Frontal sinus
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View Frank Gaillard's current disclosuresAt the time the article was last revised Tariq Walizai had no financial relationships to ineligible companies to disclose.
View Tariq Walizai's current disclosures- Frontal sinuses
The frontal sinuses are the paranasal sinuses within the frontal bone. They are lined with mucosa and are most often two in number.
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Summary
location: anterior frontal bones on either side of the midline behind the brow ridges
blood supply: supratrochlear, supraorbital and anterior ethmoidal arteries
innervation: supraorbital and supratrochlear nerves
Gross anatomy
The frontal sinus has two chambers, one on each side, and they are almost always asymmetrical and separated by a septum. Each sinus extends superior to the medial end of the eyebrow and back into the orbital portion of the frontal bone. However, three or more chambers may be present in ~10% (range 1.5%-21%). It is divided by thin bony intrasinus septa, usually off-midline and rarely dehiscent.
The orbit and anterior cranial fossa form important relations to these sinuses.
Drainage from the frontal sinus tends to be more variable than the other paranasal sinuses and there is inconsistent terminology used in its anatomic description 3. In general, the frontal sinus outflow tract consists of a narrowing at the lower medial corner of the sinus (frontal infundibulum), where an ostium (opening) is demarcated by a small ridge of bone at the anterior sinus wall. Inferior to the ostium, drainage continues along a narrow passage known as the frontal recess 4 or superior compartment of the frontal sinus drainage pathway 3. At this point, variant anatomy of the frontal/ethmoidal bone junction leads to two main variations:
drainage into ethmoidal infundibulum, through the hiatus semilunaris into the middle meatus
drainage directly into middle meatus
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Arterial supply
The frontal sinus is supplied by the supratrochlear, anterior ethmoidal, and supraorbital arteries, all of which are branches of the ophthalmic artery.
Venous drainage
Venous drainage is via the superior ophthalmic veins.
Lymphatic drainage
Lymph drainage of the frontal sinus is into the submandibular nodes (cf. the overlying skin which drains to the preauricular group of nodes).
Variant anatomy
-
may be absent (i.e. aplasia) or underdeveloped (i.e. hypoplasia): unilateral (4%) or bilateral (5%)
this may be associated with a metopic suture
may be large: extending through zygomatic processes, orbital bones, and into the squamae
Development
Frontal sinus begin as an outpouching of the lateral nasal wall, at the level of middle nasal meatus. This outpouching then extends superomedially giving origin to the ethmoidal cells and the frontal recess. The frontal recess then pneumatized into the frontal bone 5. Development begins late in intrauterine life (at 3 to 4 months) 5. However, frontal sinus are not present a birth 6. Pneumatization develops from 1-2 years old 5.
References
- 1. Danesh-Sani S, Bavandi R, Esmaili M. Frontal Sinus Agenesis Using Computed Tomography. J Craniofac Surg. 2011;22(6):e48-51. doi:10.1097/SCS.0b013e318231e26c - Pubmed
- 2. Mcminn. Last's Anatomy. (2003) ISBN: 9780729537520 - Google Books
- 3. Daniels D, Mafee M, Smith M et al. The Frontal Sinus Drainage Pathway and Related Structures. AJNR Am J Neuroradiol. 2003;24(8):1618-27. PMC7973969 - Pubmed
- 4. Huang B, Lloyd K, DelGaudio J, Jablonowski E, Hudgins P. Failed Endoscopic Sinus Surgery: Spectrum of CT Findings in the Frontal Recess. Radiographics. 2009;29(1):177-95. doi:10.1148/rg.291085118 - Pubmed
- 5. Lee S, Fernandez J, Mirjalili S, Kirkpatrick J. Pediatric Paranasal Sinuses—Development, Growth, Pathology, & Functional Endoscopic Sinus Surgery. Clin Anat. 2022;35(6):745-61. doi:10.1002/ca.23888 - Pubmed
- 6. Jacob S. Head and Neck. Human Anatomy. 2008;:181-225. doi:10.1016/b978-0-443-10373-5.50010-5
Incoming Links
- Frontalis muscle
- Metopic suture
- Middle meatus
- Patterns of sinonasal obstruction
- Depressed skull fracture
- Hiatus semilunaris
- Anterior ethmoidal artery
- Paranasal sinus mucocele
- Paranasal sinuses and facial bones (lateral view)
- Frontal sinus fracture
- Allergic fungal sinusitis
- Frontal bullar cells
- Skull (Caldwell view)
- Supra agger cell
- Kuhn classification
- Frontal infundibulum
- Frontal bone
- Supraorbital air cells
- Maxillary sinus carcinoma (staging)
- Ethmoid infundibulum
- Orbit roof subperiosteal collection
- Persistent metopic suture with frontal sinus agensis
- Frontal sinus osteoma
- Pott puffy tumor
- Paranasal sinus development (Gray's illustration)
- Esthesioneuroblastoma
- Frontal sinus osteoma
- Dental abscess
- Persistent metopic suture
- Frontal sinuses aplasia
- Persistent metopic suture
- Sinonasal angiomatous polyp
- Orbital metastasis of breast cancer
- Frontoethmoidal sinus osteoma
- Giant frontal sinus osteoma
- Frontoethmoidal mucocele
- Frontal sinus mucocele
- Concomitant orbital blow-in and blow-out fractures
- Frontal sinus osteoma
- Frontal mucocele and sinonasal polyposis
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