In countless ENT diseases, malformations occupy a special place. With the advent of new diagnostic capabilities, hitherto unknown congenital anomalies are being identified, which are increasingly easier to distinguish from diseases, including inflammatory ones, requiring special treatment with antibiotics. This means that doctors do not prescribe unnecessary drugs to patients.
Features
The frontal sinus or frontal sinus is a cavity in the bone located behind the superciliary arch, shaped like an irregular pyramid with smoothed 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 inter-axillary 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 a secret. The latter moisturizes the nasal cavity, protects its mucosa from damage and various infections.
Anomalydevelopment are considered to be slit-like messages of the sinuses with the surrounding tissues. They are called dehiscences. For example:
- Message of the lattice maze with all sinuses.
- Holes in the lateral wall of the sinus. They bring her mucosa into contact with the meningeal and optic nerve, cavernous sinus, and internal carotid artery.
- Reducing the wall thickness of the sphenoid sinus. This anomaly promotes contact with the abducens and trochlear, oculomotor and trigeminal nerves.
Basic 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 spongy bone tissue.
There are several types of hypoplasia. Aplasia is a defect when development has not yet begun, while agenesis is when it began, but stopped at a certain stage. Atresia is the complete absence of a hole.
Classification of frontal sinus hypoplasia
There is congenital hypoplasia, acquired or secondary.
A doctor can diagnose a unilateral form of pathology. For example, there is hypoplasia of the frontal sinus on the right. What it is is clear from the title. Of course, this is not the only scenario. The 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 mandatoryasymmetry of the face on the side of the lesion. There may also be some defect or reduction in the size of the sinus on the opposite side. The method of diagnostic puncture in this case will be the most informative.
There is also bilateral hypoplasia and multilocular (trabecular) hypoplasia.
Epidemiology and etiology of the disease
As we have already said, underdevelopment of the sinuses can be unilateral and bilateral. 3-5% of people in the world do not have them at all (one or two). In 71% of cases, the sinuses are absent on one side, in 29% - on both sides. 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 typical for men.
Hypoplasia of the frontal sinuses develops as a result of adverse factors affecting the fetus: oligohydramnios, injuries, fever, chemicals, including drugs, alcohol and nicotine, maternal diseases, TORCH infections, intrauterine infections, birth injuries in the face.
Pathogenesis of frontal sinus hypoplasia
The formation of the frontal sinuses is a genetically programmed process. Every child is born without them, that is, a newborn baby does not have them at all. The 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 cm3, and in adults it reaches 7 milliliters.
Functionsfrontal sinus or frontal sinus:
- reducing the mass of the skull, making it easier;
- brain protection from injury, a kind of cushioning;
- acoustic function, the formation of a characteristic voice timbre;
- personality of facial features;
- moisturizing the mucous membranes of the nasal cavity.
Agenesia or atresia of the frontal sinuses can also be acquired. Such hypoplasia is essentially secondary sclerosis. This occurs as a result of past infections - frontal sinusitis, pansinusitis or injuries of the facial region. Their consequences are cavity development regression and bone thickening.
Methods for detecting this pathology
This includes the following:
- x-ray;
- magnetic resonance imaging;
- ultrasound;
- computed tomography;
- diagnostic puncture.
On the X-ray, you can see a decrease in the transparency of the sinus, which is often misdiagnosed as sinusitis, and the person is subjected to unreasonable treatment. Doctors consider this method unreliable.
According to experts, tomography today is the only method that reliably makes it possible to determine malformations and anatomical variants of the development of structures, including those forming the osteomeatal complex. Computed tomography can be used to determine which sinus is smaller, its bone walls are pressed into the sinus or thickened, but retain smooth and clear contours, nas althe cavity is dilated or not.
Symptoms and treatment
As such, there are no symptoms, and it does not matter if the right frontal sinus is hypoplastic or the left one. In some cases, a person may experience mild discomfort. There may be discomfort in the bridge of the nose and above, in the corner of the eye, nasal congestion, lacrimation. Usually this is a sign of regressive agenesis, that is, secondary, developing as a result of changes in the mucous membrane after an infection.
According to scientists, a congenital anomaly can be considered as a variant of development and even as a variant of the norm. It comes to light incidentally and does not demand 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 to treat the hypoplasia of the frontal sinuses, you can only engage in prevention.
This is done by eliminating harmful factors affecting the fetus. During the planning period for pregnancy, treatment of all diseases of the mother, especially infections, endocrine problems, should be carried out. It is necessary to exclude all chemical attacks on the fetus: for example, you should change a job that is unhe althy.
Consequences of frontal sinus hypoplasia
Recent clinical studies have shown that frontal sinus hypoplasia is not a cause and does not affect the 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 can be acute: catarrhal, purulent, polymeric, and chronic. These diseases require specific treatment with antibiotics, antivirals, and possibly antifungals. This inflammatory process threatens with such serious complications as meningitis, arachnoiditis and encephalitis (these are inflammations of the hard arachnoid 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. Doing something on your own does not make sense, 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.
