During routine autopsy of a 62-y-old female cadaver, an unusually enlarged frontal sinus was observed. The sinus was abnormally over-developed in both width and height, as the sinus cavity spreads deeply into the frontal tubera. Numerous septa divided the sinus cavity. Because of the obvious dilation of the frontal sinus and the lack of localized bone destruction and hyperostosis, a rare condition called `pneumosinus dilatans` probably occurs in this interesting case

Alexandrov, Alexandar

Hinova-Palova, Dimka

Hristov, Atanas

Hristov, Stanislav

Iliev, Alexandar

Jelev, Lazar

Kartelov, Yuliyan

Nikolov, Dimitar

Paloff, Adrian

English

Varna Medical University Press: Journals

Scripta Scientifica Medica, vol. 45, 2013, suppl. 1, pp. 121-123Copyright © Medical University of Varna   121CASE  REPORTSAN ABNORMALLY ENLARGED FRONTAL SINUS –  A CASE OF PNEUMOSINUS DILATANSLazar Jelev1, Yuliyan Kartelov1, Alexandar Iliev1, Alexandar Alexandrov2,  Dimitar Nikolov2, Atanas Hristov2, Stanislav Hristov2, Dimka Hinova-Palova1,  Adrian Paloff11Department of Anatomy, Histology and Embryology, Medical University of Sofia 2Department of Forensic Medicine and Deontology, Medical University of SofiaINTRODUCTIONThe frontal paranasal sinuses are two irregularly shaped hollow cavities, lined by mucoperiosteum, that are located between the outer and inner tables of the frontal bone behind the superciliary arches and at the roof of the nose (9,19). They are separated from one another by a thin bony septum and are usually asymmetrical (9). The frontal sinuses may vary in size and are larger in men than in women (9,14). Numerous studies have reported an average size of the frontal sinuses among different human populations (7,12,18,14). According to the recent study of Rubira-Bullen et al. (14) the height of the frontal sinus may vary between 7 and 65 mm and Address for correspondence: Lazar JelevDepartment of Anatomy, Histology and EmbryologyMedical University of Sofiablvd. Sv. Georgi Sofiisky 1 BG-1431 Sofia  tel.: +359-2-91-72-636fax: +359-2-851-87-83e-mail: ljelev@abv.bgthe width – between 5 and 125 mm. However, some conditions exist, where even larger in size frontal sinuses are present.CASE REPORTDuring routine autopsy of a 62-y-old female cadaver, after removing the scull cap, an unusually enlarged frontal sinus was observed (Fig. 1a,b,c). It was abnormally over-developed in both width and height, as the sinus cavity spreads deeply into the frontal tubera, reaching nearly the parietal border of the frontal bone. Numerous septa divided the sinus cavity. The dilated sinus cavities, which otherwise had a nearly normal thickness, corresponded to a moderate external bossing of the forehead around the frontal tubera. Because of the obvious dilation of the frontal sinus and the lack of localized bone destruction and hyperostosis, a rare condition called “pneumosinus dilatans” probably occurs in this interesting case.DISCUSSIONThe frontal sinuses develop early in fetal life (around the fourth month) as diverticula from the lateral nasal wall (14). At the end of intrauterine life ABSTRACTDuring routine autopsy of a 62-y-old female cadaver, an unusually enlarged frontal sinus was observed. The sinus was abnormally over-developed in both width and height, as the sinus cavity spreads deeply into the frontal tubera. Numerous septa divided the sinus cavity. Because of the obvious dilation of the frontal sinus and the lack of localized bone destruction and hyperostosis, a rare condition called “pneumosinus dilatans” probably occurs in this interesting case.Key words: frontal sinus, abnormal, pneumosinus dilatansReceived: February 08, 2013Accepted: February 25, 2013122 Scripta Scientifica Medica, vol. 45, 2013, suppl. 1, pp. 121-123Copyright © Medical University of VarnaAn abnormally enlarged frontal sinus – a case of pneumosinus dilatans(32-40 weeks) the primordial frontal sinuses are still surrounded by a cartilage, part of the cartilaginous nasal capsule (17). Pneumatization of the frontal bone begins later in life at around age of four (3). The frontal sinuses are generally fairly well developed between the seventh and eighth years, reaching their full size after puberty. The pneumatization of the frontal bone, however, may continue after forty years (11). A small percent of people have absent frontal sinuses (8). The normal development of the frontal sinuses may be modified by a number of factors such as fractures, neoplasias, severe infections and also mucoceles (14).The term “pneumosinus dilatans” was introduced by Benjamins (5) who described an abnormally dilated frontal sinus containing only air. According to the classification of Urken et al. (16) there are three conditions related to an abnormally enlarged frontal sinus – hypersinus, pneumosinus dilatans and pneumocoele. Later, however, Reicher et al. (13) used the term “pneumosinus dilatans” for all cases of dilated, air filed sinuses with outwardly bulging walls. This swelling of the forehead, due to enlarged frontal sinus, frequently unilateral and asymptomatic, can be the only clinical sign of pneumosinus dilatans (1). other common symptom may be a severe local or global headache (2,6). The diagnosis can be confirmed by an X-ray or CT of the skull (1,2,6). In general, pneumosinus dilatans is a rare condition, the aetiology of which is poorly understood. Many mechanisms have been proposed by various authors:1. ball-valve action secondary to either redundant mucosa or a minor inflammatory process with consequent rise in pressure within the sinus (10);2. spontaneous drainage of a mucocoele (4);3. hormonal influence of osteoblastic activity allows ingrowth and expansion of the sinus (15);4. congenital abnormality leading to unchecked development and growth of the sinus cavity (16).REFERENCES1. Acar M, Yucel A, Degirmenci B, Yilmaz MD, Albayrak R. Pneumocele vs. pneumosinus dilatans: review of the literature with a case of frontal sinus pneumocele. - Tohoku J Exp Med., 202, 2004, No 4, 295-297.2. Adams WM, Jones RI, Chavda SI, Pahor AL, Taifa KT. Pneumosinus dilatans: a discussion of four cases and the possible aetiology. - Rhinology.,  36, 1998, No 1, 40-42. Fig. 1. Photographs of the described case of pneumosinus dilatans: (a) external surface of the scull cap with the approximate projection of the enlarged frontal sinuses (dashed-line); (b) inner surface of the cranial base with the opened cells of the enlarged frontal sinuses (asterisks); (c) inner surface of the calvaria with the opened cells of the enlarged frontal sinuses (asterisks). Scripta Scientifica Medica, vol. 45, 2013, suppl. 1, pp. 121-123 Copyright © Medical University of Varna   123Lazar Jelev, Yuliyan Kartelov, Alexandar Iliev, Alexandar Alexandrov, Dimitar Nikolov, Atanas Hristov ...3. Barghouth G, Prior Jo, Lepori D, Duvoisin B, Schnyder P, Gudinchet F. Paranasal sinuses in children: size evaluation of maxillary, sphenoid, and frontal sinuses by magnetic resonance imaging and proposal of volume index percentile curves. - Eur Radiol., 12, 2002, No 6, 1451-1458.4. Benedikt RA, Brown DC, Roth MK, Geyer CA, Ghaed VN. Spontaneous drainage of an ethmoidal mucocele: a possible cause of pneumosinus dilatans. - AJNR Am J Neuroradiol. 12, 1991, No 4, 729-731.5. Benjamins CE. Pneumosinus frontalis dilatans. - Acta Otolaryngol (Stockh), 1, 1918, 412-422.6. Bhattacharyya N, Friedlander RM. Images in clinical medicine. Pneumocephalus associated with pneumosinus dilatans frontalis. - N Engl J Med. 357, 2007, No 11:1136.7. Brown WA, Molleson TI, Chinn S. Enlargement of the frontal sinus. - Ann Hum Biol. 11, 1984, No 3:221-226. 8. Çakur B, Sumbullu MA, Durna NB. Aplasia and agenesis of the frontal sinus in Turkish individuals: a retrospective study using dental volumetric tomography. - Int J Med Sci. 8, 2011, No 3, 278-282.9. Clemente CD (ed.). Anatomy of the Human Body. 30th Ed. Philadelphia, Lea and Febiger, 1985, 191-194.10. Dhillon RS, Williams DC. Pneumosinus dilatans. - J Laryngol Otol. 101, 1987, No 8, 828-832.11. Finby N, Kraft E. The aging skull: comparative roentgen study. 25 to 34 year interval. - Clin Radiol. 23, 1972, No 4, 410-414.12. Maresh MM. Paranasal sinuses from birth to late adolescence. I – size of the paranasal sinuses as observed in routine postero-anterior roentgenograms. - Am J Dis Child., 60, 1940, 55-78. 13. Reicher MA, Bentson JR, Halbach VV, Lufkin R, Hepler RS. Pneumosinus dilatans of the sphenoid sinus. - AJNR Am J Neuroradiol. 7, 1986, No 5, 865-868.14. Rubira-Bullen IRF, Rubira CMF, Sarmento VA, Azevedo RA. Frontal sinus size on facial plain radiographs. - J Morphol Sci., 27, 2010, No. 2, 77-81.15. Smith IM, Maran AG, von Haacke NP. Pneumosinus dilatans. - Ann Otol Rhinol Laryngol. 96, 1987, No 2 Pt 1, 210-212.16. Urken ML, Som PM, Edelstein D, Lawson W, Weber AL,  Biller HF. Abnormally large frontal sinus. II. Nomenclature, pathology, and symptoms. - The Laryngoscope, 97, 1987, No 5, 606–611.17. Wang RG, Jiang SC, Gu R. The cartilaginous nasal capsule and embryonic development of human paranasal sinuses. - J Otolaryngol. 23, 1994, No 4, 239-243.18. Weiglein A, Anderhuber W, Wolf G. Radiologic anatomy of the paranasal sinuses in the child. - Surg Radiol Anat. 14, 1992, No 4, 335-339.19. Yanagisawa E, Smith HM. Radiographic anatomy of the paranasal sinuses. IV. Caldwell view. - Arch Otolaryngol.  87, 1968, No 3, 311-322.

An abnormally enlarged frontal sinus - a case of pneumosinus dilatans

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An abnormally enlarged frontal sinus - a case of pneumosinus dilatans

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