Pediatric frontal sinusitis

Abstract

Dr. Casiano has presented detailed anatomy and embryology of the frontal sinus in Chapter 3. It is however, important to consider certain salient features when considering frontal sinusitis in the pediatric group. The reader is referred to the studies by Onodi [10] and Wolf et al. [13] for the development of the frontal sinus in Table 15.1. These developmental studies are only guidelines, as the development of the frontal sinus is the most variable of all the paranasal sinuses, and the final size of the sinus can vastly differ among patients of the same age group. Certain information must to be considered when evaluating frontal sinusitis in children: Possible etiologic factors The possibility of response to medical therapy Findings of imaging studies before considering more aggressive medical or surgical therapy A classic study by Kasper [9] in which he dissected 100 pediatric cadavers remains applicable today as he noted: "Evidence is seen in the embryo at the end of the third or early part of the fourth month of a beginning extension forward and upward of the middle nasal meatus. This early extension is the forerunner of the frontal recess and, strictly speaking, is the first step in the formation of the frontal sinus and certain anterior group of ethmoidal cells." From this extension children develop frontal sinuses at varying ages: In children less than 5 years old, approximately 3% of the children have frontal sinuses [2] Between ages 5 and 10 years, approximately 50% have frontal sinuses At the age of 11 years and older, 65%-75% have frontal sinuses As previously noted, the frontal sinus development is not completed until late teenage years. However, the authors have personally seen children as young as four with a well developed frontal sinus (Fig. 15.1). Sinusitis in children with cystic fibrosis (CF) is a frequent problem,which often poses unique and difficult management issues. It is well known that general CF patients have less well-developed sinuses. In the excellent study by Eggesbo et al. in which they analyzed 116 CF patients against controls, they found that 44% of the CF patients studied had bilateral aplasia of the frontal sinuses [3]. It should also be noted that 30% of those CF patients studied had a low ethmoid roof, which must alert the surgeon to this anatomical feature when considering surgery, as it may potentially lead to intracranial complications. © Springer-Verlag Berlin Heidelberg 2005.