Complications of Frontal Sinusitis

Complications of frontal sinusitis occur when infection extends outside of the frontal sinus and into the surrounding tissue. The most commonly affected structures are the skull, brain, and orbit, which surround the frontal sinus. The anatomic proximity of the frontal sinus to these structures allows the spread of infection by both direct extension and retrograde thrombophlebitis of shared venous drainage pathways. Presenting signs and symptoms vary and depend on the location of the complication. Symptoms can range from headache, fever, and forehead or orbital swelling to decreased visual acuity and focal neurologic deficits. Work-up includes thorough history and physical examination including nasal endoscopy. Imaging with contrast is important for diagnosis and surgical planning. There should be a low threshold to obtain imaging of the orbit or brain if history or physical exam suggests involvement of these structures. MRI is the best imaging modality to evaluate intracranial pathology. Neurosurgery and ophthalmology consults are warranted in patients with intracranial and orbital complications, respectively. Prompt treatment is vital as complications of frontal sinusitis can have significant morbidity and mortality. Treatment is often a combination of culture-directed intravenous antibiotics and surgical intervention addressing the affected sinuses and associated complications.