From this article you will learn:
Frontitis is an inflammation of the frontal sinuses. The frontal sinuses are one of four pairs of paranasal sinuses (there are also the maxillary, ethmoid and sphenoid sinuses). The frontal sinuses are located in the frontal bone, just above the eyes (Figure 1).
The paranasal sinuses (including the frontal sinuses) are cavities that are filled with air and lined from the inside with mucous membrane. Through small openings, the frontal sinuses are connected to the upper nasal passages. The sinuses are involved in filtering and humidifying the air, and also give strength to the skull.
Often inflammation of the sinuses is called the general term “sinusitis” (from the word “sinus” - sinus, and the ending “-itis” - inflammation). “Sinusitis” can be understood as inflammation of any of the four pairs of paranasal sinuses -
The main signs of frontal sinusitis in adults are listed below -
With long-term chronic purulent or polypous frontal sinusitis, the patient may experience purulent abscesses on the forehead, swelling and abscessation in the eyelid area, symptoms characteristic of a breakthrough of pus from the sinus into the eye socket or brain may appear.
Chronic purulent sinusitis: photo
Below we list the main causes of sinusitis, as well as risk factors that do not themselves cause, but nevertheless contribute to the development of inflammation in the sinuses.
This creates conditions under which the outflow of mucus and inflammatory exudate into the nasal cavity is disrupted from the sinuses. At this first stage of inflammation in the frontal sinuses there is still no associated bacterial infection, i.e. there is no pus. However, in the absence of timely treatment, in a closed cavity in the absence of outflow of inflammatory exudate and mucus, bacterial inflammation will inevitably develop with the formation of pus.
Risk factors that contribute to the development of frontal sinusitis –
The ENT doctor will check the nasal cavity for inflammation, the growth of polyps, the presence of adenoids, and examine the tonsils. Ideally, your doctor will take a sample of mucus from your nose at microbiological examination to determine which microorganisms caused the development of frontal sinusitis (viruses, bacteria or fungi). The latter is especially important if you have chronic nose/throat diseases or if sinus inflammation occurs with enviable consistency.
Additional research methods –
1)
microbiological examination of mucus (see above),
2)
X-ray of the frontal sinuses, or even better CT ( CT scan),
3)
allergy test (since allergic rhinitis can cause sinusitis),
4)
Possibly a general blood test.
Frontitis on x-ray and computed tomography: photo
How to treat frontal sinusitis will depend primarily on the form of the disease (acute or chronic), as well as the nature inflammatory process(serous, purulent or polypous). It is also important to understand the cause of inflammation (allergies, viruses, bacteria, fungi), because the list of prescribed drugs and procedures will depend on this.
That is, if you don't want to improper treatment frontal sinusitis has become chronic purulent form which requires mandatory surgical intervention, consult an ENT doctor from the very beginning. The doctor will examine you, refer you for examinations if necessary, and then you can calmly take pills and put drops into your nose at home (website).
Acute frontal sinusitis arising against the background of ARVI and influenza, or allergic rhinitis It is quite possible to treat with anti-inflammatory drugs based on ibuprofen, which will relieve pain and reduce inflammation. And also with special drops in the nose - to create an outflow of mucus and inflammatory secretions from the sinuses into the nasal cavity.
Those. the most important thing in treatment is to create a good outflow of exudate and mucus from the sinuses into the nasal cavity. Most symptoms acute sinusitis begin to disappear within a few days of treatment, but you need to complete the entire course of treatment prescribed by your doctor.
Drops to relieve nasal congestion
–
Drugs to stimulate the release of mucus from the sinuses
–
These drugs can be in the form of drops or tablets. They consist entirely of herbal ingredients, which should be nice for people looking for folk methods treatment. Let us say right away that such drugs can only be auxiliary therapy, but not the main method of treatment.
The herbal components of the following drugs cause increased function of the ciliated epithelium of the mucous membrane (so to speak, cilia), which promotes the removal of mucus and exudate from the sinuses into the nasal cavity through small openings between them.
As we wrote above: acute frontal sinusitis most often develops against the background of acute respiratory viral infections and influenza, and antibiotics, as is known, do not act on viruses. Taking antibiotics for acute frontal sinusitis only makes sense if a bacterial infection occurs and develops purulent inflammation, but this does not happen immediately.
If there are indications for taking antibiotics, then the drug of first choice is Amoxicillin in combination with Clavulanic acid. Preparations that contain this combination: “Augumentin”, “Amoxiclav”. If the patient is allergic to antibiotics of the penicillin group, then it is better to use -
Antibiotics for frontal sinusitis are prescribed for approximately 10-14 days. However, after 5 days from the start of treatment, it is necessary to evaluate the effectiveness of therapy. If significant improvement is not achieved, then it is best to prescribe a more potent antibiotic.
If frontal sinusitis has a chronic course, then it is necessary first of all to conduct a microbiological examination of mucus from the nose and an endoscopic examination, as well as computed tomography. This will make it possible to determine the type of inflammation and make a choice between conservative and surgical treatment.
In the case of a chronic purulent course, or in the presence of polyps in the sinuses/nasal passages, surgical intervention in a hospital setting will be required to remove the polyps and inflamed mucous membrane from the sinuses. The same operation can also be used to treat a deviated nasal septum.
Complications arise, as a rule, only as a result of the patient’s self-medication and late consultation with a doctor. The most harmless complication will be the transformation of acute frontal sinusitis into chronic purulent or polypous, with the need for surgical intervention. Among more serious complications may be: brain abscess, orbital abscess and loss of vision, thrombophlebitis of facial veins, sepsis... We hope that our article on the topic: Frontitis symptoms and treatment at home was useful to you!
The second largest in size after the maxillary paranasal cavities are the frontal sinuses, otherwise called the frontal sinuses. They are located in the thickness of the frontal bone immediately above the bridge of the nose and represent a paired formation, divided by a septum into two parts. However, not all people have frontal sinuses; about 5% of the population do not even have their rudiments.
Normally, the final formation of the frontal sinuses ends by 12-14 years. It is by this age that they become fully functional structures, having a volume of 6-7 ml and playing important role in nasal breathing, formation of the voice and facial skeleton. This fact explains the absence of pathology of the frontal cavities in children - from 2 to 12 years old, they may develop diseases of only the maxillary paranasal sinuses.
The frontal sinuses are lined with mucous membrane, the epithelium of which constantly produces a small amount of mucus. Through the narrow frontonasal duct, which opens under the middle turbinate, the sinuses are cleansed of mucus - with it, microorganisms and dust particles that have entered them are removed from the sinuses.
The presence of this channel when certain conditions can greatly impede drainage, as when severe swelling mucous membrane, the duct is blocked, and cleansing the frontal sinuses becomes impossible. Such persistent blockade of drainage does not occur, for example, in diseases of the maxillary sinuses, which are connected to the nasal cavity not by a canal, but in most cases by an opening. This is important to remember when prescribing treatment for pathologies of the frontal cavities.
The most frequent illnesses paranasal sinuses - these are their inflammations caused by penetration into the nasal cavity and further into the sinuses of pathological microflora. In most situations, sinusitis (inflammation of the sinuses) becomes a complication of a runny nose of an infectious nature, but cases of isolated damage to the paranasal sinuses are also recorded, as well as pathological process in the accessory cavities of allergic origin.
In terms of frequency, they are in first place various inflammations maxillary sinuses, on the second - frontal, more rare are ethmoiditis and sphenoiditis (lesions of the ethmoid and sphenoid sinuses).
With frontal sinusitis (inflammation of the frontal sinuses) of an infectious or allergic nature, swelling of the mucous membrane of the sinuses and the frontonasal duct always occurs. In this case, the epithelium begins to produce an increased amount of mucus, which is a protective reaction.
Its meaning is to remove with mucus harmful viruses and bacteria, their toxins, decay products, destroyed epithelial cells, as well as allergic agents. If the inflammation is infectious nature, then the abundant contents of the frontal cavities are a mixture of mucus and pus. If allergic, then the discharge does not contain a purulent component.
Cleansing the frontal sinuses is necessary for any form of inflammatory process, since the mass discharged during persistent blockage of the frontonasal canal by the swollen mucous membrane cannot drain independently. Its accumulation causes a characteristic clinical picture frontitis.
These are symptoms of intoxication (with infectious inflammation) with an increase in body temperature to 38-39 degrees, severe and excruciating pain in the forehead and eye sockets, nasal congestion, copious flow of mucus and pus from it (when drainage is restored), impaired sense of smell and timbre of voice.
It is also necessary to clean the frontal sinuses in a timely manner due to the risk of serious complications. So, when a huge amount of mucus and pus accumulates in them, a “melting” can occur. bone wall sinus and breakthrough of contents into the orbital cavity or lesion meninges, which is very dangerous for the patient’s life.
Therefore, when symptoms of frontal sinusitis appear, you do not need to take any independent steps in treatment; you must immediately contact a doctor who will diagnose the pathology and prescribe therapeutic measures to clean and sanitize the frontal cavities.
When a patient seeks help, all necessary diagnostic measures to determine the form of inflammation, as well as to differentiate frontal sinusitis from diseases of the maxillary sinuses or from other sinusitis. Using the methods of anterior and posterior rhinoscopy, the ENT doctor notes changes in the nasal cavity, the presence of hyperemia in a certain area and the nature of the contents.
By tapping, you can find out the location of the pain; using a blood test, you can determine whether it is infectious or allergic inflammation. To obtain definitive data for the diagnosis of inflammation of the frontal, maxillary and other cavities, additional instrumental study. This includes diaphanoscopy, radiography, computed tomography, ultrasound.
Using these methods, it is possible to determine whether there is an accumulation of contents in the sinus, whether it is draining, or whether there is a blockage of the frontonasal canal. These data determine which method of cleansing the frontal sinuses will be chosen by a specialist, conservative or surgical.
In most situations, conservative methods of therapy are sufficient to cleanse the maxillary or frontal paranasal sinuses. This means that the use of certain medications quite capable of both reducing the production of mucopurulent discharge and restoring normal cavities by eliminating swelling of the mucous membrane of the excretory ducts.
Therefore, first of all, etiotropic treatment is prescribed, aimed at infectious agent or an allergic agent (antibiotics or antihistamines), then - vasoconstrictor nasal drugs (Galazolin, Nazol, Naphthyzin) strictly according to medical recommendations, in case of intoxication - antipyretic drugs.
If the patient does not have elevated temperature body, then it is very useful to do physiotherapy. For inflammation of the frontal or maxillary sinuses, UHF, HF, local and general warming procedures are very effective.
If these methods fail to remove a persistent blockade of the frontonasal duct, then the doctor has to resort to more radical methods. Depending on the patient’s condition, the form and severity of the disease, it is recommended to perform lavage using a YAMIK sinus catheter, puncture frontal sinus using an endoscope through a drainage channel or a transosseous puncture of its anterior or lower wall with further washing and sanitation of the cavity.
Cleansing the frontal sinuses with frontal sinuses of any origin is the leading direction in therapy. It is important to choose the most optimal method for the patient and perform cleansing procedures in a timely and correct manner.
The inflammatory process that affects the mucous membrane of the paranasal sinuses is designated general term"sinusitis". Sinusitis of various sinuses has common reasons development and a similar clinical picture of the course of the disease, but differ in a number of symptoms characteristic of inflammation of a particular area.
Depending on the location of the lesion in a particular sinus, the names of the disease occur.
Sinusitis cannot be frontal, although Clinical signs the lesions of these two areas are similar to each other and often a combined inflammation of the frontal and maxillary sinuses occurs.
With frontal sinusitis, the frontal sinus becomes inflamed, which is a steam sinus and is located in the thickness of the frontal bone. It borders the orbit and anterior cranial fossa, which determines the peculiarity of the symptoms and the likelihood of developing severe complications as the inflammatory process progresses.
General clinical signs of frontal sinusitis:
Features of symptoms, similarities and differences between frontal sinusitis and sinusitis:
Pain syndrome.
With frontal sinusitis, the headache occurs in the forehead area, or rather, in its center a couple of centimeters above the bridge of the nose. With sinusitis it hurts in the area upper jaw and temples.
Pain intensity.
It does not depend on the location of the inflammatory process, but the pain becomes stronger when moving the head, both with frontal sinusitis and sinusitis.
Discharge from the nose.
Wears different character and is observed in both diseases. But with frontal sinusitis, more often than with sinusitis, there is no discharge from the nose, since the outlet of the frontal sinus is easily blocked due to the peculiarities anatomical structure.
Swelling.
Swelling with frontal sinusitis extends to upper eyelid, soft tissues above the eyebrows and forehead area. With sinusitis, swelling is localized in the area of the lower eyelid and soft tissues of the cheek.
The duration of the disease rarely exceeds two weeks, but with inadequate therapy the process takes on the characteristics of a disease.
The diagnosis is made taking into account the patient’s complaints, ENT examination data and results X-ray studies. If complications develop, an additional consultation with an ophthalmologist and neurologist is prescribed.
! Important
Many consider the main symptom of frontal sinusitis to be headache in the forehead area. However, large quantity people experience underdevelopment of the frontal sinus or its absence.
This means that they cannot have frontal sinusitis. Therefore, you should not self-diagnose or self-medicate headaches, but visit a specialist to confirm the diagnosis.
Conservative treatment of frontal sinusitis does not differ from the treatment of sinusitis and is carried out in the same directions:
If the patient has severe forehead pain or conservative treatment does not bring the desired result, then trephine puncture is performed.
The essence of the procedure: Based on X-ray data, the location of the sinus is determined. Before the operation, the trephine puncture point is marked and after preliminary local anesthesia, a hole is drilled in the anterior wall of the sinus in the forehead using special instruments.
After this, the sinus is washed with an antiseptic solution, which is poured through the nose, and injected into it. medicines. A special catheter is inserted into the resulting hole to subsequently remove the discharge.
Washing with Yamik catheter.
As a non-puncture method for removing pus during sinusitis, you can use the YAMIK sinus catheter, which creates negative pressure and allows pathological secretions to be removed from the sinuses and injected into them medicinal substances. The principle of operation is no different from carrying it out during frontal sinusitis.
Surgery.
Performed in cases of blockage of the outlet, in the absence of results from conservative therapy or in the development of ocular and intracranial complications.
Endonasal drainage.
With the help of endoscopes, endonasal (through the nasal cavity) drainage of the frontal sinus according to Draf is carried out in several variations depending on the characteristics of the pathological process.
Open Jansen-Ritter operation.
Traditional open radical surgery on the frontal sinus according to Jansen-Ritter, it is performed through an incision near the inner corner of the eye and continued along the eyebrow.
There are a number of others surgical interventions(according to Killian, according to Riedel, etc.), the choice of which is made by the attending physician, taking into account the anatomical structure of the sinus and other features of the body.
Quite often, pain in the frontal sinuses is mistaken for a headache. You need to know what frontal sinusitis is and what symptoms it manifests itself!
Anatomically, the frontal sinuses belong to the accessory formations, due to which the level of pressure in the nasal passages is regulated. If the frontal sinuses hurt, it is assumed that you have sinusitis. This is an inflammatory process of the mucous membrane that lines the inner surface each branch of the paranasal sinuses. Mucosal epithelial cells have the ability to resist penetration pathogenic microflora and produce secretory fluid, which has an immunomodulatory effect. Pneumatic gasket in the form of frontal sinuses prevents hypothermia of the brain.
For the development of the disease, weakening is crucial immune defense body and presence chronic diseases mucous membranes of the nose. Most often, the infection gets into these departments upward path. Treatment is long and complex due to the anatomical distance of the frontal sinuses from the nasal passages. A puncture is often used for rinsing purposes. antiseptic solutions. Antibacterial therapy is more effective in early stage diseases. Therefore, when the first symptoms of frontal sinusitis appear, you must consult an otolaryngologist.
The main reasons include the presence of a chronic inflammatory process in the upper respiratory tract. Gradually, as the disease progresses, the immune barrier between the bacterial flora and the internal sinuses weakens. Pathogenic microflora penetrates the mucous membranes and an inflammatory process develops. Inflammation of the frontal sinuses has a wave-like course and can quickly turn into chronic form and go away on its own without specific treatment. However, the disappearance of frontal sinus symptoms does not indicate what happened complete cure. Most likely, the process has turned into a chronic, sluggish form.
Prerequisites for the development of inflammation may be:
In the pathogenesis of development, the infectious agent is of great importance. It can be pathogenic bacteria and viruses. Ciliated epithelium with cilia, which is located on the mucous membrane of the frontal sinuses, is initially not susceptible to the penetration of pathogenic microflora. Infection is possible only when the protective function is weakened, which is expressed in a change acid-base balance mucous secretion. Many scientists agree that the reason for this may be long-term use drops based on vasoconstrictor substances.
After the onset of the inflammatory process, swelling and hyperemia of the mucous membranes develop. This leads to the separation of a large amount of secretory fluid with difficulty in its outflow. Oxygen stops penetrating into the frontal sinuses. Gradually increasing internal pressure, which causes severe headaches in the forehead area.
Symptoms are divided into two groups - local and general signs diseases. When diagnosing frontal sinusitis, symptoms and treatment are differentiated from other causes of headaches and general intoxication. Local forms of the disease are manifested by the following symptoms:
Symptoms of general intoxication may also develop:
To prescribe treatment it is necessary to carry out additional methods diagnostics In particular, with the help of radiography, the lesion and the degree of the inflammatory process are established. Using culture of purulent discharge, the pathogen and its sensitivity to antibacterial therapy are identified. Rhinoscopy and magnetic resonance computed tomography can also be used.
Trepanopuncture is used only in cases where the diagnosis has already been previously confirmed by radiography and requires a puncture for the purpose of therapeutic manipulation. In all other cases, this is avoided.
It is used both medicinally and surgical treatment. Puncture of the frontal sinus is required only when severe course diseases when it is difficult to separate mucus from internal cavity. The puncture is done in outpatient setting using local methods anesthesia.
Common treatments for frontal sinusitis include:
Warming the frontal sinuses using physiotherapy methods is useful. If the temperature rises, paracetamol may be prescribed. In the first 5-7 days of the disease, strict bed rest. Sick leave is given for a period of 10 days. The statement is made upon receipt normal results general analysis blood.
For the purpose of prevention, it is necessary to avoid long-term sinusitis and rhinitis. If your runny nose does not go away after 3 days self-treatment- consult a doctor immediately. It is quite possible that you will need specific treatment. You should also use hardening and general physical strengthening techniques to maintain your immune system in excellent condition. IN autumn period Vitamin therapy and the use of drugs for prevention are recommended viral diseases. And, of course, it is necessary to monitor the cleanliness of the nasal passages and freedom of nasal breathing. The nasal mucosa neutralizes pathogenic bacteria and viruses that enter our body from the surrounding air.
If you experience pain in the frontal sinuses, consult a doctor immediately. Timely treatment will help prevent the chronic form of the disease.
Inflammation of the frontal sinus always has as its primary source a disease of the nasal cavity or occurs hematogenously.
Isolated frontal sinus disease is rare; it is almost always combined with ethmoid cell disease.
Symptoms of sinusitis. Pain localized supercilially in the forehead and on the lower wall of the frontal sinus; in acute sinusitis, this pain is often accompanied by lacrimation and photophobia. Pain in acute frontal sinusitis is periodic in nature (“frontal colic”): at about 10-12 o’clock in the morning it begins sharp pains, lasting several hours and subsiding by 3-4 o'clock in the afternoon. These pains can be explained by a delay in discharge due to a change in position. With chronic sinusitis, these pains are less pronounced and more dull in nature or may be completely absent if there is no retention of discharge.
Nasal discharge occurs in both acute and chronic inflammation of the frontal sinuses. More nasal discharge when vertical position head (the opening of the frontonasal canal is located at the bottom of the frontal sinus) and less when lying down.
Swelling is worth mentioning upper eyelid, especially often observed in children.
During diaphanoscopy, there is a darkening of the affected side, but the data obtained using this method can only be considered relative.
The x-ray also shows darkening on the affected side; An x-ray can be used to judge the size of the sinus, accessory cells, and the septum between the sinuses.
If the process occurs latently in the frontal sinus (closed empyema), the diagnosis is based only on the x-ray picture, since others objective signs No.
Catheterization of the frontal sinus is not always feasible due to the fact that access to the canal can be difficult - deviated nasal septum, polyps in chronic sinusitis, narrowing of the frontonasal canal by the adjacent ethmoidal cell. Catheterization of the frontal sinus should be avoided in case of acute frontal sinuses or aggravated chronic ones. Catheterization of the sinus is done after preliminary superficial anesthesia, used to reduce swelling of the mucous membrane of the frontonasal canal. A long flexible cannula, which can be given any bend, is inserted under the anterior end of the middle concha; the end of the cannula should opt. directed upward and forward and slightly outward. The cannula must be inserted without any force, so as not to make a false move and not get through the perforated plate ethmoid bone into the cranial cavity. After inserting the cannula, you can rinse the sinus with a penicillin solution.
Inserting a cannula is not always possible in an adult, and it is even more difficult in children, who are usually restless during any manipulation. With some patience, skill and the ability to influence the child, inserting a cannula is feasible.
Diagnosis placed on the basis of everything stated above.
At differential diagnosis it is necessary to resolve the issue of the origin of the pain - it can be purely neuralgic or depend on inflammation of the frontal sinuses. It should be based on the rhinoscopic picture: the presence of pus in frontal sinusitis, its absence in neuralgia. In addition, one must be guided by the following: 1) for neuralgia trigeminal nerve the pain begins in attacks, with frontal sinusitis the pain increases gradually; 2) with frontal sinusitis, the anterior and lower walls of the frontal sinus are painful with pressure; with neuralgia, the exit area n is painful. supraorbitalis; 3) with frontal sinus pain from pressure on the walls of the frontal sinus increases, with neuralgia it decreases.
Forecast can only be stated with caution: along with a favorable process that ends in recovery, the disease in question can cause complications such as osteomyelitis of the frontal bone, intracerebral or orbital complications.
Treatment with acute frontal sinusitis the same as with acute inflammation maxillary sinus; at chronic inflammation treatment should ensure drainage of secretions, i.e., polyps should be removed, the anterior end of the middle concha (if it is voluminous), and the nasal septum should be resected (in older children) if there is a curvature in its upper part. If after this there is no improvement, it is necessary to open the frontal sinus.
The operation is performed under general anesthesia or local anesthesia depending on the age and behavior of the child after appropriate preparation of the surgical field.
1. A skin incision is made along the entire length of the eyebrow (the eyebrow is not shaved). U internal corner In the eyes, the incision goes in an arcuate manner down to the lower end of the nasal bone and penetrates all soft tissues, including the periosteum.
2. Soft fabrics with the periosteum is moved slightly up and down to expose the lower (orbital) wall of the frontal sinus.
3. Trepanation begins from the upper inner corner of the eye; here the sinus is opened and its entire orbital wall is demolished.
4. The sinus is cleaned of pus and granulations.
5. Partially remove the proncessus frontalis and gain access to the ethmoidal cells, which are thoroughly cleaned. If necessary, you can also cleanse the main sinus.
6. The sinus is drained, and sutures are placed on the edges of the incision. The drainage is left for 2-3 weeks for scarring and in order to create a stable connection between the nose and sinus.
The operation according to the Killian method consists in completely demolishing the orbital and partially the anterior wall of the frontal sinus; on the front wall, corresponding to the superciliary arch, above the opened sinus, a subperiosteal bone bridge in the form of an arch is left. This operation is applicable only on large sinuses; Children's sinuses are not very large,
The frontal sinus in older children can also be opened by the endonasal route.
Is it possible to register an employee for the position of financial director - chief accountant? The chief accountant claims that yes, but...
The head of a small business can easily manage the budget independently. CHECKED! If you're budgeting...
The creation of new projects involves a preliminary economic justification for their feasibility, subsequent...
Reporting is generated by the RM, is agreed upon (approved) by the Risk Committee under the Management Board and transmitted to...
At the edge of a large, very large meadow, on a long emerald blade of grass lived a tiny Ladybug. Little Ladybug...
Nowadays, it is quite common for people to turn to the stars. With the help of a horoscope a person can learn a lot about...
Business or friendly. If you were pursuing a stranger, it means your level of trust in the female sex...
according to Freud's dream book If you dreamed about how you were fishing, it means that in real life you can hardly switch off...
The New Year's whirlwind will spin us around so quickly and rapidly that it's time to thoroughly think through the New Year's...
The article offers you some of the most delicious recipes for making vinaigrette. Vinaigrette is a delicious salad...
July 4th, 2015 , 08:33 pm Lately our Nastena has been completely giving up sweets (and thank God), but...
Fragrant, very tasty chocolate cake, it’s impossible to stop eating! The Negro’s Kiss cake is very easy to prepare,...
Dream interpretation is an ancient art that allows you to at least assess the psychological status...
As soon as the first mirrors were born, people immediately endowed them with all sorts of mystical abilities....
The head of a small business can easily manage the budget independently. CHECKED! If you manage...
The creation of new projects involves a preliminary economic justification for their feasibility, subsequent...