Pediatric paranasal sinuses—Development, growth, pathology, & functional endoscopic sinus surgery

Abstract

The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated utilizing a number of different methods ranging from cadaveric analysis to modern cross sectional imaging with 3D modeling. An understanding of normal pediatric paranasal sinus embryology and development enables us to better determine when pathology may be affecting the normal developmental process.Cystic fibrosis, chronic sinusitis, deviated nasal septum and cleft lip and palate are some of the conditions which have been shown to effect paranasal sinus development to varying degrees. Functional endoscopic sinus surgery (FESS) is becoming increasingly common and an understanding of sinus anatomy together with when periods of rapid growth occur during childhood is important clinically. Although concerns have been raised regarding the impact of FESS on facial growth, there is limited evidence of this in regards to either changes in anthropomorphic measurements or clinical assessments of symmetry post operatively.

Persistent Pneumosinus Dilatans Refractory to Endoscopic Frontal Sinus Surgery: A Case Report

“…The frontal sinus pneumatizes throughout early childhood, becoming radiographically evident between the ages of 4 and 7 years and reaching its final size in late adolescence or early adulthood. 10,11 In this patient, it was important to differentiate PD from other differential diagnoses for an enlarged frontal sinus, such as hypersinus or pneumocele. 9 It should be noted, however, that these terms have often been used interchangeably in the literature.…”

Pädiatrische Rhinologie

“…Concern has repeatedly been expressed about whether extensive sinus surgery in general, and es-pecially in unilateral surgery, might have an effect on cranial and facial growth in adolescence [95]. This could not be confirmed by Lee and colleagues [96]. Rather, the pathologic process itself leads to a change in pneumatization and anatomy [97].…”

“…Immer wieder wurde Sorge geäußert, ob eine ausgedehnte Nasennebenhöhlenoperation generell und insbesondere bei einseitigen Operationen einen Einfluss auf das Schädel-und Gesichtswachstum von Heranwachsenden haben könnte [95]. Dies konnten Lee und Kollegen [96] nicht bestätigen. Vielmehr führt der pathologische Prozess selbst zu einer Veränderung der Pneumatisation und Anatomie [97].…”

Predictors of Surgical Intervention for Pediatric Acute Rhinosinusitis with Periorbital Infection

“…With improvements in surgical techniques and equipment used for endoscopic sinus surgery (ESS), more procedures are being performed in children and have been proven to be effective and safe in pediatric patients [6,7]. The rate of surgical intervention for complicated pediatric sinusitis has been increasing in the last two decades, ranging from 15.8% to 19.5% [8][9][10].…”

“…Children recover quicker with endoscopic drainage, and the hospital stay is approximately half of that when an external approach is used [11]. However, considering the uncertain impact of surgery on facial growth [12,13], the possible dramatic improvement after intravenous antibiotic therapy in some cases, and poor cooperation with postoperative local nasal treatment in children, avoiding unnecessary surgery is as important today as it has always been [6].…”