Primary Malignant Disease of the Frontal Sinus

PRIMARY Malignant Disease is met with not uncommonly in the ethmoid cells and maxillary antra ; but its existence in the frontal and sphenoid sinusesjias been questioned or denied by most observers. Capps in his recent article on Malignant Disease of the Para-nasal Sinuses states, " It would seem to be fairly generally accepted that primary malignant disease occurs only in the maxillary antrum and ethmoid cells ". Neither the cases of malignancy of the sphenoid I have come across in practice, nor those met with in the literature reveal one single instance of primary malignant disease of these sinuses. All these were cases of secondary malignant disease of the sphenoid sinuses originating in neighbouring structures. As to the frontals, only a small number of cases are found reported as primary malignant disease of these sinuses; however, the growth in a good number of them wasjiot lirnitedjto the frontals and frontal sinus origin although very probable was not certain. Earle G. Breeding, in reviewing the literature on primary malignant disease of the frontal sinus in his article on Malignancy of the Nasal Accessory Sinuses states, " While there seems to be some contradiction of the number of cases reported in the literature investigated, I have encountered only 28 cases that are probably authentic." However, he reports two cases of his own; the first at least was an undoubted example of primary carcinoma of the left frontal sinus, as even as late as after exploration the growth was found still limited to that region. In my practice, I have come across two^ases of carcinoma and five cases of endothelioma of the frontal region ; in six out 6T~tnese, the origin was difficult to ascertain as the growth was too extensive when first seen and other neighbouring structures were then implicated; but jn one case, the right frontal sinus was undoubtedly the site of origin and could be given here as a proof of the existence of primary malignant disease of the frontals. The latter case, too, is of particular interest radiologically, as it demonstrates the X-ray appearances of the early stages of bone invasion, which we rarely meet with.