Endoscopic Management of Different Pediatric Frontal Sinus Pathologies
Although paranasal sinus disease has been extensively studied in literature, it has yet to be comprehensively studied in the pediatric population. The difficulty arises as a result of the variability in the size, shape, and pattern of development of each of the sinuses, along with a wide spectrum of pathologies that can affect them. These pathologies include congenital malformations, traumas, neoplasms, and inflammatory etiologies. Among all the paranasal sinuses, the frontal sinus is of particular significance due to its close anatomical relationship to the orbit and anterior skull base, which makes it vulnerable to complications, caused by either the disease or surgery The aim of this article was to study the clinical presentation, diagnosis, and endoscopic management of six different rare frontal sinus pathologies in pediatrics, which include extensive allergic fungal sinusitis, mucoceles, osteoma, superior sagittal sinus thrombosis, CSF leak, and subdural empyema.. All were managed with an image-guided endoscopic surgical approach in King Fahad Specialist Hospital, a tertiary referral hospital in Dammam, Saudi Arabia.
Authors retrospectively studied all pediatric patients with frontal sinus pathologies presenting to our center, King Fahad Specialist Hospital, Dammam, Saudi Arabia, from the period of 2006 to 2020.
A total of 8 patients presented to hospital with different frontal sinus pathologies. 5 of them were males, and 3 were females with an age of presentation ranging from 7 to 17 years. The diagnosis and localization were performed through computerized tomography without contrast and magnetic resonance imaging, when indicated. All cases were primarily managed with endonasal endoscopic approaches successfully without complications and with no recurrence evident upon follow-up.
Just like in adults, paranasal sinuses in pediatrics can harbor a large variety of pathologies. These pathologies range from self-limiting diseases to life-threatening conditions. In this case series, we present to you eight different cases of frontal sinus disease in pediatrics, which represent a fairly rare entity reported in the literature.
Acute sinusitis is highly prevalent in pediatrics. The surgery comes into the scene when the infection causes intracranial or intraorbital complications. Among all the paranasal sinuses, the frontal sinus is the usual culprit when it comes to complications, Generally, intracranial complications are rare, with only 3% of pediatric patients developing such complications. These complications include meningitis, subdural or epidural abscess, and cavernous sinus thrombosis.
Diagnosis of acute sinusitis is especially challenging in pediatrics because patients often lack the typical nasal symptoms of the disease; thus, most patients are diagnosed upon the development of complications. Intracranial complications should be suspected in any pediatric patient presenting with persistent high-grade fever, progressive headache, and neurological symptoms.
Subdural empyema is recognized in the literature as the most common sinogenic intracranial complication, making up to 85% of all complicated cases of sinusitis. Management of such cases generally includes the administration of broad spectrum antibiotics and surgical drainage.
A mucocele is a mucous sac lined with an epithelial lining. Frontal mucoceles are usually rarely encountered, with only sporadic reports. Identified underlying causes include chronic inflammation and trauma, with prior sinus surgery being the most common cause. Mucoceles are managed surgically. #e surgical approach may vary from endoscopic sinus surgery to craniotomy and craniofacial exposure, which ultimately depends on the extent of disease, whether intracranial or extracranial extension exists, and patient-specific characteristics.
Endoscopic approaches are paramount when it comes to the pediatric population, as these approaches provide excellent results with no facial scarring and minimal morbidity.
In this case series, six different frontal sinus pathologies were managed by an endoscopic approach, with excellent recovery and no recurrence upon follow-up demonstrated. This approach enabled excellent visualization of the pathologies, accurate localization, adequate drainage, and repair or grafting when needed. Authors recommend the use of this approach to be the rule, especially when the disease is confined to the frontal sinus, as it provides superior cosmetic outcomes along with minimal postoperative morbidity as opposed to open approaches.
Source: Ali Almomen, Zainab Alshuhayb, Hussain Alsheef; Hindawi International Journal of Otolaryngology
https://doi.org/10.1155/2022/1078178
