Endoscopic Endonasal Treatment of Ostium of the Frontal Sinus and the Results of Endoscopic Surgery

Abstract

We discuss a procedure for opening the nasofrontal duct and the postoperative findings in endoscopic endonasal surgery. The route of the anterior ethmoidal artery was also studied. The subjects of this study were 57 patients (105 sides) who had frontal sinus disease. The patients all underwent surgery for chronic sinusitis between 1990 and 1992. Patients undergoing revision surgery were excluded. All patients were operated on by the same surgeon. In each patient, following anterior and posterior ethmoidectomy, the frontal sinus ostial region was opened using a 70 endoscope, while carefully monitoring the anterior ethmoidal artery. The agger nasi was left intact. The cells around the ostium were opened using a curved suction tip and upward bent forceps, and the lamellae were removed to achieve the greatest possible communication with the frontal sinus. In 77 sides (73.4%), the communication between the frontal and ethmoidal sinuses was well maintained. The ostium was patent with edematous mucosa in 18 sides (17.1%). The opened ostium could not be confirmed due to presence of polyp, etc., in 10 sides (9.5%). During surgery, the route of the anterior ethmoidal artery was confirmed in 70.8%; and of these cases, it was located anterior to the third ground lamella in about 50%.