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Case Reports
.2024 Feb 13;16(2):e54158.
doi: 10.7759/cureus.54158. eCollection 2024 Feb.

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

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Case Reports

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

Smriti Wadhwa et al. Cureus..

Abstract

Frontal osteomyelitis is characterized by localized osteal inflammation of the frontal bone. This is a rare complication of acute frontal sinusitis. The present case is being reported to highlight the likely role of anatomical variations in frontal sinus drainage pathways in the causation of this complication apart from other known predisposing factors like young age and immunocompromised state. The patient initially presented with seizures, fever, and headache and was diagnosed with viral encephalitis. However, the symptoms gradually progressed to cause right eye swelling and an increase in the severity of headache without any nasal complaints. Diagnostic nasal endoscopy revealed mucopurulent secretions in both nasal cavities. Computed tomography and magnetic resonance imaging diagnosed the anatomical variations, the extent of sinus involvement, and frontal osteomyelitis. Antimicrobial therapy for an extended duration of four weeks, along with functional endoscopic sinus surgery resulted in excellent outcomes.

Keywords: drainage pathway; endoscopic sinus surgery; frontal sinus; osteomyelitis; pansinusitis; sinusitis.

Copyright © 2024, Wadhwa et al.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Right periorbital swelling (red arrow).
Figure 2
Figure 2. Contrast-enhanced CT showing collection in bilateral maxillary, ethmoidal, and frontal sinuses (red arrows).
Figure 3
Figure 3. Erosion of the outer wall of the frontal sinus and the adjacent bony orbital roof (indicated with red arrow).
Figure 4
Figure 4. Contrast-enhanced CT showing erosion of the inner table of the frontal sinus (indicated with red arrow).
Figure 5
Figure 5. Contrast-enhanced CT showing periorbital cellulitis (indicated with red arrow).
Figure 6
Figure 6. CT showing paradoxical curvature of middle turbinates (as indicated with red arrows).
Figure 7
Figure 7. CT showing attachment of the right uncinate process to the middle turbinate (indicated by a red arrow).
Figure 8
Figure 8. Patient in the immediate post-operative period with significantly reduced periorbital swelling.
See this image and copyright information in PMC

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