Osteite frontale post-sinusitique: Etude rétrospective à propos de 31 cas

Abstract

Objective : Post-sinusitic frontal osteitis is defined as an extension of frontal sinus infection to the adjacent bony structures. It is an emergency that should rapidly be diagnosed and treated. The aim of this study is to analyze epidemiologic, clinical and paraclinical features, and to review different therapeutic modalities of this disease.
Materials and methods : We carry a retrospective study about 31 patients diagnosed and treated between 1996 and 2010. All patients underwent complete ENT and neurological examination, biological investigations, sino-nasal and cerebral CT scan. Antibiotherapy was administrated intravenously. Surgical drainage of the frontal sinus was performed either
by trephination, by osteoplastic flap confection, or by Lemoyne drain placement. Endonasal drainage consisted of middle meatotomy with anterior ethmoidectomy. Frontal sinus cranialisation was performed with coronal approach. Evolution was assessed on clinical, biological and radiological criteria.

Results : Mean age was 24,4 years (8-62 years) and sex-ratio 4,16. Frontal headache (10 cases) and intracranial hypertension signs (8 cases) were the most frequent functional symptoms. Frontal tumefaction was noted in 9 patients, associated in 5 cases with orbital tumefaction of the internal eye angle. Rhinological signs were essentially purulent rhinorrhea
(9 cases) and nasal obstruction (5 cases). Nasal endoscopy showed purulent secretions at themiddlemeatus in 12 cases. CT scan revealed a typical aspect of frontal osteitis with bony lysis. A sub-periostal abscess was associated in 7 patients. Intracranial extension was noted in 15 cases and orbital extension in 7 cases. Bacteriological examination was positive
in 8 cases. Most frequent bacteria were streptococcus and staphylococcus aureus (3 cases each). Antibiotic therapy was initially administrated in all cases. Concerning initial surgical treatment, 9 patients underwent frontal
drainage and 2 others orbital drainage. On the other hand, 4 patients underwent only sub-periostal abscess drainage. This one was associated with cranialisation in another case. For patients having endocranial complications, empyema drainage was realized in 14 cases, associed in 6 of them with cranialisation. Cerebral abscess drainage was performed
in one other patient. Clinical and radiological evolution was favourable in 24 patients (77,4%). The seven other patients were reoperated because of persistence or aggravation of clinical symptoms. Later evolution was favourable.
Conclusion : Post-sinusitic frontal osteitis a rare and serious affection. Diagnosis, based on clinical and radiological features, should be early made. Adequate treatment have to be instituted to prevent life-threatening complications.

Keywords : osteitis, frontal sinus, sinusitis, computed tomography, drainage, cranialisation