Vol 30, No 4 (2024)

Over the past century, frontal sinus surgery has undergone substantial transformation, with advances in imaging, optics, and instrumentation contributing to current treatment paradigms. This review article is devoted to the evolution of surgical methods for treating frontal sinus diseases, demonstrates the complexity of surgical access, anatomical features, and the high rate of postoperative complications in this area. The historical development of frontal sinus surgery is outlined, from ancient trepanation practices, first thoroughly described in the 18th century, to modern minimally invasive endoscopic techniques. Particular attention is given to the transition from radical external approaches, such as the Ogston–Luc procedure, radical ablation, and complete sinus obliteration, to more conservative procedures aimed at preserving anatomical integrity and frontal sinus function. The review includes an analysis of early surgical milestones by Ogston, Kuhnt, Riedel-Schenke, and Killian, and examines the evolution of external frontoethmoidectomies known as Lynch–Howarth procedures. The limitations of these techniques, including high restenosis rates, scarring, and cosmetic deformities, are discussed, along with the development of various modifications intended to improve drainage and reduce postoperative complications. The article also addresses the challenges of intranasal approaches, such as limited visualization and the risk of intracranial complications. Advances in osteoplastic techniques are reviewed, noting their high efficacy alongside technical difficulty and risks such as cerebrospinal fluid leak and neuralgia. Despite the rise of endoscopic methods, external approaches remain relevant for certain specialists due to the unique anatomy of the frontal sinus, limited surgical experience, or complex disease course, either as stand-alone options or part of combined strategies. The review demonstrates that optimizing surgical treatment of the frontal sinus remains a relevant challenge, requiring continuous refinement of techniques and an individualized approach to each patient.

Background: Nasopharyngeal microbiota plays a crucial role in maintaining respiratory tract health; however, its composition and changes in time can vary significantly with age. Opportunistic microorganisms commonly present in the nasopharynx are not always associated with disease, necessitating a rational approach to interpreting bacteriological findings.

Aim: To examine the composition of nasopharyngeal microbiota in healthy residents of Saint Petersburg.

Methods: The study included two groups: children (n = 5) and adults (n = 5). Nasal and throat swabs were collected from all participants every two days over a 10-day period. Samples were cultured on nutrient media, followed by microorganism identification and antibiotic susceptibility testing.

Results: Significant differences in microbiota composition were observed between the groups. Opportunistic bacteria (e.g., Haemophilus influenzae, Streptococcus pneumoniae) were more frequently detected in children, whereas adults exhibited a predominance of commensal flora (Corynebacterium spp., Streptococcus viridans). High variability of microbiota in children was noted, reducing the clinical value of single-timepoint bacteriological tests.

Conclusion: The findings highlight the importance of a balanced approach to interpreting microbiological data. Clinicians should consider that the presence of opportunistic microorganisms may be transient and not necessarily indicative of active disease. Particular attention should be paid to diagnostics in children, as shifts in microbiota composition may represent a natural process rather than a sign of illness. In this context, it is advisable to consider clinical manifestations alongside laboratory findings to avoid unwarranted antibiotic use and reduce the risk of antimicrobial resistance.

Background: Chronic adenotonsillar disease is highly prevalent in pediatric populations. The functional status of the Waldeyer’s lymphoepithelial pharyngeal ring plays a key role in the body’s immune response to respiratory viruses. SARS-CoV-2 infection may aggravate the course of chronic adenotonsillar disease, possibly due to the virus’s prolonged persistence in the tissues of the lymphoepithelial pharyngeal ring.

Aim: To identify factors contributing to the development and progression of chronic adenotonsillar disease in children following COVID-19.

Methods: A prospective cohort study was conducted involving 135 children hospitalized at Filatov Children’s City Hospital No. 5 (Saint Petersburg) with symptoms of acute respiratory viral infection. Participants were divided into groups with and without pre-existing chronic adenotonsillar disease. Clinical assessments included general medical examination, otorhinolaryngological assessment, laboratory tests, and PCR testing for SARS-CoV-2 and other respiratory viruses. A follow-up examination at 6 months included a full otorhinolaryngological assessment to identify chronic adenotonsillar symptoms and determine the need for surgical intervention. Statistical analysis was performed using the Mann–Whitney U test and Pearson’s chi-square test (χ²).

Results: Significant factors associated with the development of chronic adenotonsillar disease included prior COVID-19, concurrent viral infections, frequent ARVI episodes, and elevated erythrocyte sedimentation rate. Factors significantly associated with the need for surgical intervention included prior COVID-19, preschool age, and absence of typical throat pain complaints.

Conclusion: COVID-19 significantly increases the risk of developing and progressing chronic adenotonsillar disease, particularly in preschool-aged children, emphasizing the need for further research into its pathogenesis and preventive strategies.

Fungal sinusitis comprises a heterogeneous group of diseases differing in etiology, clinical presentation, and pathogenesis. One such form is a mycetoma, a noninvasive form characterized by the accumulation of fungal hyphae and debris within a sinus cavity, without invasion of the mucosa. Isolated sphenoid sinus mycetoma is relatively rare, and its pathophysiology remains incompletely understood. The patient’s immune status plays a critical role in the pathogenesis of fungal sinusitis, as immunosuppression is a major risk factor for the transformation of noninvasive mycetoma into an invasive form, potentially resulting in severe complications. Therefore, immune status assessment in patients with noninvasive fungal sinusitis, particularly in the presence of comorbidities and immunosuppressive therapy, is essential for determining optimal treatment strategies. This article presents a clinical case of fungal sphenoiditis in a female patient with granulomatosis with polyangiitis (ANCA-associated vasculitis) undergoing immunosuppressive therapy. The case is notable for the combination of noninvasive fungal sphenoiditis with a high risk of invasive disease due to immunosuppression. Given the elevated risk, the patient underwent endoscopic sphenoethmoidectomy followed by systemic antifungal therapy. This case highlights the importance of early surgical intervention and appropriate systemic antifungal treatment in preventing infection progression and complications in patients with noninvasive fungal sinusitis, especially in the context of immunosuppression.

Mucocele is a benign, cyst-like lesion of the paranasal sinuses that develops as a result of persistent obstruction of drainage through the sinus ostium. The frontal sinus and ethmoid cells are most commonly affected. Isolated involvement of the ethmoid cells, particularly its posterior part, is relatively rare and often asymptomatic. Prolonged blockage of the ostium leads to secretion stasis and increased pressure on the bony walls. This results in thinning and expansion of the bone, with cavity formation. Currently, the main treatment approach is endoscopic sinusotomy with opening and drainage of the mucocele, followed by ostium enlargement. Surgical access to this area is technically difficult. Opening the posterior ethmoidal cells often requires dissection of the anterior group. However, in cases of isolated lesions, the necessity and advisability of disrupting intact surrounding structures, which common in the traditional transethmoidal approach, remain debatable. In such cases, computer-assisted navigation is used as an auxiliary technology to facilitate the surgeon’s orientation within the surgical field. This article presents a clinical case of surgical treatment of an isolated mucocele of a posterior ethmoidal cell, performed under local anesthesia with the use of navigation equipment. The lesion was drained through a direct approach, positioned medial to the middle turbinate, analogous to the access route used for the sphenoidal recess.