Frontal Recess Surgery Research Articles

Tổng quan về hình thái lâm sàng và kết quả phẫu thuật nội soi u nhầy xoang trán sàng

Objectives: To describe manifestation of fronto-ethmoid sinus mucocele and results of endoscopic surgery. Methods: The research method was carried out according to PRISMA-ScR guidelines. The PubMed/Medline database was used to search for studies around the world. Results: Out of 1017 search results, there were 21 studies that matched the selection criteria. The results of a review of 21 studies showed that frontal mucocele had 10 studies with 265 cases, followed by fronto-ethmoid mucocele had 9 studies with 108 cases and ethmoidal mucocele had 2 studies with 74 cases. The common types of sinus surgery methods included endoscopic marsupialization, followed by endoscopic frontal recess surgery, Frontoethmoid surgery and Ethmoidectomy. Conclusion: Frontal mucocele were most mucocele, followed by fronto-ethmoid mucocele and the ethmoid mucocele. The methods showed few complications and were effective in treatment mucocele. The choice of the appropriate surgical method should still be individualized. Keywords: Fronto-ethmoid sinus mucocele, endoscopic surgery.

Anatomical Variations of Uncinate Process in a Tertiary Care Hospital of a Coastal city in Karnataka

Introduction: Superior attachment of uncinate process is the most important anatomical landmark in frontal recess surgery. The uncinate process is an integral struc­ture of osteomeatal complex and prevents the direct contact of the inspired air with the maxillary sinus. It acts as a shield and also plays a role in muco-ciliary activity. Anatomic variations of the uncinate process have surgical implications.
 Aim: This study was done to know the different variations of superior attachment of uncinate process.
 Materials and Methods: In this retrospective observational descriptive study, Computed Tomography (CT) scans of Para Nasal Sinuses (PNS) of 256 patients from Sept 2018 to May 2020 were studied. The results were expressed in percentages and proportions.
 Results: Among 256 CT images, 139 belonged to males and 117 females. In the CT films examined, on the right side, the most common attachment of uncinate was to lamina papyracea which was (64.8%) followed by skull base (19.5%) and to the middle turbinate(15.6%). Similar findings were seen on left side.
 Conclusion: Uncinate process shows different variations in its superior attachment. Superior attachment to lamina papyracea was the most common attachment of uncinate in our study.

Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations.

Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation.Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.

The Anterior Ethmoidal "Genu": A Newly Appreciated Anatomic Landmark for Endoscopic Sinus Surgery.

Human sinonasal anatomy varies widely between patients, challenging surgeons operating in the sinuses. Ethmoid sinus anatomy is so variable it has been referred to as a labyrinth. Accordingly, reliable, consistent anatomic landmarks aid surgeons operating in this region. The goal of this investigation was to explore our observations and hypothesis that the ethmoidal bulla and the uncinate process are not entirely separate structures but rather attach, and the attachment could potentially provide a landmark for surgeons performing ethmoid and frontal recess surgery. Ethmoid sinus anatomy was studied in 57 sinonasal complexes through a variety of methods including gross anatomic dissection, endoscopic dissection and 3D CT stereoscopic imaging. The uncinate process and ethmoidal bulla were noted to fuse at the superior aspect of the hiatus semilunaris in 57/57 cases, forming a genu-like feature in the anterior ethmoid. This consistent anatomic feature related closely to the frontal sinus drainage pathway, which drained medial to it in 44/57 (77%) cases. The anterior ethmoidal "genu" appears to be an excellent anatomic feature that surgeons can use during ethmoid and frontal recess surgery. High resolution 3D stereoscopic CT scan is capable of demonstrating sinonasal anatomy in a detailed fashion previously only achieved by cadaveric dissection. This technology can potentially allow for a virtual dissection of a patient's anatomy prior to surgery and could improve minimally invasive procedures and reduce complications. Clin. Anat. 32:534-540, 2019. © 2019 Wiley Periodicals, Inc.

Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study

ObjectiveIn the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery. MethodsWe retrospectively reviewed the records of 96 patients with chronic rhinosinusitis (CRS). 48 patients undergoing endoscopic sinus surgery with surgical navigation (A group) and other 48 without navigation (B group). Data about percentage of complications, olfactory function (Visual Analogue Scale), Sino-nasal Outcomes Test (SNOT-22), Rhinosinusitis Quality of Life (RhinoQoL), recurrence (CT Lund–Mackay score), total nasal resistance (rhinomanometry) and duration of the intervention were collected and analyzed. ResultsA group evidenced a decrease of recurrence rate (p=0.009), a reduction of total nasal resistance (p=0.007), of frontal recess stenosis (p=0.04) and of nasal symptomatology (p=0.008). QoL had a better improvement in group A. Rate of other complications and olfactory function did not show statistically significant differences between the two groups. The average calibration time was approximately 11min in the A group. Total time of surgical procedure does not evidenced statistically significant difference between the two groups (p>0.05) but if it is considered only the time of the surgical intervention, the difference of duration is significant reduced statistically (p<0.05) in CAN surgery. ConclusionComputer assisted navigation in ESS can be useful for the most experienced surgeons, especially in the frontal recess surgery, decreasing the recurrence rate and reducing the total nasal resistance.

The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus.

The frontal sinus is considered the most challenging sinus to address surgically. There are no current classifications of the degree of surgical complexity of different frontal sinus configurations. The aim of this study is to develop a classification system of the degree of complexity of frontal recess surgery based on preoperative computed tomography (CT) scans. Authors were asked to submit a classification system. These were circulated to all authors. Selection of the final 3 classifications was based on a majority consensus. These classifications were compared further for time-taken, ease-of-use, and interrater agreement. These were assessed by the authors on 10 CT scans representing a range of anticipated surgical difficulty. Out of 3 compared classifications, classification A was the quickest to score (1.44 minutes vs 1.57 minutes and 2.25 minutes), subjectively easiest (3.23 vs 4.07 and 5 on a visual analogue scale [VAS]), and had a moderate interrater agreement (0.52 vs 0.42 and 0.79). In addition, the grading of complexity was as good whether measurements were taken on the CT scans or whether size of the frontal ostium was visually estimated. We propose a fast, easy classification to anticipate the complexity of surgery in the frontal sinus and recess, for patients undergoing primary surgery.

Implication study of angled handed cutter with suction system in endoscopic frontal recess surgery

Implication study of angled handed cutter with suction system in endoscopic frontal recess surgery

Functional frontal recess surgery under 70 degree endonasal endoscopy

Functional frontal recess surgery under 70 degree endonasal endoscopy

Usefulness of three-dimensional computed tomographic anatomy in endoscopic frontal recess surgery.

The endoscopic bidimensional vision offered by the endoscope during endoscopic sinus surgery involves difficulty in visualizing surgical field depth which makes it difficult to learn this surgical technique and makes it necessary for the endoscopic surgeon to mentally create a three-dimensional (3D) picture of the paranasal sinuses anatomy. In particular, frontal recess surgery requires good knowledge of its anatomic position, also since it is necessary to use angled endoscopes, which distort the view, and angular instruments which are difficult to use. Purpose of this project is to offer to the endoscopic surgeon a detailed 3D model of the nose and paranasal sinuses with particular attention to the frontal recess. A 3D reconstruction of the frontal recess and its related structures, starting from computer tomography scans of the human skull, was realized using a professional 3D graphics software. A detailed reconstruction of the main structures which contribute to form the frontal recess was obtained. Particular attention was paid when reproducing the agger nasi cells, uncinate process, ethmoidal bulla, anterior ethmoidal cells, frontoethmoidal cells and their anatomic variants. This is the first experience reported in literature regarding this new technique of iconographic didactics applied to endoscopic sinus surgery. It represents a new frontier, which surpasses and integrates the previous didactic techniques to help the surgeon to mentally create a 3D image of the paranasal sinuses.

Ophthalmic complications of endoscopic sinus surgery

IntroductionThe proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01–2.25% and some of them can be serious, leading to permanent dysfunction. ObjectiveThe aim of this study was to determine the risk and type of ophthalmic complications among patients operated due to a chronic rhinosinusitis. MethodsThis is a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele. Surgeries were performed under general anesthesia in all cases and consisted of polyps’ removal, followed by middle metal antrostomy, partial or complete ethmoidectomy, frontal recess surgery and sphenoid surgery if necessary. The ophthalmic complications were classified according to type, frequency and clinical findings. ResultsIn our material 32.68% of the patients required revision surgery and only 10.1% had been previously operated in our Department. Overall complications occurred in 11 patients (0.66%). Minor complications were observed in 5 patients (0.3%) with the most frequent being periorbital ecchymosis with or without emphysema. Major complications were observed in one patient (0.06%) and were related to a lacrimal duct injury. Severe complications occurred in 5 cases (0.3%), with 2 cases and referred to a retroorbital hematoma, optic nerve injury (2 cases) and one case of extraocular muscle injury. ConclusionsOrbital complications of endoscopic nasal surgery are rare. The incidence of serious complications, causing permanent disabilities is less than 0.3%. The most important parameters responsible for complications are extension of the disease, previous endoscopic surgery and coexisting anticoagulant treatment.

Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study.

Augmented reality (AR) fuses computer-generated images of preoperative imaging data with real-time views of the surgical field. Scopis Hybrid Navigation (Scopis GmbH, Berlin, Germany) is a surgical navigation system with AR capabilities for endoscopic sinus surgery (ESS). Predissection planning was performed with Scopis Hybrid Navigation software followed by ESS dissection on 2 human specimens using conventional ESS instruments. Predissection planning included creating models of relevant frontal recess structures and the frontal sinus outflow pathway on orthogonal computed tomography (CT) images. Positions of the optic nerve and internal carotid artery were marked on the CT images. Models and annotations were displayed as an overlay on the endoscopic images during the dissection, which was performed with electromagnetic surgical navigation. The accuracy of the AR images relative to underlying anatomy was better than 1.5 mm. The software's trajectory targeting tool was used to guide instrument placement along the frontal sinus outflow pathway. AR imaging of the optic nerve and internal carotid artery served to mark the positions of these structures during the dissection. Surgical navigation with AR was easily deployed in this cadaveric model of ESS. This technology builds upon the positive impact of surgical navigation during ESS, particularly during frontal recess surgery. Instrument tracking with this technology facilitates identifying and cannulation of the frontal sinus outflow pathway without dissection of the frontal recess anatomy. AR can also highlight "anti-targets" (ie, structures to be avoided), such as the optic nerve and internal carotid artery, and thus reduce surgical complications and morbidity.

Factors Affecting the Outcome of Frontal Sinus Surgery: A Prospective Study

Chronic frontal sinus disease has always been a difficult problem to treat. We undertook this study to evaluate our results of frontal recess surgery, to determine the factors which affected the surgical outcome and to determine whether the post-operative findings correlated with the symptomatic improvement in the patients. Twenty-four patients with chronic sinus pathologies involving the frontal sinus were included in this study. After failure of maximal medical treatment, they were subjected to endoscopic surgery. The factors assessed included the pneumatisation of the frontal recess on CT scan, the technique of surgery, the intra-operative frontal glow, the state of the frontal recess at the end of surgery, the appearance of the recess on follow-up endoscopy and the symptomatic relief in the patients. 81.2% of well pneumatised frontal recesses had a good outcome while only 42.1% of the poorly pneumatised frontal recesses had a good outcome. 76.2% of cases with a frontal glow seen intra-operatively had a favourable surgical result while 44.4% of cases without a frontal glow intra-operatively had a favourable surgical result. Two-thirds (66.7%) of cases with mucosa-lined frontal recess did well post-operatively while only 33.3% of cases with a raw frontal recess did well following surgery. Well pneumatised frontal recesses, presence of an intra-operative frontal glow and a mucosa-lined frontal recess corresponded with better post-surgical outcomes. A difference in the intra-operative technique did not influence the result after surgery. Nineteen out of 24 patients (79.2%) were asymptomatic after surgery while 5 patients had residual symptoms.

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.

Management of Frontoethmoidal Cells in Frontal Recess Surgery

Frontal recess surgery is the most demanding and technically challenging part of endoscopic sinus surgery. The complexity of the anatomy and proximity with the skull base, the orbit, and the anterior ethmoidal artery often make the endoscopic approach to the frontal sinus drainage pathway difficult and increase the possibility of complications. The basic key structures to the frontal recess are the agger nasi cell and the superior fusion of the uncinate process. Above the agger nasi, the four categories of frontoethmoidal cells contribute to the complexity of the anterior wall of the frontal recess, and the bulla ethmoidalis, the suprabullar cells, and frontal bulla cells may also narrow the frontal sinus outflow. The supraorbital cells are often associated with low position of the anterior ethmoidal artery. Finally, the intersinus septal cells displace the frontal sinus drainage pathway posterolaterally, draining anteriorly into one or both middle meatuses. Clear understanding of the three-dimensional anatomy of the area is of upmost importance for a successful surgical approach. Thorough preoperative study of the CT scan with graphical reconstruction, as described in the literature, is the best way to achieve this. The concept will be presented with examples of various pathologies and anatomical configurations. The aid of frontal mini trephination and the use of image guidance will be outlined. Finally, the balloon dilatation of the frontal drainage pathway will be discussed, with reference to possible indications and contraindications.

Comparison of frontal pneumatization patterns between Koreans and Caucasians

To evaluate the prevalence of specific frontal recess cells in Korean and Caucasian populations; to evaluate and compare the relationship between anterior skull base length and frontal recess pneumatization in these two populations. Frontal recess anatomy was studied with high resolution sinus CT scans obtained in 60 Korean adults and 41 Caucasian adults. None of the subjects had a history of frontal sinus disease or trauma. The anterior cranial base length (ACBL, distance between the nasion and center of the pituitary fossa) and anterior ethmoid length (AEL, distance between the nasion and upper attachment of basal lamella) was also measured on each side. Supraorbital ethmoid cells were more common in Caucasians whereas suprabullar cells and recessus terminalis were more common in Koreans. The prevalence of some frontal recess pneumatization patterns (specifically supraorbital ethmoid cell, suprabullar cell, and recessus terminalis) were more commonly associated with race rather than with ACBL or AEL. Frontal recess pneumatization patterns differ in the Korean and Caucasian adult populations. Because corresponding differences in skull base length were not identified, these differences seem likely to reflect other factors. Such information has clinical significance for frontal recess surgery in these patient populations.

Relationship between the superior attachment type of uncinate process and presence of agger nasi cell: A computer-assisted anatomic study

The uncinate process (UP) is an important anatomic landmark in frontal recess surgery. Its superior attachment shows great anatomic variability. The agger nasi (AN) cell is another important structure that affects frontal recess anatomy and there is a close neighborhood between them. The aim of this study was to investigate the relationship between superior attachment type of UP and the presence of AN cell. A retrospective anatomical study. Computed tomography scans were evaluated of 486 sides of 243 patients who had had paranasal sinus. In 125 (26%) sides, the superior attachment of the UP could not be identified. In the remaining 361 (74%) sides, the prevalence of superior attachment of UP types and the presence of AN cell in each side were recorded. The results were evaluated with chi2 test. The AN cell was found in 290 (80.3%) of 361 sides. The prevalence of AN cell according to superior attachment of UP types were 79.6% for type 1/2, 90.1% for type 3, 71.4% for type 4, 86.5% for type 5, and 83.3% for type 6. The presence of AN cell according to superior attachment types of UP was not statistically significant (chi2= 3.54, P = 0.315). The AN cell was found to be present in 80.3% of the cases. However, the relationship between the presence of the AN cell and the superior attachment types of UP was not statistically significant.

Three-dimensional building block approach to understanding the anatomy of the frontal recess and frontal sinus

Frontal sinus and frontal recess surgery remain a challenge for endoscopic sinus surgeons. In order to remove obstructing cells from the frontal recess and frontal sinus, the surgeon needs to have a clear understanding of the anatomy of this region. The technique presented uses high-definition computerized tomography scans to create a 3-dimensional picture of the cellular structure of this region, which allows surgeons to formulate a step-wise surgical plan prior to surgery and encourages cell-by-cell removal of the obstructing cells during surgery. This improved understanding of the anatomy of this complex region should allow the surgeon to perform a competent and complete dissection with improved results.

A Randomized Control Trial of Surgical Task Performance in Frontal Recess Surgery: Zero Degree versus Angled Telescopes

The use of angled telescopes in frontal recess surgery has the theoretical advantage of improved visualization in areas characterized by reduced access such as the frontal recess. However, their use also is accompanied by the disadvantage of increased visuospatial distortion. To examine the surgical error and task performance of angled telescopes when compared with the use of the 0 degree telescope in frontal recess surgery, we carried out a surgical controlled trial on a cadaveric specimen. Ten surgeons performed randomly predetermined surgical tasks on both sides of the frontal recess. The surgical tasks were divided into three components (passing, grasping, and withdrawing) for analysis. Our study revealed significant difficulty passing instruments with the highly angled 70 degrees telescope as implied by the increased passing time ratio (p = 0.000). This was associated with significant risk of passing instruments blindly (p = 0.011), resulting in significant surgical error of hits to the middle turbinate (p = 0.005). This study also showed that use of less-angled telescopes (30 and 45 degrees) in frontal recess surgery does not appear to be associated with these risks.

Frontal recess surgery for diving-related frontal pain: Case report

We report the case of a professional scuba diver who was unable to dive because he began experiencing severe frontal pain on descent. Following endoscopic surgery to open the frontal recess, the man was able to resume diving unrestricted by pain. We discuss the causes and treatment of this complaint, and we suggest that this might be considered a new indication for surgery in a limited number of cases.