Management Of Frontal Sinus Research Articles

Management of frontal sinus and frontal recess inverted papilloma: our experience and systematic review.

For frontal sinus inverted papilloma (FSIP) management, an endoscopic endonasal approach (EEA) can be combined (or not) with an external approach by an osteoplastic flap (OPF) or with a more conservative open approach. The present study aims to describe our experience in the management of FSIP, focusing on disease-related and anatomical features influencing outcomes and recurrence. This case series of FSIP investigated anatomical and disease-related predictors of recurrence associated with EEA or a combined EEA-OPF approach. A systematic review was also performed, selecting publications on IP with the insertion point in the frontal sinus or frontal recess. Among 30 patients included, 18 underwent EEA, while 12 received a combined EEA-OPF approach. During a median follow-up of 37 months, the frontal sinus was cleared of IP in all cases except 2 in the EEA group, who presented a complex posterior wall shape of the frontal sinus. From the systematic review, a combined EEA-OPF approach was associated with a lower risk of recurrence. A correct indication for a combined EEA-OPF approach is paramount and should integrate all disease-related and anatomical features, including posterior wall shape.

Controversies in Maxillofacial Trauma.

Craniomaxillofacial trauma management has continued to improve and evolve as a result of advances in technology and scientific inquiry. Controversies exist where there is little evidence-based literature to guide treatment in frontal sinus management, rigid versus absorbable fixation, open versus closed treatment of mandibular condyle fractures, extraction of teeth in the line of fracture, optimal timing for repair of mandible fractures, antibiotic use for facial wounds and fractures, and reconstructive materials in orbital fracture reconstruction. This article reviews current literature to resolve some of the controversies, to improve patient care by reducing variability and uncertainty in the optimal management of facial trauma patients.

A golden experience: Fifty years of experience managing the frontal sinus.

The frontal sinus is one of the most anatomically complex and inaccessible of the paranasal sinuses. As a result, surgeons have continually tried to improve surgical management of the frontal sinus. The senior author (c.w.g.) shares 50 years of experience managing the frontal sinus. PubMed literature search. Review of the literature regarding landmark innovations in frontal sinus surgery. Open approaches established that the frontal sinus is accessible, and in certain circumstances, such as with large osteoma or papilloma, are still required. The endoscope changed the surgical landscape and allowed for greater finesse and decreased morbidity. Sinus balloon dilation is the newest change in frontal sinus management and shows promise in properly selected cases. Surgery of the frontal sinus continues to evolve and improve. Although there are new techniques, the older techniques are still pertinent.

Newly designed double-vascularized nasoseptal flap to prevent restenosis after endoscopic modified Lothrop procedure (Draf III): laboratory investigation

Despite advances in endoscopic approaches, instrumentations and imaging guidance systems, the management of frontal sinus is still challenging. Failure of the endoscopic procedure and restenosis of the newly formed ostium have been demonstrated even with large frontal sinusotomy. We describe a newly designed double nasoseptal flap to cover the bare bone after endoscopic modified Lothrop procedure (EMLP). Five fresh, double-injected cadavers were dissected through an endoscopic endonasal approach. Posteriorly based nasoseptal flap on one side and laterally based nasoseptal flap on the other side were harvested before performing wide EMLP. Feasibility of the procedure, versatility of the flap, coverage area and measurements were calculated. Harvesting the mucoperichondrial/mucoperiosteal flap over the septectomy site was straightforward step. Two different designed flaps (one on each side) are more practical to avoid torsion of the flap. The flap measures 2 × 3 cm on average that was able to cover the bare bone of the anterior and posterior wall of frontal sinus. Osteoneogenesis and progressive osteoplastic activity after EMLP plays a major role in restenosis of frontal sinus. Vascularized nasoseptal flap helps in preventing closure of the newly formed ostium. Applying these flaps over the bare bone enhances the healing process and minimizes the crust formation.

A Study of Anatomy of Frontal Recess in Patients Suffering from ‘Chronic Frontal Sinus Disease’

A study designed to describe the anatomical features of the frontal recess area in patients suffering from chronic frontal sinusitis. A prospective study done in adult patients admitted in our hospital between July 2009 to June 2011. Tertiary level, private ENT care centre. 50 adult patients of chronic frontal sinusitis who did not have history of previous sinus surgery. The frontal recess anatomy was studied by 2mm slice CT scans pre-operatively. CT findings were confirmed intra operatively by meticulous dissection in frontal recess area endoscopically with aid of image guided system. A chart prepared for each patient of different anatomical variations present in frontal recess on each nasal side and analyzed. Agger nasi cell was found in 94% of cases. The superior attachment of the uncinate was to the lamina papyraceae in 82% of cases. Type 1 frontal recess cells were found in 44%, type 2 in 8%, type 3 in 48% and type 4 in 2% of the cases. Over all 74% of cases had frontal recess cells. The management of frontal sinusitis is a challenge to endoscopic surgeon and as more and more rhinologists got expertise in endoscopic sinus surgery skills; the next challenge is management of frontal sinus. Hence, the need arises for more precise study of frontal recess anatomy. Detailed studies of anatomic features of the frontal recess by coronal and sagittal CT scans are very important and helpful for endoscopic frontal sinus surgery. Our study suggests that there is high prevalence of frontal recess cells in Indian population suffering from frontal sinusitis.

External frontal sinusotomy and endoscopic repair of cerebrospinal fluid fistula in the posterior wall: preliminary report of a new technique

Cerebrospinal fluid rhinorrhoea is the abnormal leakage of cerebrospinal fluid into the nasal cavity. The posterior wall of the frontal sinus can be the site of such leakage. Traditionally, these leaks were repaired via external osteoplastic or neurosurgical approaches. Despite advances in instrumentation, it is difficult to manage superiorly or laterally placed defects endoscopically. We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus. Preliminary study involving patients presenting with frontal sinus cerebrospinal fluid leaks, with defects in the frontal sinus posterior wall, between 2006 and 2010. Patients were treated in a tertiary referral centre for nose and sinus diseases. Patient records were reviewed and analysed. Nine patients underwent external frontal sinusotomy under endoscopic vision. Repair was successful in all cases, with no complications. Follow up ranged from three months to three years. External frontal sinusotomy and endoscopic repair is a simple, precise and cosmetically acceptable alternative to osteoplastic and major neurosurgical techniques for management of frontal sinus posterior wall defects. This new, previously undescribed technique enables otolaryngologists to play a role in managing such defects.

The management of frontal sinus during the endoscopic surgery for chronic sinusitis

目的 探讨慢性鼻窦炎手术中额窦开口的手术处理原则,以提高慢性鼻窦炎鼻内镜手术的治疗效果.方法经鼻内镜手术治疗慢性鼻窦炎113例(226侧),根据额窦口和额隐窝的不同病变和解剖特征,采用不同的方法处理局部病变.结果术中可见所有病例均有不同程度的中鼻道阻塞.额窦口和额隐窝情况:局部没有气房阻塞,仅有肿胀黏膜、息肉样变黏膜或者息肉阻塞者89侧(39.3%);额隐窝被发育过度的鼻丘气房、筛泡气房或终末气房挤压导致额窦引流通道狭窄者80侧(35.4%);额隐窝完全被发育过度、呈蛋壳样气房阻塞者为36侧(15.9%);额窦自然开口狭窄者21侧(9.4%).额窦内病变情况:积脓、黏膜充血肿胀58侧;黏膜肿胀61侧;黏膜充血90侧,黏膜未见明显病变17侧.随访6～20个月,其中治愈198侧(87.7%),好转21侧(9.29%),无效7侧(3.01%),未见严重手术并发症.结论窦口、鼻道复合体和额隐窝的阻塞是慢性额窦炎的主要原因,额隐窝和额窦口阻塞有4种病变状态,应根据不同的病变采用不同的手术方式。

Early Combined Management of Frontal Sinus and Facial Fractures

Early Combined Management of Frontal Sinus and Facial Fractures

SKULL BASE SURGERY WITH SUPERIOR ORBITOTOMY

Three approaches to central cranial base lesions are reported based on experience with orbital advancement in craniosynostosis. The basal approach for large lesions is indicated for total superior orbitotomy after bilateral frontal craniotomy. The basal interhemispheric approach by superomedial orbitotomy with bilateral frontal craniotomy was used for midline, suprasellar and third ventricle lesions. The orbitozygomatic approach by superolateral orbitotomy after front-temporal craniotomy was performed for the spheno-orbital lesion, cavernous sinus lesion and high-placed basilar top aneurysm. Our surgical techniques for each approach are described with case presentations, and the management of frontal sinus, dural and bone defects are stressed to prevent of liquorrhea.