External endoscopic multiportal frontal sinus obliteration for laterally pneumatized frontal sinus: a feasibility study

Abstract

IntroductionOsteoplastic flap procedure is a standard method used for frontal sinus obliteration. Endoscopic external frontal sinus obliteration is a minimally invasive new technique confined to small-sized and medium-sized pneumatized frontal sinuses.ObjectiveThe aim of this study was assess the feasibility and surgical application of this technique for far-lateral pneumatized frontal sinuses.Materials and methodsTen sides of adult dry skull were assessed for frontal sinus pneumatization and supraorbital cells by computerized tomography. Three sides were selected with frontal sinus pneumatization extending beyond midorbital line. Feasibility of obliteration of frontal sinus was tested. Endoscopic external multiportal frontal sinus approach was done using angled endoscopy and standard instrumentation. Classic frontal sinus trephine port was performed initially to safely locate the frontal sinus. In-situ nondisplaced superiorly based miniosteoplastic flap reaching to midorbital plane was performed providing another port. Additional lateral trephine port beyond midorbital plane was performed. Angled endoscopy and standard instrumentation were used reciprocally through different ports to reach different areas of frontal sinus. Outcome parameters were ability to reach corners of frontal sinus, remove sinus septae and nasofrontal duct, and maintain integrity of anterior wall of frontal sinus. Surgical application was done in two cases of frontal sinus mucocele and meningoencephalocele.ResultsIn three laterally pneumatized frontal sinuses of dry skulls, corners, septae, and nasofrontal ducts could be handled using external multiportal endoscopic approach without disruption of anterior frontal wall. Three ports allowed two-hand surgical technique. Surgical application in two cases with follow-up over 6 months revealed no significant complication. Subcutaneous collection developed in one case after 2 weeks and resolved with medical treatment.ConclusionExternal endoscopic multiportal obliteration is feasible for frontal sinuses with lateral pneumatization beyond midorbital line. This technique is minimally invasive with less morbidity. Long-term follow-up in a larger series is needed.