This document provides an overview of the management of frontal sinus fractures. It begins with a case presentation of a 30-year-old male with a right frontal sinus fracture from a motor vehicle accident. It then discusses the anatomy, patterns of fractures, diagnostic imaging, and treatment considerations for frontal sinus fractures. Surgical management depends on factors like the location and displacement of fractures, involvement of surrounding structures, and presence of cerebrospinal fluid leaks. Treatment options include observation, open reduction and internal fixation, obliteration using various grafts, cranialization, or ablation. The document provides details on various surgical approaches and closure techniques.
Rare case of nasal mass- Polyostotic Dysplasia of sinonasal tractShruti Baruah
Unilateral nasal obstruction since childhood which had aggravated for the last one year,
Two episodes of epistaxis two weeks apart since 30 days.
There were no other associated complaints of nasal discharge, headache, diplopia or facial deformity.
Diagnostic Nasal Endoscopy: showed a bony hard mass possibly arising from the inferior turbinate, occupying the entire right nasal cavity with probable attachments to the middle turbinate and extending up to the posterior choana.
CT scan PNS: revealed a well-defined bony lesion with sclerotic borders and ground glass appearance; in the right nasal cavity.
Extension was seen into the right ethmoid, frontal and right half of sphenoid sinuses.
The mass was endoscopically resected by curetting from its attachments from the inferior and middle turbinate in the nasal cavity up to the anterior skull base
Rare case of nasal mass- Polyostotic Dysplasia of sinonasal tractShruti Baruah
Unilateral nasal obstruction since childhood which had aggravated for the last one year,
Two episodes of epistaxis two weeks apart since 30 days.
There were no other associated complaints of nasal discharge, headache, diplopia or facial deformity.
Diagnostic Nasal Endoscopy: showed a bony hard mass possibly arising from the inferior turbinate, occupying the entire right nasal cavity with probable attachments to the middle turbinate and extending up to the posterior choana.
CT scan PNS: revealed a well-defined bony lesion with sclerotic borders and ground glass appearance; in the right nasal cavity.
Extension was seen into the right ethmoid, frontal and right half of sphenoid sinuses.
The mass was endoscopically resected by curetting from its attachments from the inferior and middle turbinate in the nasal cavity up to the anterior skull base
Journal of Pathology & Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pathology & Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pathology & Microbiology. Journal of Pathology & Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pathology & microbiology.
Journal of Pathology & Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
The term “blow out” refers to partial herniation of the orbital contents through one of its walls. This usually occurs via blunt force trauma to the eye. Most often, the orbital floor is fractured in conjunction with the inferior orbital rim “impure” blowout fracture, but “pure” orbital floor fractures, with intact orbital rim can be seen. An extensive and careful history, physical examination, together with CT scans is vital for the diagnosis of orbital floor fractures. The timing of treatment, surgical approaches, and reconstruction of the orbital floor are presented.
Journal of Pathology & Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pathology & Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pathology & Microbiology. Journal of Pathology & Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pathology & microbiology.
Journal of Pathology & Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Dr. Ahmed M. Adawy
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
The term “blow out” refers to partial herniation of the orbital contents through one of its walls. This usually occurs via blunt force trauma to the eye. Most often, the orbital floor is fractured in conjunction with the inferior orbital rim “impure” blowout fracture, but “pure” orbital floor fractures, with intact orbital rim can be seen. An extensive and careful history, physical examination, together with CT scans is vital for the diagnosis of orbital floor fractures. The timing of treatment, surgical approaches, and reconstruction of the orbital floor are presented.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
3. Case: Habtamu Aklilu 30yr/M
O Hx:
O Presented with RTA of 1 week durtion.
O Has no vomiting, seizure, loc but Has
headache since trauma that continued
worsening.
O No ear and nasal discharge.
O Referred from DBH.
O No previous surgery & known medical
illness.
3/26/2021 3
4. Pertinent P/E
O v/s: normal
O HEENT: has bilateral raccon eye &
subconjunctival hrge. No open wound.
O Neuro exam:
O GCS:15/15
O Pupil: mid sied & reactive to light
bilaterally.
O CN: all intact.
O Meningeal signs: +ve
O Lab Ix: normal 3/26/2021 4
6. Introduction
O Frontal sinus fractures account for 5–15%
of facial fractures.
O The thick cortical bone of the anterior
table of the frontal sinus is more resistant
to fracture than any other facial bone [2].
O 2*mandible and 5* maxilla:
pneumatization & thick anterior wall.
3/26/2021 6
7. Basics of Frontal Sinus
O The only paranasal sinus not present at birth
O Bilateral agenesis : 4%
O Pneumatization : begins after the 2nd yr.
O Radiologicaly evident at 8 yrs
O Adult size attained at 15 yrs.
O Anterior and posterior wall: 4-12 & 0.1-4.8
mm.
O Ciliated pseudostratified columnar
O Opens into the middle nasal meatus
3/26/2021 7
8. FS fractures pattern: four
Categories
O Isolated anterior table fractures:50%
O Isolated posterior table fractures
uncommon,
O Combined anterior and posterior
table fractures:most common
O Fractures with involvement of the NFD
or NFOT.
3/26/2021 8
9. Ix
O High-resolution 0.5 mm CT:gold standard
i. Axial : presence and degree of
displacement of anterior and posterior table
fractures;
ii. Coronal : floor of the sinus and orbital roof;
iii. Sagittal : NFOT injuries
O Endoscopic evaluation
O Methylene blue/fluorescine dye
O CT cisternography: fistula accurate
localization
3/26/2021 9
10. Why is FS # important?
i. Chronic frontal headache due to injury to the
supraorbital nerve
ii. Chronic CSF leak
iii. Chronic frontal sinusitis
iv. Mucocele
v. Mucopyocele
vi. Subdural empyema
vii. Frontal bone osteomyelitis
viii. Meningitis
ix. Brain abscess (due to spread of infection from the
FS
intracranially via foramina of Breschet)
x. Residual forehead contour defects and deformities.
3/26/2021 10
11. Mgt
Factors
O Location of the fracture, (Involvement of anterior,
posterior or both walls of the sinus.)
O Presence and degree of displacement of the
fractured fragments,
O Status of the NFOT,
O Degree of injury to the dura mater and brain (CSF
leak),
O The presence of other associated
craniomaxillofacial injuries, and
O Associated neurological injuries
3/26/2021 11
12. Treatment options
O Observation,
O Reconstruction of the sinus walls /ORIF/
O obliteration
O osteoneogenesis
O cranialization.
O ablation/exenteration
3/26/2021 12
13. Conservative treatment
O Bed rest
O Oral acetazolamide 250 mg every 8
hours,
O Laxatives and
O Prophylactic
antibiotics/vaccination???
O Avoidance of breath holding and straining.
O LP
3/26/2021 13
14. Principles in mgt of FS #
O Restoration of normal sinus mucosa with a patent
drainage system
O Eradication of the sinus cavity if the normal
mucosa or drainage system cannot be
reestablished,
O Creation of a permanent barrier between the
intracranial and extracranial systems to px
infection
O Protection of the intracranial contents
O Protection of the orbital contents
O Control CSF leakage/rhinorrhea,
O Prevention of posttraumatic wound infection
O Restoration of an esthetic 3/26/2021 14
19. Approach
O Bicoronal: work horse of frontal sinus
surgery
O suprabrow approach
O upper eyelid approach
O Subbrow
O Transnasal
3/26/2021 19
20. Choice of graft for Obliteration
of the frontal sinus
O Autogenous fat
O Autogenous muscle
O Autogenous bone
O Pericranial flap
O Allografts like lyophilized cartilage
O Alloplastic materials: E.g Hydroxyapatite
O Spontaneous obliteration
3/26/2021 20
25. References
O Greenburg 9th edition
O Youman 7th edition
O ENT journals
O Craniofacial journals
O Neurosurgery journal
3/26/2021 25
Editor's Notes
y 1/3 is isolated to the anterior table and 2/3 are a combination of anterior table, frontal recess, and posterior table [1]. Isolated posterior table fractures are rare
The posterior wall provides attachment for SSS (vulnerable in fractures of theposterior wall but is rare).
rupture is uncommon because thedura is tough and unyielding, and the sinus is often atreticfor some distance from its origin, close to the frontal sinus.
Prophylactic antibiotics/vaccination
Controversial even in the presence ofa CSF fistula
However, most ENT physicians recommend treating fractures through the nasal sinuses as open contaminated fractures, and they use broad spectrum antibiotics (e.g. ciprofloxacin) for 7–10 days.
If there is a CSF leak pneumococcal vaccine is recommended for adults age 2–65 years
difficult to diagnose even on CT scans.
sagittal reconstruction of the paranasal sinuses besides axial and coronal CT image.
Naso-orbitoethmoid (NOE) complex fractures, anterior skull base injuries near the junction of the posterior table and cribriform plate of ethmoid, fractures involving the floor of the FS, depressed or inferiorly located fractures of the posterior table of the FS, etc., are stronglysuggestive of the possibility of NFOT injuries
The presence of sinus opacity or air‑fluid level within the FS persisting for more than 7–10 days following the trauma/injury.
A unilateral air‑fluid level indicates patency of the contralateral NFD.
Removal of the intersinus septum (intersinus septectomy),using the osteoplastic flap approach, the so-called“Lothrop procedure,” or
When disruption of both the nfds is evident uponexploration or suspected due to persistent bilateral air‑fluidlevels, complete fs obliteration is the treatment ofchoice.
Endoscopic frontal sinusotomy /dilatation of NFD with stent/ for NFOT recanalization too is prone to failure.
FS exclusion either by its obliteration orcranialization.
CSF leak with minimally displaced posterior table fracture, an initial conservative approach by observation for 5–7 days withadministration of intravenous antibiotics, bed rest, headelevation, and if indicated, lumbar drainage at 10cc/h maybe employed.
if there is a persistent CSF leak beyond 8–10 days, FS obliteration via either osteoplastic flap approach or bifrontal craniotomy is indicated.
When disruption of the posterior table is more than 25%, andthere is associated dural tear and CSF leak, cranialization ofthe sinus with dural repair is indicated. Cranialization
is the most radical method of FS management.
It is obliteration with complete removal of the posterior table.
Anumber of autogenous and alloplastic materials have been used as fillers in FS obliteration.Autogenous fat is probably the most widely used and has the longest tradition [47]. Theadvantages of fat grafts include ease of harvest, minimal donor site morbidity, ample availablevolume, and favorable handling characteristics. However, complication rate was reported ashigh as 18% [48]. Magnetic resonance study 24 months post-operatively found vital fatty tissuein only 6 out of 11 cases of obliteration of FS via an osteoplastic approach. Fatty necrosisoccurred five times; whereas in four cases a transformation into granulation tissue and in onecase into connective tissue could be seen [49].The harvest of the fat is performed using steriletechnique: the surgeon will rescrub and a separate set of instruments that have not come incontact with the infected field is used. A transverse incision is made in the left lower abdominalquadrant, and subcutaneous fat is removed. Alternatively, a periumbilical incision can also bemade. Bleeding is controlled using monopolar cautery, but excessive cauterization should beavoided because it may harm the fat cells and result in graft failure. Drainage of the abdomenis usually not necessary. [46]Autogenous muscle graft harvested from temporalis muscle has advantage of being locatedwithin the operative field and being available in adequate volume. Like autogenous fat graft,this nonvascularized graft undergoes necrosis and eventual replacement by fibrous tissue.Donor site morbidity, including temporal hollowing and trismus, is unacceptable. [37]Autogenous bone graft for FS obliteration was first described in 1969 [50]. Since then,cancellous bone grafts, most often harvested from the ilium, have been widely used as a fillermaterial. Cancellous bone promotes re-ossification from both the periphery of the defect andcentrally. The main contributions of the grafts are their osteoconductive properties andosteoinductive factors that are released from them during the process of resorption. [51]Another advantage of cancellous bone over adipose or muscle tissue for obliteration is that itContemporary Management of Frontal Sinus Injuries and Frontal Bone Fractureshttp://dx.doi.org/10.5772/59096451is easier to distinguish radiographically in postoperative period between resorption, infection,and mucocele formation.[13,37] The greatest disadvantage to the use of cancellous bone graftslies with the potential donor site morbidity. [52] Much more comfortable and safer is to harvestbone chips from adjacent calvarium. It can be done using bone scraper. In case the harvestedamount of bone is not sufficient for filling of a large sinus, it can be augmented by admixtureof bone substitute such as demineralized bone matrix (Figure 10) [53].
Pericranial flap has been widely used in anterior cranial fossa repair, reconstruction of themiddle third of face defects, full-thickness scalp defects, and orbital defects. It is composed ofthe skull periosteum and the subgaleal fascia. The anteriorly based flap receives its bloodsupply from the supraorbital and supratrochlear arteries. Branches of the superficial temporal452 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2artery supply the laterally based flap. In contrast to all other avascular grafts used for sinusobliteration, the anteriorly based pericranial flap is composed of a well-vascularized tissue.The high vascularity makes this flap less prone to infections and turns it into an ideal methodfor obliteration of an infected cavity in a contaminated surgical field. [54]Allografts like lyophilized cartilage [55] have the advantage of unlimited availability and lackof donor site morbidity. They are easy to handle, well adaptable to the defect, and thus reducethe operative time. Nevertheless, a failure in revascularization or subsequent osseointegrationmay occur, with associated risk of infection and extrusion [56]. Allogenic transplantation maybe associated with increased risk of transmitting such diseases as hepatitis, AIDS or bovinespongiform encephalopathy.Alloplastic materials.Methyl methacrylate has been widely used alloplastic material since itsintroduction in 1940. It is well tolerated by soft tissues and has a density similar to bone, lowthermal conductivity, and acceptable strength. However, the material produces a significantexothermic reaction during polymerization and foreign body reaction has been noted when itis polymerized in contact with tissue. [57]Hydroxyapatite is a nonceramic calcium phosphate substance (BoneSource, Stryker Leibinger).It has osteoconductive properties, may be contoured to a defect, adheres to adjacent bone, hasthe ability to resist mucosal ingrowth, is resistant to infection, and is gradually replaced bynative bone without a loss of volume. It has been investigated in experimental and clinicalfrontal sinus obliteration, but no long term observation results were reported [58]. Currentlythe use of hydroxyapatite cement in FS is not recommended. Significant problems related tomaterial failure have been reported. [37]Glass-ionomer cement is a hybrid glass polymer composite consisting of inorganic glassparticles in an insoluble hydrogel matrix and bonded by ionic cross-links, hydrogen bridges,and chain entanglements. It is widely used in dentistry and also has been used in frontal sinusreconstruction [59]. However, because of severe complications after using glass ionomercement next to dura mater this material has been taken off the market. [51]Proplast, a polytetrafluoroethylene (Teflon) polymer with vitreous carbon fibers with poresizes of 200 to 500 μm, is extremely porous to body fluids. Fibrous tissue ingrowth occursrapidly and acts to mechanically stabilize the material. The material can cause a mild foreignbody reaction. [51, 60]Glass ceramic(bioactive glass) has proved biocompatible, non-toxic and bone conductingmaterial for occlusion of bone cavities. Total accurate obliteration of the sinus is achieved withdifferent sizes of granules and blocks. Uneventful recovery and clinical outcome were seen in92% of patients. Histopathological samples revealed a healing process progressing from thefibrous tissue phase to bone formation with scattered fibrous tissue and granule remnants.Bone produced by replacement of material was similar to natural frontal bone. Microbiologiccultures obtained with histological samples revealed no growth of bacteria. [61, 62]Spontaneous obliteration was reported long ago by Samoilenko (1913), who found oblitera‐tion by osteofibrous ingrowth in an experimental study on cats and dogs. His results wereContemporary Management of Frontal Sinus Injuries and Frontal Bone Fractureshttp://dx.doi.org/10.5772/59096453confirmed by later experimental studies that found subsequent replacement of obliterated FSsby cancellous bone to a variable degree. [51] Because FS after removal of all of its mucosa andoccluding the nasofrontal duct is nothing more than an isolated bone cavity, it is not irrationalto expect its gradual ossification. [63]