Development of the Paranasal Sinuses in Children

Like many of the anatomic features that we have as adults, not all of our anatomy is present at birth, and some of our anatomy continues to develop after birth (thank goodness :)). Our sinuses – the “paranasal sinuses” – are a good example of this. This articles is a review of the development of the paranasal sinuses in children, from birth to adulthood, including anatomic illustrations and CT Scan.

Please take a look at my review of nasal and sinus anatomy and histology for the basic anatomy. Also take a look at my article on How to “Read” A Sinus CT Scan.

In this article, we’ll review the Development of the Paranasal Sinuses. I want to focus on what is present at birth, and during the first year of life.

Keep in mind that these descriptions of when the sinuses develop – what age they appear – are merely ranges. They are not precise ages that are etched in stone. Every child is different!

Development of the Paranasal Sinuses in Children

At Birth

We are essentially born without sinuses, at least as they exist in our adult heads.

At birth, the entire extent of our sinuses is limited to a little indentation in the lateral nasal wall on each side (the blue area in FIGURE 1) – those will become the maxillary sinuses, and a couple dimples in the wall of the inside of the nose between the eyes – these will become the ethmoid sinuses. These will develop over the first few years of life into the maxillary and ethmoid sinuses. See FIGURE 1.

Development of the Paranasal Sinuses in Children

FIGURE 1. Development of the Paranasal Sinuses in Children

What Does This Mean for Your Little Boogorhead?

It means that your infant probably does NOT have sinusitis! When they have a fever and gross green nose-pudding, you would more correctly say that they have “rhinitis” or even “rhino-sinusitis,” since they don’t yet truly have “sinuses”.

The frontal sinuses don’t usually begin to develop until around age 8 or so, later in girls than in boys, and they may simply fail to develop in some people. Again, every child is different. I have seen some 10-year-old girls who have fully-developed frontal sinuses, and I have seen grown men without frontal sinuses. As the name suggests, the frontal sinuses are located in the frontal bone, in the forehead, at the level of the eyebrows.

What Does This Mean for Your Little Boogorhead?

It means that their headache is most likely NOT due to sinusitis! The sinuses are the first thing to be blamed for a headache – especially a “frontal” headache – but studies have found that when we think that we have a sinus headache, we are usually wrong. In fact, the most common cause of recurrent and chronic “sinus headaches” in children is …. migraine.

See FIGURES. Note that the BLUE sinuses in this second figure are about what you would find in a 15-year-old male:

Development of the Paranasal Sinuses in Children

FIGURE 2. Development of the Paranasal Sinuses in Children

The sphenoid sinuses are similar to the frontal sinuses, both in timing of development, and in variability. These may even develop a little later than the frontal sinuses (Not shown in figure). The sphenoid sinuses are located literally in the center of the head.

I won’t spend time on the potential for complications of sinusitis. You can imagine that the complications of sinusitis are related to where these sinuses are located, and what other important anatomic structures are that located nearby. Please read the articles here about those complications of sinusitis.

Here is a CT Scan of the Sinuses to compare to the drawings above:

Image: Coronal CT Scan of Sinusitis

FIGURE 3: Coronal CT Scan, with Maxillary Sinusitis on the patient’s right side

The CT scan shown above is a “coronal” CT scan of the sinuses. Here is my article on how to “read” your child’s sinus CT scan, and also the article on what to expect when you take your child for their CT scan.

Takeaway Points:

  1. Development of the paranasal sinuses really doesn’t begin until childhood. That means your infant probably does not have “sinusitis” despite what everyone is telling you. That’s okay, since that rhinitis or “rhino-sinusitis” can still be approached in similar ways: find out what the triggers are for that underlying inflammation (particle pollutants, pet dander, true allergies, or infection), and eliminate them.
  2. Your child’s headaches are probably not from the sinuses. If you have a family history of migraine headache, start there. Also consider having their eyes checked – eye strain due to the need for eyeglasses often presents with headaches (mine did). In fact, when we are convinced that our headache is from our sinuses, we are wrong about 80% of the time!!

Until next time, peace …

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Russell Faust, PhD, MD boogordoctor

Dr. Faust and a patient

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Comments

  1. SIBAHATHULLAH ABDUL WAHAB says:

    Thanks Dr Faust.

  2. Monica Reyes says:

    Wow, thanks for this interesting educational article, all this time I thought sinuses developed at an earlier stage. Thanks.

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