The frontal sinus lining has veins that penetrate the posterior wall and go directly to the dura on the opposite side. These veins can quite easily transmit organisms or become vectors of propagation of an infected clot. This can quickly lead to meningitis and even brain abscess. Therefore, whenever patients have acute frontal sinusitis with an air fluid level in the frontal sinus, they are brought into the hospital for intravenous antibiotics. The key is to cover Haemophilus influenzae and Staph.
Topical vasoconstriction is effected in the clinic and quite often throughout the hospital stay.
This is to shrink the swollen mucosa around the nasofrontal duct and restore the natural drainage into the nose. Systemic steroids may also be considered to decrease swelling. If the patient's sinusitis does not greatly improve within 24 hours, the frontal sinus is drained through a very small incision just below the medial aspect of the eyebrow. This operation is called frontal sinus trephination. Apart from meningitis being a complication of acute sinusitis, there is another complication which has perhaps even more grave implications.