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Physiological Considerations of Frontal Sinus

Physiological Considerations of Frontal Sinus


The physiological role of the paranasal sinuses is a contiriuation of the respiratory cavity and are lined by a respiratory mucosa. They share certain features with the nose but the responses are much less marked due to relatively poorly developed vasculature and nerve supply. In man, their main interest relates to disease (Lee,2008).

Mucosa:
The frontal sinus mucosa resembles the rest of the upper respiratory mucosa with its ciliated columnar respiratory

epithelium, along with numerous glands and goblet cells that produce serous and mucinous secretions. The frontal sinus mucosa is constantly producing secretions in order to ensure that the cavity is at all times cleared of particulate matter, and that proper humidification is achieved ( Kuhn ,2001).

Respiratory Cilia:
the respiratory cilia are found throughout the respiratory tract except for the nasal vestibule, the posterior oropharyngeal wall, portions of the larynx, and terminal ramifications of the bronchial tree. They are found in the eustachian tube, much of the middle ear, and the paranasal sinuses. Cilia in a modified form also occur in the maculae and cristae in the inner ear and in the eye as retinal rods ( Ballenger, 2003) .

Physiological Considerations of Frontal Sinus

Fig. IV -l histologic section of the respiratory epithelium.

Ciliary Beat:
The to-and-fro movement of the cilium is termed the ciliary beat. The forward beat is the more forceful, effective stroke in which the cilium is fully extended, and the claws at the tip penetrate the top layer of mucus bordering on the luminal surface and propel the mucus forward. The recovery stroke is less forceful and slower, and the shaft curls back on itself so that it does not reach the overlying flakes of mucus.- Beating occurs 1,000 or more times per minute (Messerklinger,1976). In health, particles resting on the mucous blanket are moved by active cilia at 3 to 25 mm per minute, with an average of about 6 mm per minute. Dryness of the mucosa is quickly detrimental to ciliary activity. Other factors known to influence clearance speeds are the relative humidity and the pH of the fluids, B2- Adrenergic
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Physiological Considerations of Frontal Sinus agonists accelerate the wave frequency, whereas X2- adrenergic activity retards the movement ( Probst R et al,2006) .

Fig. IV -2 Diagram of the normal

ciliary cycle.

Drainage:
Mucociliary Clearance:

Nitric oxide (NO), a substance with many important physiologic functions, including bactereostasis and stimulating ciliary beat rate, is produced in remarkably large quantities from epithelial cells in the maxillary sinuses. NO is reported to b e locally increased in allergic rhinitis but decreased in chronic sinusitis and Kartagener's syndrome, indicating an important role as a regulator of mucociliary function. High levels of NO increase ciliary beat frequency whereas low levels are correlated to ciliary dysfunction. Ciliary beat frequency is also altered by many inflammatory substances causing acceleration or retardation, the net effect being difficult to predict in the clinical situation (Bolger et al,2001).

Physiological Considerations of Frontal Sinus

Fig. IV -3:
Diagram Cilia on the respiratory epithelium beat in a coordinated, metachronous pattern in the periciliary fluid (deeper sol layer), which transports the superficial gel layer toward the nasopharynx (arrow).

Oxygen tension:
The P02 is lower in the maxillary sinuses than in the nose and it is lower still in the frontal sinuses. If the ostium becomes blocked, the oxygen tension drops further. Ciliary motion remains normal if the blood supply is adequate. If the blood supply is impaired, ciliary activity is reduced and. stasis of secretions results. Levels of nitrous oxide are higher in the sinuses than in the nasal cavity. Blockage of the natural sinus ostium results in a reduction of ventilation and stasis of secretions. An ostium below2.5 mm presposes to disease ( Aust et al,1976).

Physiological functions of the sinuses :( Ballenger ,2003) diminution of auditory feedback. air conditioning. pressure damper. reduction of skull weight. flotation of skull in water. mechanical rigidity. heat insulation.

Most Important Physiological Concepts:( Mullol et al,2000).


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Physiological Considerations of Frontal Sinus 1. Contrary to long-held popular concepts, the drainage pathway, not the frontal sinus, is the primary cause of chronic frontal sinusitis. 2. The frontal recess, an inverted funnel shaped space, not

a tubular shaped duct, connects the sinus to the anterior ethmoid region and is the controlling area in frontal sinus drainage. 3. Frontal sinus ciliary beat pattern and therefore mucus flow is up the interfrontal sinus septum, lateral across the frontal sinus roof, and then medial over the frontal sinus floor to the ostium .
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Fig. IV -4
Frontal sinus mucociliary flow and clearance p at t ern

4. Mucus clearance out of the sinus is active by ciliary action down the lateral aspect of the frontal recess, whether it is directly down the medial orbital wall, or over the medial or posterior aspect of a frontal recess cell, such as an agger nasi cell. 5. If this mucus membrane is damaged or removed, the sinus may not function properly after healing. As columnar epithelium does not regenerate well after being stripped off of bone ( Moriyama et al,1996).