Osteoplastic Flap Surgery Research Articles

A Case of Mini Osteoplastic Flap Surgery for Recurred Inverted Papilloma Originating From Frontal Sinus

A Case of Mini Osteoplastic Flap Surgery for Recurred Inverted Papilloma Originating From Frontal Sinus

Navigation Assisted Frontal Sinus Osteoplastic Flap Surgeries - A Case Series.

Osteoplastic flap surgery of the frontal sinus is still a relevant surgical technique for frontal sinus pathologies despite advancements in endoscopic techniques due to the complex anatomy of frontal sinus and limitations of endoscopic techniques for certain pathologies. The most crucial step in this surgery is accurate delineation of the frontal sinus pneumatisation which guides the osteotomies and this is conventionally done with radiographs which is not without errors. Here we present three cases where we have utilized image guidance technology for osteoplastic flap surgery of the frontal sinus with superior results.

Widespread Inverted Papilloma in the Frontal Sinus Treated by Unilateral Osteoplastic Flap Surgery without Obliteration

Widespread Inverted Papilloma in the Frontal Sinus Treated by Unilateral Osteoplastic Flap Surgery without Obliteration

Minimally invasive approach for lesions involving the frontal sinus

Background. Traditional open surgery for frontal sinus pathology and cerebrospinal fluid (CSF) leaks is complex and involves a craniotomy. Minimally invasive options offer an alternate solution. We describe and assess the outcome of a minimally invasive approach for lesions and defects involving the frontal sinus. Methods. The technique introduces an endoscope via a small frontal sinusotomy accessed via a small medial brow incision. This allows excellent visualisation of the frontal sinus. Fine thin-shafted instruments traditionally used during tympanoplasty or pituitary surgery are passed through the sinusotomy together with an endoscope for dissection and tissue excision. This technique can be combined with conventional endonasal surgery. Results. We describe the use of this technique in three patients: A fracture of the posterior table of the right frontal sinus with CSF leak, a right frontal sinus osteoma and a right frontal sinus mucocoele. Symptom resolution occurred in all patients and no short-term postoperative complications occurred. Conclusion. This approach avoids the morbidity associated with a craniotomy and obviates the need for postoperative intensive care required for conventional osteoplastic flap surgery or extensive endonasal surgery required for the alternative minimally invasive endoscopic technique. Our initial success merits further assessment of the use of this technique.

An Unusual Presentation of Frontal Bony Defect with Pneumocephalus and its Management in an Elderly Patient

Pneumocephalus can be caused by neurosurgical procedures, endoscopic sinus surgery, craniofacial trauma, tumors of the skull base, frontal sinus cranialization, and can rarely occur spontaneously. The treatment options are conservative treatment, craniotomy, osteoplastic flap surgery of the frontal sinus, and endoscopic endonasal surgery. We herein present the case of a 61-year-old man with a frontal sinus bony defect with pneumocephalus caused by craniotomy who presented atypically with left facial cellulitis, followed by meningitis and seizures. This bony defect was successfully repaired with endoscopic modified Lothrop procedure (EMLP). At 18 months' follow-up after the surgery, neither obvious postoperative complications nor signs of pneumocephalus were noted. EMLP offered a less invasive, safer, and effective way to repair the frontal bony defect in our elderly patient.

Modified Osteoplastic Flap Approach for Frontal Sinus Disease

We review the use and outcomes of osteoplastic flap surgery in the current era of almost entirely endoscopic management of frontal sinus disease. A retrospective review was performed of 312 consecutive sinus surgeries performed for frontal sinus disease at the University of Iowa Hospitals and Clinics from July 2002 to July 2008. Seventeen subjects (10 men and 7 women; mean age, 56 years) were identified. The indications for osteoplastic flap surgery were laterally located mucoceles in 8 patients, tumors in 7 patients, and osteomyelitis in 2 patients. Ten patients had skull base erosion, and 5 underwent cranialization for large posterior frontal bone defects. The average blood loss was 175 mL, and the average hospital stay was 3 days. There were no major intraoperative or perioperative complications. Two patients with mucoceles required revision surgery for disease recurrence. The mean follow-up was 25 months (range, 6 to 66 months). Osteoplastic flap surgery is an uncommon procedure in the modern endoscopic era of sinus surgery. In our series it was most commonly indicated for laterally located disease. Osteoplastic flap surgery is relatively safe and effective for a wide range of recalcitrant and complicated frontal sinus disorders.

Frontal sinus models and onlay templates in osteoplastic flap surgery

Precise delineation of the extent of frontal sinus pneumatisation is a crucial step in osteoplastic flap frontal sinus surgery. The authors present a novel method of achieving this objective. First, models of the frontal area are generated using three-dimensional printing based on pre-operative computed tomography image data. These models are then used to create an onlay template of the frontal sinus, which is used intra-operatively. In a series of 10 patients undergoing osteoplastic flap frontal sinus surgery, the described frontal sinus templates were consistently accurate to within 1 mm. Frontal sinus templates are potentially useful adjuncts to current techniques employed to guide frontal sinus surgery.

Jatrogenne płynotoki w przebiegu operacji osteoplastycznych zatoki czołowej

to evaluate CSF leak as a complication of osteoplastic flap surgery of the frontal sinus. Medical recordings of the patients that underwent osteoplastic flap surgery of the frontal sinus were analyzed. among 62 patients operated between 2000 and 2007 there were 4 cases of intraoperative CSF leak (6.5% of cases). In all complicated cases indication for surgery was benign large tumor of the frontal sinus, among them there were two cases of osteoma, one cholesterol granuloma and ossifying fibroma. All CSF leaks were successfully closed with multilayer underlay or overlay graft. The technical aspects of the osteoplastic flap surgery of the frontal sinus are discussed.

Analysis of Methods to assess Frontal Sinus Extent in Osteoplastic Flap Surgery: Transillumination versus 6-ft Caldwell versus Image Guidance

The aim of this study was to compare three common methods (transillumination, plain radiographs, and computerized tomography [CT] image guidance) for estimating the position and extent of pneumatization of the frontal sinus in osteoplastic flap surgery. Axial CT scans and 6-ft Caldwell radiographs were performed on 10 cadaver heads. For each head, soft tissue overlying the frontal bone was raised and the anticipated position and extent of the frontal sinus at four points was marked using three common methods. The silhouette of the frontal sinus from the Caldwell plain radiograph was excised and placed in position. Four points at the periphery also were made using information obtained from a passive optically guided image-guided surgery device, and transillumination via a frontal trephination also was used to estimate sinus extent. The true sinus size was measured at each point and compared with experimental values. The use of CT image guidance generated the least difference between measured and actual values (mean = 1.91 mm; SEM = 0.29); this method was found statistically superior to Caldwell (p = 0.040) and transillumination (p = 0.007). Image guidance did not overestimate the size of the sinus (0/36) and was quicker than the Caldwell approach (8.5 versus 11.5 minutes). There was no learning curve appreciated with image guidance. Accurate and precise estimation of the position and extent of the frontal sinus is crucial when performing osteoplastic flap surgery. Use of CT image guidance was statistically superior to Caldwell and transillumination methods and proved to be safe, reproducible, economic, and easy to learn.

Osteoplastic Flap for Frontal Sinus Obliteration in the Era of Image-Guided Endoscopic Sinus Surgery

This study evaluates the management of frontal sinus disease using osteoplastic flap surgery (OPFS) in the current era of image-guided endoscopic sinus surgery (IGESS). A retrospective chart review was performed of patients who underwent OPFS and imaged-guided endoscopic frontal sintus surgery in the past 10 years at a tertiary care teaching hospital. Chart reviews of clinic patients and inpatients who underwent OPFS were performed. Indications for surgery, prior sinus surgeries, time to OPFS, post-OPFS sinus surgeries, and associated comorbid factors were reviewed. In the period under review, 710 IGESS cases were performed. Thirty patients, who were candidates for OPFS, underwent IGESS for frontoethmoid disease. Fourteen patients from this group failed IGESS and underwent OPFS. The indications for OPFS included mucocele in 10 cases, tumors in 2 cases, and trauma in 2 cases. Four patients underwent revision OPFS. The patients who failed IGESS had prior trauma, tumor resection, radiation, or large septate frontal sinus with lateral extension in which the mucocele could not be drained endoscopically. The average time to OPFS was 6.2 years (0-27 years). Nine patients had prior sinus surgery (1-7 prior surgeries) and five patients had subsequent endoscopic surgical procedures. In all patients with frontal mucocele, surgery should be attempted endoscopically using IGESS because of the low morbidity of the procedure. Patients with risk factors for failure should be considered for OPFS if IGESS proves to be unsuccessful.

Computed Tomography-Generated Templates: A New Approach to Frontal Sinus Osteoplastic Flap Surgery

The aim of this study was to present a new technique for frontal sinus template creation used in osteoplastic flap surgery, obviating the need for the traditional 6-ft Caldwell radiograph. Seventeen human cadaver skulls were studied prospectively. Using digital addition algorithms of sequential coronal computed tomography (CT) images of the frontal sinus to create a composite image, an image is printed to 1 cm = 1 cm scale. A frontal sinus template was created using this processed image and compared with a control 6-ft Caldwell radiograph. The mean variance between corresponding vertical points on the templates was 0.71 mm (95% confidence interval, 0.56-0.87 mm). The mean variance between horizontal points was 1.11 mm (95% confidence interval, 0.97-1.28 mm). The mean difference in width was 2.46 mm. The plain film templates were always wider than the CT-generated templates. The CT-generated frontal sinus templates are virtually identical to the Caldwell radiograph-derived templates. They may obviate the need for additional imaging and minimize the potential errors commonly associated with 6-ft Caldwell templates.

Modern techniques in osteoplastic flap surgery of the frontal sinus

Osteoplastic flap access to the frontal sinus remains a valuable approach for the treatment of benign and malignant lesions of the sinus and posterior table, as well as for sinus obliteration. Even in the age of endoscopic sinus surgery, frontal sinus obliteration remains a definitive procedure for control of severe frontal sinus disease. Obliteration is successful in 90% of cases, despite these patients having had multiple prior surgeries. We present techniques for safe elevation of an osteoplastic flap and effective methods of sinus obliteration. Management of complications is also discussed.