A minimally invasive endoscopic approach to chronic isolated frontal sinusitis

Abstract

Chronic isolated frontal sinusitis occurs infrequently. When it does, most of the ethmoid cells are well aerated, and the frontal sinus is involved secondary to anatomic obstruction or inflammatory changes confined to the frontal recess. In this article, we describe a targeted endoscopic approach in which standard anterior ethmoidectomy is unnecessary in treating this condition. Complete uncinectomy with resection of the terminal recess, or the agger nasi or frontal cell is followed by frontal sinusotomy. The ethmoid bulla and the maxillary ostium are left intact. The ethmoid bulla and the anterior wall of the suprabullar recess serve as an effective posterior boundary of frontal recess dissection in the coronal plane, and as a barrier between the surgical instruments and the anterior ethmoid artery. The described technique may be insufficient in certain anatomic variations, such as frontal recess pneumatization originating behind the plane of the bulla lamella. In these situations, the ethmoid bulla will need to be resected. It is concluded that chronic isolated frontal sinusitis can be effectively treated in select cases with a minimally invasive endoscopic procedure that is limited to the reestablishment of frontal sinus outflow.