Treatment of frontal sinus diseases via combined transfrontal and intranasal endoscopic approaches

Abstract

To summarize the clinical experience of treatment of frontal sinus diseases via combined transfrontal and intranasal endoscopic approaches, and to explore its indications. A retrospective study of 24 patients was conducted. All patients were underwent combined transfrontal and intranasal double approaches because of different kinds of frontal sinus diseases, including 16 cases with frontal sinus cerebrospinal fluid rhinorrhea caused by traumatic comminuted fractures located in posterior wall of frontal sinus, 5 cases with osteoma, 3 cases with inverted papilloma (cancer was confirmed in one case). All sixteen cases with frontal sinus cerebrospinal fluid rhinorrhea were cured after the first attempt. All cases with osteoma and inverted papilloma (including the patient with canceration) were resected completely after the first attempt. Postoperative follow-up lasted from 3 to 132 months in frontal sinus cerebrospinal fluid rhinorrhea, 8-38 months in osteoma, 7-42 months in inverted papilloma and canceration, the median follow-up period was 36 months. No recurrence was found. Operations were successful in all the patients and frontal sinus outflow tracts were unobstructed. No intraoperative or postoperative complications occurred and no disfigurement was found. The potential indications for the combined transfrontal and intranasal endoscopic approaches are listed as follows, (1) frontal sinus lesions mainly located on the posterior wall, (2) propensity to recur or malignant neoplasms, (3) the lesions of frontal sinus with their lateral boundaries or operative site beyond the plane of the lamina papyracea.