Frontal sinus cyst

Today, medicine is increasingly confronted with various pathologies of the paranasal sinuses. These are various congenital, genetic anomalies, and the consequences of injuries, injuries, and all sorts of complications of the transmitted infectious and inflammatory processes. Increasingly, there are hyperplastic processes, neoplasms. In many patients, the frontal sinus cyst is diagnosed, which is a benign neoplasm. 

[1], [2], [3], [4]

Epidemiology

Most often observed in patients aged 11 to 20 years. This category accounts for approximately 54% of the pathology. The least common cyst can be found in patients in the middle age group (up to 7%). In people aged 55 to 65 years, a cyst occurs in 30% of people, and in old age, in people older than 65 years, such neoplasms are not found. In all 100% of cases it is located strictly in the frontal sinus. In 47% of cases the cyst is filled with mucous contents, in 50% - purulent exudate. In 3% of cases, a pneumatic target is observed.

[5], [6], [7], [8], [9]

Causes of the cysts of the frontal sinus

Often the cause of cyst formation is mechanical damage to the frontal sinus, or inflammatory process in the nasopharynx, sinus, ear. Often the cause is a long front, which later develops into a cyst. As a primary infection, the cyst develops extremely rarely. A prolonged runny nose, frontal sinusitis, tonsillitis, tonsillitis often result in inflammation of the frontal sinus, and then the formation of a cyst.

[10], [11], [12], [13],

Risk factors

The risk group includes people who are prone to frequent and long catarrhal diseases, inflammations in the upper respiratory tract, as well as those with maxillary sinusitis and other inflammations of the sinuses. The risk of head trauma, mechanical damage to the head, or sinuses increases substantially.

[14]

Pathogenesis

Normally, the frontal sinus inside is covered with a layer of epithelial cells. It contains glands that produce secretions. It is aimed at protecting the mucous membrane from drying out, bacterial infection, moisturizing the nasal passages. Also this liquid softens, humidifies incoming air. Due to various causes of mucus, excessive amounts can be produced, or there may be a blockage in the outflow ducts, through which the liquid must leave the sinuses. Despite the impossibility of excretion of mucus, its synthesis continues. As a result, a cavity is formed, filled with mucous contents. Over time, an infection can join, resulting in a neoplasm (cyst).

[15], [16], [17], [18], [19], [20]

Symptoms of the cysts of the frontal sinus

In cyst, as a rule, blood circulation is disturbed, lymphatic exchange becomes more difficult. This leads to the development of edema, redness, condensation of the mucosa. It has negative consequences for the entire respiratory system, because through numerous ducts, all the sinuses are connected to each other and to the nasal cavity. When tapping and lowering the head, pain is often felt. Edema can intensify and spread to other organs, eyes. The most dangerous is the spread of edema or the ingress of the resulting exudate into the meninges and the brain, since with the help of the orbit the frontal sinus has a direct connection to the brain.

A person with a cyst in the frontal sinus area develops pain in the area of the sinus and nearby areas. Often the pain arises in the region of the nose, the eye, pushes into the head. Pain can radiate to other parts of the body. If you do not heal the cyst, the cases of pain become more frequent, they become pulsating, there is a strong pain in the temples. This condition is often accompanied by dizziness, weakness, nausea. A frequent complication is frontal - inflammation of the frontal sinus. When the infection passes into the eye, conjunctivitis develops , the vision is reduced significantly, a constant flow of tears from the eyes appears.

Dangerous inflammation that occurs against the background of the cyst, because they can cause inflammation and lead to the formation of pus, which clogs the ducts between the sinuses. Blockage of sinuses with pus can lead to the need for urgent surgery. The danger is also that any benign cyst can always develop into a malignant, cancerous tumor.

They are often detected randomly during the examination. If the cyst proceeds with severe symptoms, manifests itself in the form of headaches, violation of nasal breathing. Frequent sinusitis, sinusitis, frontal sinusitis and other inflammatory processes in the sinuses can indicate the development of the pathological process and the formation of cysts. A person with a cyst can often get sick, recovery is slow, the illness is protracted. A person may be concerned about pain in the orbit. With palpation neoplasm is probed well enough. In addition, any pressure, or even tilt, a sharp turn of the head, can cause severe pain. Also, palpation is often accompanied by a specific sound. If you press strongly, the contents can come out through the resulting fistula.

Also, in severe forms, it becomes anomalous, which leads to a visual impairment - diplopia may occur, in which the image is doubled, tearing appears.

[21], [22]

First signs

It should be remembered that the cyst is often asymptomatic, so it is important to undergo preventive examinations, especially if a person falls into a risk group. Otherwise, you can recognize by such signs: nasal congestion, difficulty breathing, periodic or permanent frontitis, which are an inflammatory process. With palpation, tenderness can be detected. As the size of the cyst increases, soreness increases.

[23], [24], [25]

Cyst of right frontal sinus

You can recognize the cyst of the right sinus primarily by soreness in the area of the right frontal lobe, nasal congestion, headache. You need to treat as quickly as possible. If the pathology is not treated in a timely manner, fistula may develop, which is an opening through which pus pours out and serous contents. Excess can occur in neighboring areas. The most dangerous is the outflow in the brain, the orbit. Often, the cyst can be cured by conservative methods (only if the treatment starts on time).

In other cases, treatment with surgical methods is indicated.

Often the diagnosis is based on subjective sensations. It is not excluded and such an option, when pathology is detected by accident, during the diagnosis of another disease. The main diagnostic method is the radiograph. During the treatment you have to deal with ophthalmologists and neurologists. If the information obtained during the radiographic examination is insufficient, CT and MRI are performed. In addition, various procedures are applied to restore local immunity. Remove the edema and wash the frontal sinuses. Often the emptying of cystic contents occurs spontaneously through the nose. It should be borne in mind that there is no clinical recovery in this situation. Often there are relapses, the cyst continues to be filled with new contents. After spontaneous emptying, further treatment should be carried out. The goal of such treatment should be to reduce hypertrophic mucosa. This allows you to eliminate numerous symptoms of the disease. Earlier, frontotomy was conducted. Today, this method is practically not applied, since it is highly traumatic. Often there are bleeding, postoperative complications. The recovery period lasts a very long time. There are cases of postoperative stenosis.

[26],

Cyst in the left frontal sinus

A cyst means a small spherical cavity. It has elastic walls and is filled with liquid from the outside. Mucous swells, a cavity is formed, which is filled with the formed liquid. Under pressure of the liquid the cavity is constantly expanding. Of interest is the fact that the cyst can be completely asymptomatic. Sometimes it manifests itself as pain, pressure in the area of the left sinus, which increase with tilt, movement. In the course of a routine examination, an otolaryngologist does not show any pathology. Often, for its detection requires special instrumental diagnostics. Often used X-ray examination, which allows you to identify pathology by visualizing it in the image.

Treatment is often conservative. Only if it is ineffective, surgical treatment is used, during which the cyst is removed. Endoscopic methods are used more often. Currently, the open operation is practically not applied.

In the course of conservative treatment, drainage of the cystic cavity is often used, aimed at gradual resorption of the cyst. Treatment takes place in several stages. At the first stage, the contents of the sinus are removed by washing using various drainage means. Many experts prefer to use phytopreparations, homeopathic remedies.

At the second stage, therapy is performed to fix the result, the final removal of fluid from the cavity. At this stage, it is important to remove the swelling and hypertrophy of the mucosa. This allows you to open the natural sinuses ducts.

At the third stage, treatment is performed, aimed at resorption of the cyst. In this case, special medicinal drops, containing tanning substances, are instilled in the nose. When you hit the cyst, a reaction occurs, during which the  fistula cyst  gradually dissolves.

Diagnostics of the cysts of the frontal sinus

In order to diagnose a cyst, you need to contact an otolaryngologist. He will conduct a survey and an examination of the patient, after which he will assign the necessary additional studies. Sometimes the cyst can be palpated with normal palpation. But all on the basis of only clinical studies do not diagnose the diagnosis, so it will be necessary to conduct several refining laboratory analyzes and instrumental studies.

[27], [28], [29], [30]

Analyzes

Of the tests, a clinical blood test is first appointed . If necessary, a biochemical blood test, an expanded immunogram, rheumatological tests, which will give an opportunity to approximately determine the nature and severity of the lesion, the neglect of the pathological process can be assigned .

In the study of blood, the highest diagnostic value is the level of leukocytes. He will immediately differentiate the cyst from a malignant neoplasm. If there are any malignant tumors in the body, organic leukopenia is detected, that is, a decrease in the number of leukocytes circulating in the blood. This may indicate an easy stage of bone marrow dysplasia, or an already developed aplasia, as a result of which the bone marrow is replaced by fat tissue.

The increase in leukocytes will indicate that the body has an acute inflammatory or infectious process, as well as hyperplastic processes that result in a new growth in the body. It is benign, it is often a cyst or polyp. But such an analysis can not be the basis for the diagnosis. It allows only to assume the direction of the main processes, since a similar picture can be observed in other diseases, for example, during prolonged bleeding, after recent severe infections, against bacteremia, under the influence of toxic substances, in necrotic processes, burns, endocrine disorders. As we can see from the presented, far from complete list, further research will be required for the final diagnosis.

[31], [32], [33], [34]

Instrumental diagnostics

Quite often, the microscope method is used, during which the nasal cavity is probed with rubber catheters. Sometimes special metal probes are used. Assess the condition of various sinuses, you can identify the cyst, examine it. On the basis of visual inspection, it is possible to make a preliminary conclusion about the nature and severity of the tumor. Often such a study is conducted using local anesthesia.

A modern and highly informative method of research is computed tomography, which makes it possible to comprehensively assess the condition of the nasal cavity and paranasal sinuses, reveal inflammatory and infectious processes, anomalies in it. The advantage of the method is that it allows to conduct research in various projections, has no contraindications and side effects, and also allows to reveal the tumor at the initial stages of its formation. You can assess the condition of soft tissues and the bone system.

X-ray of the frontal sinus

The main method of instrumental research is X-ray. It makes it possible to visualize the tumor, scan sinuses in various projections and to identify possible pathologies, as well as the nature of the tumor, the degree of its severity, the size, tissue structure and localization features. Based on this method, you can put a differential diagnosis.

Differential diagnosis

First of all, the essence of differential diagnosis is reduced to the need to separate the cyst from other tumors and neoplasms. It is determined whether it is malignant or benign, if the risk of its transformation. For this, a biopsy is usually performed with a tissue sample taken for further histological examination. So, from a tumor take a piece of tissue, then it is placed in a sterile test tube or a petri dish.

After that, under sterile conditions, a seeding is carried out on nutrient media intended for culture of tissue culture. After primary cultivation under optimum conditions (usually in a thermostat or incubator), the cultures are reseeded to selective media for further identification. After this, a histological examination of the tissue and the determination of its nature are carried out. The direction and nature of growth can determine the type of tumor, predict its further growth. This is the basis for the final diagnosis.

Treatment of the cysts of the frontal sinus

Treatment of the fistula cyst includes measures to eliminate the risk factors that contribute to the development of pathology, antibacterial therapy, restoration of normal circulation and respiration, restoration of the normal state of tissues (swelling, redness, redness), gas exchange, organism, climatotherapy. It is important to exclude smoking and drinking alcohol. If these agents are ineffective, surgical treatment is used.

Prevention

The basis of prevention is the timely detection of pathology, and taking the necessary measures to eliminate it. For this, it is necessary to undergo regular preventive examinations, carry out the necessary examinations, and promptly treat the associated comorbidities. Also, prevention is reduced to proper nutrition, maintenance of the necessary level of immunity, normalization of microflora, sanitation of the foci of the infectious-inflammatory process. It is necessary that the body receives the right amount of vitamins and trace elements.

[35]

Forecast

With timely detection of pathology and taking the necessary measures, the prognosis may be favorable. If the cyst is detected at an early stage, it can be cured by conservative methods. If they are ineffective, surgical methods are used. In an operative way, you can remove almost any cyst, so if it is done in time, the prognosis may be favorable. If you do not remove it in time, there is a high risk of complications. The most dangerous are inflammation, blockage of the sinus ducts with pus and liquid exudate, the spread of the infectious and inflammatory process to the membranes of the brain, and malignant degeneration.

[36], [37]

Can I live with a frontal sinus cyst?

With a cyst live quite a long time. The quality of life is significantly reduced. It is better to remove it, because life with a cyst is a constant risk. At any time, complications may occur, the inflammation of the brain may develop, which will result in death or disability. Also it is necessary to remember that the cyst of the frontal sinus will burn at any moment to transform into a cancer tumor.

[38], [39], [40]