Frontal sinusitis and its intracranial complications

Although there has been a significant decrease in the incidence of frontal sinus disease since the advent of antibiotics, frontal sinus infection still occurs and may follow a clinical course not unlike that seen during the preantibiotic era. Secondarily to cranial and intracranial invasion the following complications may occur: osteomyelitis, cavernous sinus thrombosis, meningitis, extradural, subdural and cerebral abscess. The proximity of the frontal sinus to both the dura and the marrow of the frontal bone, as well as a rich communicating venous system, lends support to the facility of intracranial extension. Classically, frontal sinusitis presents with headache or pain usually following an upper respiratory infection. Purulent nasal discharge may be noted on physical examination. Roentgenographic studies will show opacification or an air-fluid level within the sinus. We present 4 cases of intracranial complications of frontal sinusitis seen in male adolescents. It is our contention that this disease bears a notable preponderance in males; a postulation that appears to be substantiated in the literature. Frequently even the classic signs and symptoms of frontal sinusitis may be undetected, which indicates that certainly the more subtle presentation of this disease may escape diagnosis during the course of examination. The use of CT scanning has proved an invaluable tool in the diagnosis of both frontal sinusitis and intracranial involvement. The importance of its incorporation into the diagnostic workup of the patient with frontal sinus disease cannot be overemphasized. We advocate aggressive medical and surgical management for all adolescents presenting with frontal sinusitis in an attempt to avoid possible intracranial complications.