Endoscopic Frontal Sinus Research Articles

Complications of Endoscopic Frontal Sinus Surgery

Complications of Endoscopic Frontal Sinus Surgery

Initial Clinical Experience with Balloon Dilation in Revision Frontal Sinus Surgery

The purpose of this study was to determine whether balloon dilation is effective in revision frontal sinus surgery. We retrospectively reviewed all patients who had previously undergone endoscopic frontal sinus surgery and had persistent sinusitis. All patients then underwent balloon dilation of the frontal ostium. Outcome measurements included endoscopic patency of the frontal ostium, Lund-Mackay scores, culture-positive postoperative infections, and subjective persistence of symptoms. Twenty-four frontal ostia and recesses were dilated in 13 patients. The mean follow-up was 13 months (range, 7 to 19 months). During follow-up, 21 of 24 ostia (86%) remained patent and 3 required additional procedures. Postoperative computed tomography scans were performed an average of 12 months after dilation (range, 6 to 18 months) in 9 patients (17 sinuses). The average Lund-Mackay score was 1.35 before dilation and 0.87 at follow-up (p = 0.0076), with 41% of sinuses (7 of 17) displaying radiographic improvement. The average number of postoperative infections was 2.07 (range, 0 to 7). Frontal headaches persisted in 38% of patients (5 of 13) at follow-up. Balloon dilation of the frontal ostia has a posttreatment patency rate comparable to those of other endoscopic revision techniques. Although it may not fully address the frontal sinus disease of all patients, it is a less invasive technique that may be helpful for some patients.

Apply mesh silica-drainage tube and mitomycin C synchronization during surgery to the effect of endoscopic frontal sinus surgery

Objective To investigate effect about application of mesh silica-drainage tube and mitomycin C (MMC) synchronization in endoscopic sinus surgery. Methods We selected 65 patients (116 sides)who have been operated on under nasal endoscopy in this study,included chronic frontal sinusitis,frontal mucocele,osteoma and inverted papilloma. 35 patients (64 sides) of the total was performed to apply mesh silica-drainage tube and MMC synchronization in endoscopic sinus surgery, which as MMC group;the other 30 patients (52 sides) who were not apply it as a control. What's more, all patients were followed 2 ～ 3 years after operation, and the postoperative efficacy and the incidence of complication in the two groups were compared. Results The total effective rate in MMC group(97.4%) was higher.than that of the control group(72.9%) (P<0.01). In MMC group, nasal adhesion after endoscopic sinus surgery was 1 case, and the incidence of complication was 1.6% ;but in control group, nasal adhesion was 7 cases,the ostium of frontal sinus atresia 1 case, the nasofrontal duct stenosis 2 cases, recurrence of the polyps or tumors 2 cases, so the incidence of complication was 23.1% The incidence of complication rate in MMC group was lower than that of the control group (P<0.01)Conclusion To apply mesh silica-drainage tube and mitomycin C synchronization in endoscopic sinus surgery can improve clinical effects of operation method, and postoperative complications are obviously decreased. So this method is convenient, safe and effective. Key words: Endoscopy surgery; Mitomycin C; Nasal sinuse

Computer-aided endoscopic sinus surgery: a retrospective comparative study

BACKGROUND AND OBJECTIVES:Endoscopic sinus surgery (ESS), markedly improved with the introduction of new preoperative imaging techniques, intraoperative visualization tools, and the use of surgical navigation systems. In this retrospective study we evaluated the usefulness of CT-guided endscopic sinus surgery and studied its advantages over conventional endscopic sinus surgery.METHODS:We retrospectively reviewed the records of 60 randomly chosen patients with chronic rhinosinusitis (CRS) and moderate-to-severe sinonasal polyposis, undergoing endoscopic sinus surgery with surgical navigation (n=30) and without navigation (n=30). Data on the operative note, time of surgery, complications, and recurrence rate were collected and analyzed.RESULTS:Of the 60 patients, 40 (66.7%) were diagnosed with CRS and 20 (33.3%) had allergic fungal sinusitis. Primary surgery was performed in 37 (61.7%) and revision surgery was performed in 23 (38.3%) cases. The computer-aided surgery (CAS) group included 28 (93.3%) patients with extensive disease and 12 (40%) with bone erosions, with intraorbital or extradural extension, while the non-CAS group included 24 (80%) patients with extensive disease and seven (23.3%) with bone erosions, with intraorbital or extradural extension. The average operative time was approximately 13 minutes greater in the navigation group, with significant improvement in the recurrence rate (n=11, 36.7% in the non-CAS group; n=5, 16.7% in the CAS group), and intraoperative complications were fewer in the CAS group (two exposures of orbital fat in the non-CAS group; no complications in the CAS group).CONCLUSION:Computer navigational systems appear to serve as a valuable adjunct in preoperative planning and safe intraoperative dissection.

前頭陥凹・前頭洞に進展した内反性乳頭腫に対する内視鏡下副鼻腔手術―６例の検討と適応について―

Endoscopic nasal and paranasal sinus surgery (ESS) provides superior magnification, illumination, and angled visualization enabling a tumor base to be isolated and the disease extent accurately defined. Extended endoscopic frontal sinus surgery, including Draf type I-III, is effective in treating extensive frontal sinus lesions, but endoscopic endonasal management of inverted papilloma (IP) involving frontal sinus and drainage remains controversial. We analyzed six cases of IP involving the frontal recess and sinus and their clinical outcomes treated from 2005 to 2008. ESS by an experienced surgeon under general anesthesia involved four frontal recess tumors without frontal sinus attachment undergoing Draf type IIa procedures and 2 with frontal recess and infundibulum attachment undergoing Draf type IIb procedures. All were successfully, with an uneventful postoperative course and no recurrence observed in follow-up examination. We concluded that ESS achieves complete IP removal, plus the advantages of no external incision, decreased blood loss, low morbidity, and short hospitalization.

Stirnhöhlenfraktur: aktuelle Kontroversen zur Therapie

The surgical treatment of frontal sinus fractures is foreshadowed by fears of late complications. Complications such as meningitis and mucoceles should be prevented by cranialization or obliteration of the frontal sinus. These procedures are still standard treatment despite of recent developments over the last two decades in endoscopic sinus surgery, in medical imaging and surgical instrumentation. Nowadays the role of cranialization and obliteration is challenged by refined endoscopic frontal sinus surgery techniques, the widely-used image-guided systems and the multiplanar high-resolution computed tomography along with new data about postoperative complications. This overview summarizes the current literature, taking into account the existing evidence in the treatment of frontal sinus fractures.

Endoscopic Frontal Sinus Drillout for Recurrent Barotrauma: A Procedure to Save a Pilot's Career

Complete sphenoethmoidectomy with a Draf IIA frontal dissection is the standard of care surgical management for medically resistant diffuse recurrent sinus barotrauma. Surgical failures still occur with this technique mainly due to the propensity of the frontal outflow tract to stenose. Endoscopic frontal revisions are notoriously prone to failure and historically represented the only option for aircrew afflicted by this career-ending complication of surgery. The frontal sinus drillout or endoscopic modified Lothrop procedure (EMLP) offers a highly successful salvage surgery for postoperative frontal ostium stenosis and is particularly suited to the physiologic requirements of the aviator. A high-performance aircraft pilot developed frontal stenosis after extensive sinus surgery for recurrent sinus barotrauma. Multiple failed endoscopic attempts to rehabilitate his sinuses finally gave way to success using the EMLP. He was returned permanently to flight duty at 6 wk post-op. This case report represents the first published successful application of the modified endoscopic Lothrop procedure to a pilot with recurrent frontal sinus barotrauma.

Long‐term frontal sinus patency after endoscopic frontal sinusotomy

The frontal recess is the drainage pathway that connects the frontal sinus to the anterior ethmoid sinus. Mechanical obstruction is the primary cause of chronic frontal sinusitis with or without a secondary inflammatory process. Eosinophilic inflammation is one of the underlying causes for chronic rhinosinusitis. OBJECTIVES/HYPHOTHESIS: To evaluate long-term frontal sinus patency after endoscopic frontal sinusotomy in chronic rhinosinusitis patients and to assess the effect of eosinophilic inflammation on frontal sinus patency. Retrospective chart review. Symptom assessment and archived endoscopic photographs were prospectively collected on patients who underwent frontal sinusotomy between 7-1-1999 and 12-31-2000. Subjective symptom improvements were evaluated using the SNOT-20 = 20-item Sino-Nasal Outcome Test. Objective findings of endoscopic frontal sinus patency were documented by archived digital photography. A total of 161 patients with 294 frontal sinuses who underwent endoscopic frontal sinus surgery in the 18 months had an average follow-up of 45.9 months. The patient population was divided into two groups: 58 patients had eosinophilic CRS (ECRS), and 103 patients had CRS without eosinophils (non-ECRS). The mean follow-up for patients with ECRS is 61.6 months and 37.0 months for non-ECRS patients. The non-ECRS patients had a documented endoscopic frontal sinus patency of 90%, and the ECRS patients had an endoscopic frontal sinus patency of 85%. The overall frontal ostium patency rate for all patients was 88.0%. Long-term endoscopic confirmation of frontal ostium patency demonstrates that endoscopic frontal sinusotomy can yield high quality, durable results. There was no significant difference in patency results between ECRS and non-ECRS patients. Laryngoscope, 2009.

Operative findings in the frontal recess at time of revision surgery

Objective Endoscopic sinus surgery is the gold standard for the treatment of medically refractory chronic rhinosinusitis. There is, however, a population of patients for whom persistent disease is a problem. Of all the sinuses, the frontal sinus is the most likely to have recurrent obstruction. We evaluated the findings causing frontal recess obstruction at the time of revision surgery. Study design and setting A retrospective review was performed in a tertiary care academic otolaryngology department. Results Findings obstructing the frontal recess at the time of revision sinus surgery were reviewed. Two hundred eighty-nine frontal sinuses were included. Seven findings were identified: mucosal disease (67%), retained ethmoid cells (53%), lateralized middle turbinates (30%), retained agger nasi cells (13%), scar (12%), retained frontal cells (8%), and neoosteogenesis (7%). Most frontal recesses had multiple etiologies for failure listed above, with an average of 1.6. Conclusions Multiple findings can be identified that contribute to frontal recess obstruction requiring revision sinus surgery. A comprehensive approach to address all factors is necessary to prevent surgical failure among patients presenting for endoscopic frontal sinus surgery.

Basic and clinical techniques for endoscopic frontal sinus surgeries

在鼻内镜鼻窦手术中，额窦手术被认为最具有挑战性。针对额窦手术相关解剖研究仍未止步，且研究的着重点是围绕手术方式进行的。经鼻额窦开放手术的关键是准确判断额隐窝中额窦口的引流位置。但额隐窝解剖异常或变异、额窦内广泛病变及额窦内肿瘤等，单纯经鼻开放额窦口，无法彻底清除窦内病灶；术后复发或外伤后，额隐窝解剖结构紊乱，瘢痕狭窄或闭锁，经鼻开放或重建额窦引流通道非常困难。这意味着，一方面，

Comprehensive surgical management of the aerosinusitis patient

Provide a comprehensive overview of the pathophysiology and surgical management strategies of sinus barotrauma with attention to recent advancements in endoscopic surgical technique. New endoscopic frontal sinus surgery techniques have been shown to be highly effective with rhinosinusitis management, but these techniques have not been evaluated with sinus barotrauma management. We discuss the surgical goals and expectations with sinus barotrauma and contrast these to those with chronic rhinosinusitis (CRS). Sinus barotrauma surgery requires anatomic patency of involved sinuses whereas CRS patients are satisfied with a lack of symptoms from any residual mucosal disease.

Prolonged stenting of the frontal sinus

Stenting of the frontal sinus outflow tract is occasionally used following surgery to prevent stenosis. The optimal length of stent retention has not been defined and some experts advocate up to 6 months prior to removal. The tolerance of even longer periods of stenting is unknown. Retrospective review. We identified adult patients in a tertiary rhinology practice with frontal sinus stents placed between July 2000 and December 2006 and in place at least 6 months. Length of stenting and condition at last follow-up were determined. : During the 6-year study period, 10 frontal sinus stents were placed out of over 450 endoscopic frontal sinus surgery procedures. Each patient had only one stent placed. Of these 10 patients, one was excluded because the stent was electively removed at eight weeks. None of the remaining nine has been lost to follow-up. The mean length of stenting was 32.6 months (median 17, range 11 to 73). One patient had the stent removed at 61 months because of infection. Another had the stent removed at 11 months because of pain and edema. The remaining seven patients remain asymptomatic with patent stents and no granulation tissue seen on nasal endoscopy. In this group, long-term frontal stenting was rarely used but relatively well tolerated with only two of nine patients requiring removal up to 6 years after placement. With the optimal length for frontal stenting unknown, risks and benefits of removal at each evaluation point must be weighed.

State of the art in craniomaxillofacial trauma: frontal sinus

Many of the successes and controversies in endoscopic management of craniofacial trauma are exemplified in the management of frontal sinus trauma. The effort to reduce surgical morbidity and to optimize reconstruction of craniomaxillofacial injuries has resulted in the development of less invasive surgical approaches and in the use of computer image guidance in surgical planning and execution. Minimally invasive management of frontal sinus inflammatory disease has gained wide acceptance. The technology and techniques applied to surgery of the floor of the frontal sinus is now being applied to the management of frontal sinus trauma. A paradigm shift in the treatment of frontal sinus trauma may be underway. An increasing scope of less severe injuries is being managed expectantly with endoscopic frontal sinus surgery available for salvage. There may be an overall decrease in the most severe frontal sinus injuries owing to enforcement of seatbelt and airbag usage. And the most severe injuries are often best managed through cranialization with anterior skull base reconstruction. Thus, the role for frontal sinus obliteration purely to obviate fractures of the frontal sinus outflow tract may be vanishing.

The Role of Frontal Sinus Obliteration in the Era of FESS

Objective To determine the current indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease. Methods Retrospective case series from a single tertiary care facility. The medical records of 35 patients who underwent OFSO for chronic frontal sinusitis (n=26) and frontal sinus mucocele (n=9) between 1995 and 2007 were reviewed. Data regarding age, gender, date and nature of previous frontal sinus operation(s), pre-operative imaging, pre-operative diagnosis, and operative complications were culled. Results There were 19 males and 16 females with an age range of 19 to 76 years. All patients had pre-operative sinus CT, while 6 patients had additional MRI. Among the 9 patients diagnosed with frontal sinus mucocele, OFSO was first-line treatment in 8 and salvage for 2 failed endoscopic masupialization procedures in 1. Among the 26 patients with chronic frontal sinusitis, OFSO was first-line in 9 and salvage for failed frontal sinus surgery in 17. The failed surgeries were OFSO (n=7), Lynch procedure (n=2), and endoscopic frontal sinus surgery including drill-out (n=10). Five patients failed multiple previous operations. The failed operations dated from 1 to 33 years prior to the present illness in the case of OFSO, 1 to 4 years in the case of Lynch procedure, and 1 to 7 years in the case of endoscopic frontal sinus surgery. There was one reported complication (orbital hematoma). Conclusions OFSO remains a key surgical treatment for frontal sinus mucocele, but is used more commonly as a salvage procedure for chronic frontal sinusitis.

Various causes for frontal sinus obstruction

Purpose A variety of inflammatory and structural conditions can cause frontal sinusitis. The present study was conducted as pilot study to determine the primary cause of frontal sinusitis at the time of endoscopic sinus surgery. Materials and methods Retrospective chart review was performed from 1997 to 2004 of patients who underwent endoscopic frontal sinus surgery at the University of Virginia. Demographic data, intraoperative frontal recess findings, and history of prior sinus procedures were collected. Results There were 102 patients, and 176 endoscopic frontal sinus surgeries were performed with mean follow-up of 29 months. The major causes for frontal sinusitis were polyp (53%), frontal recess synechia (21%), agger nasi cell (12%), and narrow osteomeatal complex (5%). Frontal recess synechia was present only in patients who had prior surgery. Conclusions Inflammatory polyps, followed by synechia, were the most common causes of chronic frontal sinusitis requiring frontal sinus surgery. Further investigation is warranted to identify the sources of frontal recess synechia and to develop preventative strategies of this iatrogenic problem.

Multiplanar Computed Tomographic Analysis of the Frontal Recess Region in Chinese Subjects without Frontal Sinus Disease Symptoms

The purposes of this study were to determine the prevalence of frontal-ethmoidal cells and to evaluate variation in the superior attachment of the uncinate process in Chinese subjects. 202 normal Chinese subjects (404 sides) underwent spiral computed tomography and multiplanar reconstruction images were evaluated. Agger nasi cells showed a prevalence of 94.1%. Of all the frontal cells identified in 159 sides (39.6%) of frontal recesses, the prevalence of type I, type II and type III cells was 24.4, 7.0 and 8.2%, respectively. Suprabullar, frontal bullar and interfrontal septal cells were identified in 148 sides (36.6%), 36 sides (9.0%) and 25 subjects (12.4%), respectively. 244 uncinate processes (60.4%) had 1 superior attachment and the remainder (39.6%) had 2 superior attachments. The prevalence of terminal recesses was 89.1%. Our results characterized normal frontal recess pneumatization patterns in Chinese subjects. That, together with variation in the superior attachment of the uncinate process, emphasized the role of agger nasi cells and the uncinate process in endoscopic frontal sinus surgery.

Study of the cells of frontal recess region with multi-detector CT multiplanar reconstruction and clinicaI significance

Objective To observe the cells of frontal recess region with multi-detector CT muhiplanar reconstruction(MPR).Methods One hundred patients without the disease of frontal sinus and frontal recess region underwent axial multi-detector CT scan with axial,coronal and sagittal multiplanar reconstruction.Results In 100 cases(200 sides),the agger nasi cell is present in 186 sides(93.0%),the frontal cells were identified in 88 sides(44.0%),the prevalence of type Ⅰ,type Ⅱ,type Ⅲ and type Ⅳ cells were 51 sides(58.0%),23 sides(26.1%),14 sides(15.9%)and 0 sides,respectively. The suprabullar cells,the frontal bullar cells and the supraorbital ethmoid cells were identified in 130 sides (65.0%),23 sides(11.5%)and 11 sides(5.5%),respectively.The interfrontal septal cells were identified in 36 sides(18.0%).There was no significant difference between males and females,as well as between left and right side(P＞0.05).Conclusion With MPR imaging,doctors could better understand the frontal recess region,which is helpful to the endoscopic frontal sinus surgery. Key words: Frontal sinus; Tomography; X-ray computed

Minitrephination as an Adjunctive Measure in the Endoscopic Management of Complex Frontal Sinus Disease

Frontal sinus disease and its surgical management continues to remain an area of controversy among rhinologists. This is evidenced by the multitude of surgical procedures, both external and endoscopic, that have been developed in its management. This study was performed to evaluate the safety and efficacy of frontal sinus minitrephination in combination with endoscopic frontal sinus exploration for the management of complex frontal sinus disease. A retrospective chart review identified 13 patients treated with minitrephination, in conjunction with endoscopic frontal sinus exploration, at the University of California at Los Angeles Medical Center or West Los Angeles VA Medical Center from July 2004 to October 2005. Thirteen patients with diagnoses of chronic sinusitis (n = 10), nasal polyposis (n = 7), frontal mucocele (n = 4), allergic fungal sinusitis (n = 3), and inverting papilloma (n = 1) underwent either unilateral (n = 9) or bilateral (n = 4) minitrephination during primary or revision functional endoscopic sinus surgery. Median follow-up was 14.2 months. There were no complications attributed to the procedure, and all patients had improvement of their sinus symptoms and displayed no evidence of recurrence of their frontal sinus disease at last follow-up. Minitrephination is a safe and effective adjunct in the management of complex frontal sinus disease, as it allows identification of the frontal recess and vigorous irrigation of the sinus contents.

11:14: Evidence-Based Review of Endoscopic Frontal Sinus Surgery

11:14: Evidence-Based Review of Endoscopic Frontal Sinus Surgery

Long-Term Results after Endoscopic Sinus Surgery Involving Frontal Recess Dissection

To assess long-term follow-up on a cohort of patients who underwent endoscopic frontal sinus surgery with identification and preservation of the natural frontal outflow tract. Retrospective chart review, telephone interview, and endoscopic evaluation on a previously studied cohort of patients at a university affiliated medical center. Two hundred patients who underwent endoscopic frontal sinus surgery were previously studied and reported after short-term (mean = 12.2 mo) follow-up. One hundred fifty-two (76%) patients were available for long-term (mean 72.3 mo) follow-up and assessment of subjective symptoms. Fifty-seven of 152 (37.5%) patients also had nasal endoscopy for evaluation of objective findings. The percentage of patients responding to telephone interview reporting overall improvement after surgery was 92.4%. Endoscopic assessment revealed patency of the frontal sinus in 67.6% of the patients after initial surgery. Thirteen additional patients had patent sinuses after revision procedures, bringing overall patency rate to 71.1%. We found statistically significant correlation of asthma and smoking and poor subjective and objective outcome. Long-term assessment of subjective and objective findings in our previously reported cohort of patients who underwent frontal sinus surgery indicates that the frontal sinus, similar to any other sinus, can be successfully treated surgically by preserving the natural frontal sinus outflow tract.