An insufficiently treated acute frontal sinusitis can,
especially in adolescent patients, lead to a subperiosteal
abscess over the frontal bone and to an underlying
osteomyelitis. In children and adolescents there is a
relatively large cancellous layer in the frontal bone which
allows easier spread of infection. An intracranial extension
through the posterior wall of the frontal sinus can lead to
meningitis or an extradural, subdural, or frontal brain
abscess. The infection is transmitted by the small veins in
the diploeic bone which have no valves.
The patient will complain of headache and clinical
examination shows a soft swelling over the forehead.
The clinical diagnosis is confirmed by imaging studies
. Treatment usually requires surgical debridement
which may have to be done as a joint neurosurgical
procedure if there is an intracranial extension of the
infection. In cases where a significant section of the
frontal bone has been eroded or resected and a cosmetic
impairment results, delayed reconstruction can be
undertaken as a secondary procedure.



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