In countless ENT diseases, malformations occupy a special place. With the advent of new diagnostic capabilities, hitherto unknown congenital anomalies are revealed that are becoming easier to distinguish from diseases, including inflammatory ones, requiring special treatment with antibiotics. This means that doctors do not prescribe unnecessary medications to patients.
Features
The frontal sinus or the frontal sinus is the cavity in the bone located posterior to the superciliary arch that resembles an irregular pyramid with smooth corners. Its sides: the outer wall of the frontal bone in front, the upper wall of the orbit below, the posterior wall is the inner side of the frontal bone, bordering the frontal lobe of the brain, the inner wall is, in fact, the interdigital septum. The norm is their asymmetry, that is, the partition is always beveled to the side.
From the inside, the frontal sinus is lined with a mucous membrane containing goblet cells that produce secretions. The latter moisturizes the nasal cavity, protects its mucosa from damage and various infections.
An abnormality of development is considered to be slit-like communications of the sinuses with surrounding tissues. They are called degeneration. For instance:
- The communication of the trellis maze with all the sines.
- Holes in the side wall of the sinus. They lead to the contact of its mucosa with the meningeal membrane and optic nerve, cavernous sinus and internal carotid artery.
- Reducing the wall thickness of the sphenoid sinus. This anomaly promotes contact with the abduction and block, oculomotor and trigeminal nerves.
Key Definitions
It is necessary to consider the basic concepts. Hypoplasia is a varying degree of underdevelopment of some anatomical unit up to its complete absence. This is a congenital defect of the above cavity, which is the result of incorrect resorption of the trabecular bone.
There are several types of hypoplasia. Aplasia is a defect when development has not yet begun; agenesis is when it started, but stopped at a certain stage. Atresia is the complete absence of a hole.
Classification of hypoplasia of the frontal sinuses
There is congenital hypoplasia, acquired or secondary.
The doctor can diagnose a one-sided form of pathology. For example, there is hypoplasia of the frontal sinus on the right. What is it, it’s clear from the name. Of course, this is not the only scenario. Hypoplasia of the left frontal sinus also occurs with the same frequency. What is it, the doctor will tell, if he finds such an anomaly. It is characterized by the obligatory asymmetry of the face on the side of the lesion. Some kind of defect or reduction in the size of the sine on the opposite side is also possible. The method of diagnostic puncture in this case will be most informative.
There is also bilateral hypoplasia and multicamera (trabecular).
Epidemiology and etiology of the disease
As we have already said, the underdevelopment of sinuses can be one-sided and two-sided. 3-5% of people in the world have none at all (one or two). In 71% of cases, sinuses are absent on the one hand, in 29% - on two. In 45% of cases, hypoplasia is observed, in 55% - complete aplasia. Quite often there are multi-chamber sinuses - this is called trabecular hypoplasia. This pathology is characteristic of men.
Hypoplasia of the frontal sinuses develops as a result of adverse factors affecting the fetus: oligohydramnios, trauma, fever, chemicals, including drugs, alcohol and nicotine, maternal diseases, TORCH infections, intrauterine infections, and birth injuries in the face.
Pathogenesis of frontal sinus hypoplasia
The formation of the frontal sinuses is a genetically programmed process. Each child is born without them, that is, a newborn baby does not have them at all. Frontal sinuses normally begin to develop from about 7-8 years old and by the age of 25 this process ends. Their cavity in an eight-year-old child is a maximum of 0.7 cm 3 , and in adults reaches 7 milliliters.
Functions of the frontal sinus or frontal sinus:
- decrease in the mass of the skull, its relief;
- protection of the brain from injuries, a kind of depreciation;
- acoustic function, the formation of a characteristic voice timbre;
- personality facial features;
- moisturizing the mucous membranes of the nasal cavity.
Agenesis or atresia of the frontal sinuses can be acquired. Such hypoplasia is essentially secondary sclerosis. This occurs as a result of past infections - frontal sinusitis, pansinusitis or facial trauma. Their consequences are regression of the development of the cavity and compaction of the bone.
Methods for identifying this pathology
This includes the following:
- X-ray examination
- Magnetic resonance imaging;
- ultrasonography;
- CT scan;
- diagnostic puncture.
On an x-ray, a decrease in the transparency of the sinus can be observed, which is often incorrectly diagnosed as sinusitis, and the person undergoes unreasonable treatment. Doctors find this method unreliable.
According to experts, tomography today is the only method that reliably gives the opportunity to identify malformations and anatomical options for the development of structures, including those that form the ostiomeatal complex. Using computed tomography, it is possible to determine which sinus is smaller, its bony walls are pressed into the sinus or thickened, but retain even and clear contours, the nasal cavity is dilated or not.
Symptoms and treatment
As such, there are no symptoms, and it does not matter, hypoplasia of the right frontal sinus or left. In some cases, a person may experience mild discomfort. Unpleasant sensations may occur in the nose and above, in the corner of the eye, nasal congestion, lacrimation. This is usually a sign of regressive agenesis, that is, secondary, developing as a result of changes in the mucous membrane after an infection.
According to scientists, the congenital anomaly can be considered as a variant of development and even as a variant of the norm. This is detected by chance and does not require any treatment and observation. On the contrary, in no case should hypoplasia be confused with the inflammatory process and sinus cysts. Since in this case there is no need for the treatment of hypoplasia of the frontal sinuses, you can only deal with prevention.
This is done by eliminating harmful factors affecting the fetus. During the period of pregnancy planning, treatment should be carried out for all diseases of the mother, especially infections, problems of an endocrine nature. It is necessary to exclude all chemical attacks on the fetus: for example, work that is harmful to health should be changed.
Consequences of hypoplasia of the frontal sinus
As a result of recent clinical studies, it has been found that hypoplasia of the frontal sinus is not the cause and does not affect the occurrence of inflammation of the mucous membranes of the paranasal sinuses or sinuses, which is called sinusitis.
This is frontal sinusitis, sinusitis, ethmoiditis or inflammation of the mucous membranes of all sinuses at once (pansinusitis). Such diseases are complications of catarrhal infectious pathologies of the upper respiratory tract, that is, the throat and nasopharynx, and require special examination and treatment by an otorhinolaryngologist.
Sinusitis is acute: catarrhal, purulent, polymeric, as well as chronic. These diseases require special treatment with antibiotics, antiviral and, possibly, antifungal drugs. This inflammatory process threatens with such serious complications as meningitis, arachnoiditis and encephalitis (these are inflammations of the hard cobweb-like membrane of the brain and the substance of the brain).
Science does not stand still, new methods of treating diseases are being created, drugs are being produced that can quickly and easily cure and correct defects. But all appointments are made exclusively by the doctor, based on the results of the examination. It does not make sense to undertake something on your own, since in this case it can lead to undesirable consequences. Therapy is carried out only under the supervision of the attending physician and according to his recommendations.