send for additional examinations. This is necessary if there is a risk of disease formation due to the penetration of viruses or microbes, as well as if there is a risk of a tumor or cyst.

It is known that the disease occurs when this occurs. This most often occurs when the area of ​​the lower septum is too elastic. In addition, if the right frontal sinus or both parts at once are undeveloped, the patient often complains of the temporal region, as well as feeling of constant pressure on the bridge of the nose.

A common cause of frontal disease is the anatomical structure. When examined on an x-ray at this time, it is clear that the paranasal cavities are filled with air. In this case, the patient is given treatment in which the general condition is normalized and excess air flows are removed. With poor quality or incorrect therapy, disease in this area leads to consequences that are dangerous for overall health.

It is important to note that children do not have frontal sinuses at all. Before the age of eighteen, they are just beginning to develop and form in the upper part of the eyes. Towards the completion of formation, this side grows into the mucous region of the nose and becomes covered with mucous membrane.

At the same time, the dissolution of the spongy bone occurs, which is located between the inner bone and the outer part of the skull.

Conclusion

With sharp pain in the head or nasal area, doctors often diagnose voids in the frontal sinus. In this case, patients complain of a feeling of pressure in the bridge of the nose, pain in the forehead, excessive production of tears, as well as anemia.

When palpating the wall of the eyes, sharp shooting pains often form. In this case, an individual course of treatment is prescribed.