Medical expert of the article
New publications
Hypoplasia and aplasia of the frontal sinuses
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Of particular interest is the fact that a person has an organ that may or may not be present, and nothing will change from this. This applies in the first place, frontal sinuses. Hypoplasia and aplasia of the frontal sinuses may develop, and this does not entail any serious consequences. A person can have two frontal sinuses, or one. More than 5% of people on the planet does not have frontal sinuses.
Epidemiology
In 12-15% they can be completely absent. At the same time, 71% of cases are absent from one side only, 29% are absent from both sides. In 45% of cases, hypoplasia is observed, in 55% - complete aplasia. Quite often a multichamber sinus is observed. In most cases, it is divided by a bone septum into two cavities. The volume of the underdeveloped sinuses usually does not exceed 0.5 ml. But sometimes there are also huge sinuses, the volume of which is approximately 500 ml.
[3],
Causes of the hypoplasia and aplasia of the frontal sinuses
There can be many reasons. Most of them are genetically conditioned. Some were formed during the period of intrauterine development. Formation of frontal sinuses and their anomalies are due mainly to endogenous or exogenous factors that affect the development of the fetus. When hypoplasia occurs incomplete fusion of facial bones, with aplasia - they do not fuse at all.
The formation of hypoplasia or aplasia can be indirectly caused by the transferred infectious diseases, persistent viruses, uncontaminated infections, progressive fungus, incompletely cured acute rhinitis, swelling in the sinus of the nose, in any other facial area. Nasal trauma, allergic reactions, the consequences of surgical interventions, neuralgic diseases and impaired metabolism also contribute to improper frontal sinus formation.
[4],
Risk factors
People who have relatives with genetic anomalies in the development of the frontal sinuses are at risk. Children at risk of exposure to various adverse factors, with complicated pregnancies, and heavy births are also at risk. If a child is injured during childbirth, especially the facial part of the skull, the risk of hypoplasia or aplasia increases substantially. Also risk children who in early childhood or during fetal development suffered severe infectious diseases, allergies, neuralgia.
Pathogenesis
They are the paranasal sinuses, which are located in the frontal bone and are directed backward, beyond the area of the superciliary arches. They have four walls, while the lower one is the upper wall of the eye sockets. Using the posterior sinus walls, the sinus is separated from the frontal lobes of the brain. On the inner side of the sinus lined with a mucosa.
At birth, the frontal sinuses are completely absent, they begin to form at the age of 8. The maximum size is achieved after puberty. Most often there is no symmetry between the sinuses, the bony septum deviates from the median line in one direction or another. Sometimes additional partitions are formed. They stop developing by the age of 25.
Dimensions can be different. Sometimes there is a delay in the normal development of sinuses, or they simply do not develop. Similar phenomena can develop against the background of the inflammatory process, which is transmitted from the focus of infection to the frontal sinuses.
As a result of the development of inflammation, reverse development of the sinuses may occur. By hypoplasia means a condition in which the process of sinus development began normally, and then either a delay or reverse development began. Under aplasia, the absence of frontal sinus formation is implied. As the pathology develops, ossification occurs, during which the bone in the region of the superciliary arches becomes denser.
[7]
Symptoms of the hypoplasia and aplasia of the frontal sinuses
Quite often, pathology generally does not bother the person. She finds out quite by accident during the examination. But sometimes there are cases when such pathologies give a person discomfort. There may be a space in the place of sinus localization, filled with fluid or air. When pressed, a cavity is formed, redness occurs.
The place of the frontal sinus is formed edema, the mucosa is compacted. When tapping or tilting the head down, there may be soreness, a feeling of pressure. Pain can be felt in the eye area, especially in the corners of the eyes, from the inside. Many patients note increased tearing, swelling of the eye area, nose bridge. Nasal congestion is felt , sometimes mucous, serous or purulent discharge can appear.
The condition can not disturb a person if it is in a healthy state, but begins to bring discomfort and aggravate the condition during the disease. Against the backdrop of any disease, especially the common cold, severe pain develops in the sinus area, transmitted to the head. Less often, the pain radiates to other parts of the body. Later, cases of pain can become more frequent, it can acquire a pulsating character. Sometimes there is a feeling of heaviness, a throbbing pain in the temples.
The condition is accompanied by chills, dizziness, weakness. A front can develop , which must be treated. If treatment is neglected, the disease is transmitted to the bones of the orbit, and through them to the outer meninges.
As the earliest signs of pathology, pain in the forehead area, which is enhanced by tilting, tapping, palpation, can serve . Pain can intensify from sudden movements, jumps, sudden changes in position and even when you try to blow your nose. In many people, the usual blowing of the nose leads to the development of spasm and dizziness.
Pressure can be felt in the forehead area, or the areas are filled with air, liquid, which move when moving their side to the side. Sometimes the sensations give a person discomfort, sometimes do not cause any concern. When the first signs appear, you need to see a doctor as soon as possible and undergo a checkup.
Hypoplasia of the right frontal sinus
The term implies an insufficient development of the frontal sinus. That is, it began its development first, after which it slowed down or stopped. May occur with symptoms, may be asymptomatic. Often found during examination by percussion and palpation. When tapping, a characteristic percussive sound is heard, and pain during palpation can also be detected.
Indigestion can indirectly indicate hypoplasia. The left side is slightly larger than the right side. There may be swelling, pain that increases with tilt. There is a feeling that the fluid flows to the right side of the forehead. All this can be accompanied by temperature and general weakness. Sometimes there are abundant discharge of mucous or purulent.
The examination is carried out mainly in the direct or lateral projections, which allows to assess the volume and depth of the sinus, as well as to reveal in it the presence of a pathological process, pathological substances. It is necessary to make sure that the sinus is not inflamed and there is no purulent or other exudate in it. This is due to the fact that the frontal sinus is connected through the orbit to the brain, respectively, in the presence of infection, it can quickly be transmitted to the brain, causing various infectious diseases, including meningitis.
Hypoplasia of the left frontal sinus
This term means that the left frontal sinus is not developed enough. At the same time, the right one is fully developed. Usually, the sinus begins its development, then for any reason it slows down, or completely stops development. Often, this pathology does not manifest itself in any way, it proceeds absolutely asymptomatically, without causing any discomfort to the patient. You can diagnose it during the examination. It is easily detected with percussion and correct palpation, causing painful sensations.
Aplasia of the left frontal sinus
Often, aplasia is a hereditary pathology and means a complete absence of frontal sinuses, their underdevelopment. Pathology is formed when the process of normal formation of various cranial parts is disturbed. First of all, the formation of the facial surface of the brain is irregular.
Occurs often with a small indentation or a confluence of the frontal lobe of the head. At the same time, there is a complete or partial narrowing of the other paranasal sinuses and nasal canal. There is excessive pressure on the front or nasal wall, mild asymmetry. In the canine fossa region, slight indentation can be observed. It ends with a complete fusion of the nasal and facial walls.
Aplasia of the right frontal sinus
Unilateral pathologies develop quite often. In this case, facial asymmetry is well developed. The main feature is also the insufficient development of the opposite sine. At attempts of a puncture by means of a puncture, the needle gets at once in soft tissues of a cheek. Most often found in men. Often becomes the cause of sinusitis, affects the frequency of formation of pathology of nasal passages. Pain is usually heard only when palpating or percussion.
Complications and consequences
The disease in many is absolutely asymptomatic, no consequences and complications do not cause. Usually, aplasia does not give a person any inconvenience. Whereas hypoplasia can lead to some complications. For example, underdeveloped sinuses can be complicated by sinusitis, otitis, other inflammatory and exudative processes. The frontal sinus by means of various channels is connected to other paranasal sinuses, nasopharynx, ear and nasolacrimal canal. As a result, the existing infection can persist in these channels as a single system, transmitting an infectious and inflammatory process to any of the sites.
The danger is that the frontal sinus is connected through the bottom of the orbit with the brain. Accordingly, inflammation can be transmitted to the brain. Also, if the bones are thin and porous, the infection can penetrate into the brain areas, causing inflammation of the meninges.
Outside, there may be severe swelling, redness, which is transmitted and spread to other sinuses and areas of the body. The danger is that the entire system may be affected. In this case, along the descending pathways, the infection can spread to the lungs, bronchi, and trachea, causing corresponding inflammatory reactions. May affect the eye, contributing to the development of the inflammatory process. Most often, conjunctivitis develops , vision is impaired, tear appears.
The danger is the accumulation of infection, which is accompanied by general weakness, fever, reduced care and efficiency. Pus, purulent-mucous exudate may be formed, which is capable of further spread to neighboring areas, especially the brain, which can have extremely negative consequences.
Also, the presence of pus in the sinuses is dangerous, since the canal that connects the nasopharynx with the sinuses is very thin, and can easily be clogged by purulent masses. Also, in the presence of pus, the mucosa increases, which makes the canal narrower. Thus, the excretion of pus will be disturbed, a surgical operation may be required. It is important to conduct it in a timely manner to prevent the ingress of pus into the meninges.
[8]
Diagnostics of the hypoplasia and aplasia of the frontal sinuses
Diagnosing the malformations of the paranasal sinuses is usually not difficult. The diagnosis can be made already on the basis of a survey and a visual examination of the patient, as the clinical picture is sufficiently pronounced and specific. A standard physical examination is carried out using clinical research methods. Using percussion, you can identify a characteristic sound that will indicate the development of hypoplasia or aplasia. With the help of palpation, you can feel the frontal sinus, determine its border, volume. Auscultation is rarely used, because in this case it is not very informative.
If there is insufficient information to confirm the diagnosis, special laboratory and instrumental studies can be prescribed. Differential diagnosis is carried out if several diseases have a similar clinical picture and make it difficult to differentiate.
Analyzes
Assign standard studies: a blood test, urine. They allow us to identify in the body such violations as inflammatory, or infectious process, allergic or parasitic reactions. Inflammation and infection will be indicated by an increase in the blood of the ESR, shift of the leukocyte formula to the left, the presence of a large number of neutrophils, leukocytes, and lymphocytes. The presence of allergies will be indicated by a high level of eosinophils, basophils, and a rise in histamine in the blood. With parasitic infection, there will also be an elevated level of eosinophils.
A bacteriological study may be required in the presence of inflammation and the need to identify the causative agent of the disease, to select the optimal dosage of the drug. When suspected of a viral infection, virological and bacteriological studies are performed. If suspected of an allergic reaction, allergic tests and immunoglobulin E assays are performed , which is the main indicator of allergy in the body.
Instrumental diagnostics
To conduct the study using the method of radiography, which allows you to view the various projections of the main sinuses of the nose, including the frontal, to identify possible foci of infection, signs of inflammation, bone defects. You can differentiate hypoplasia from aplasia complete, determine which side is the pathology.
No less informative method is micrinoscopy, in which the nasal cavity is probed with rubber catheters or metal probes. The study provides an opportunity to assess the state of various sinuses, nasal passages, and also determine the degree of underdevelopment of sinuses, or to diagnose their complete absence. Carried out under local anesthesia.
The most informative method is computed tomography, with which you can comprehensively assess the condition of the nasal cavity and paranasal sinuses, identify possible anomalies and birth defects, assess the degree of pathology, consider the presence or absence of the inflammatory process, the focus of infection. Various tumors can be identified at an early stage of their formation. It allows to evaluate not only the condition of the bone system, but also soft tissues.
If necessary, fibroinoscopy is carried out, which, together with microrinoscopy, makes it possible to assess the state of the microstructure of the nose, to identify abnormally altered areas.
Differential diagnosis
Also an important stage of diagnosis is the conduct of medical genetic counseling. It includes a thorough analysis of the family and hereditary history, which allows you to establish an accurate diagnosis and comprehensively study the causes, pathogenesis of the disease. In the course of counseling, concomitant factors are established, and internal and external teratogenic factors that can affect the fetus are examined.
It is important to differentiate hereditary and non-hereditary diseases, as well as determine the type of inheritance in each family, based on clinical genealogical research methods. The goal is to determine the probability of a family member with a genetically determined pathology. It is important to choose the optimal method of treatment and rehabilitation as soon as possible.
Treatment of the hypoplasia and aplasia of the frontal sinuses
Treatment is used if the pathology causes discomfort to the patient. In the absence of any complaints, treatment can be avoided. In the presence of pain, discomfort, shortness of breath, inflammatory process, a conservative method of therapy is used, the medicamentous path is predominantly chosen.
Various drugs are used, in particular, vasoconstrictive drops, sprays, solutions for rinsing the nasopharynx, oral cavity. With allergy and puffiness, antihistamines are used. To stimulate the outflow of the contents of the sinuses and restore mucociliary clearance, mucolytic agents are used. According to the prompts, antibiotics, antiviral drugs, antimycotics, immunomodulators can be prescribed.
Often there is vitamin therapy. If necessary, physiotherapy is performed. Most often, physiotherapy is resorted to after puncture, liberation of the sinus from purulent contents, which helps to prevent relapses. In this case, it is usually necessary to warm up, UHF-therapy.
Therapy allows to reduce atrophic processes in the mucous membrane, to prevent the development of the inflammatory process. In some cases, even pathological changes in bone tissue can be prevented. Physioprocedures do not apply with a vivid manifestation of the allergic reaction, since it is possible only to aggravate the pathology, intensifying the edema.
It is recommended to carry out complex therapy, which will also include alternative drugs, homeopathic medicines, medicinal herbs. It is possible to carry out steam inhalations at home using various vegetable decoctions, essential oils. Inhalations are contraindicated in the presence of pus, as this can cause complications. Also conduct various warm-ups, make compresses, rinses, rinses. An excellent treatment is massage and manual therapy.
To remove puffiness and inflammation apply hormonal and other means. Adrenalization of the mucous membrane proved to be well established. To do this, frequent and abundant lubrication or irrigation of the mucosa with drugs containing adrenaline in their composition. Similar drugs can be used for instillation in the nose. This therapy helps to reduce the thickness, looseness of the mucosa, respectively, reduces inflammation and stops producing excessive amounts of mucus.
Surgical methods are rarely used, only when conservative therapy is ineffective. Trepanopuncture is performed, in which the frontal sinus is punctured to purify it from the accumulated transudate or exudate.
Prevention
The basis of prevention is the identification, in the early stages of the development of pathology, of various inflammatory processes, anomalies. It is important to conduct timely medical genetic counseling in order to identify possible anomalies in a timely manner and develop a plan for further rehabilitation and treatment.
It is also important to observe the hygiene of the nose, maintain immunity at a high level, avoid catarrhal and other diseases. If the nasal congestion is blocked, you can not blow your nose, as the mucus from the nasopharynx can get through the canals into the frontal sinuses and cause inflammation or blockage.
Prevention also includes hardening, performing physical exercises, proper breathing, relaxation practices.
Forecast
With timely access to a doctor and the necessary treatment, the forecast is quite favorable. It can be unfavorable with the development of an infectious-inflammatory process and the absence of treatment. The greatest danger is the penetration of infection and pus into the meninges. Hypoplasia and aplasia of the frontal sinuses can be detected during the course of medical genetic counseling in the planning of pregnancy.