Treatment Of Chronic Frontal Sinusitis Research Articles

The value of frontal sinusotomy in cases of sinonasal polyposis

BackgroundChronic frontal sinusitis is being treated with less invasive transnasal endoscopic treatments. Surgery relieves illness and prevents recurrence. Our study was conducted on 80 patients who suffer from frontal opacity with sinonasal polyposis and divided randomly into 2 groups: group A: 40 patients candidate for anterior ethmoidectomy without identification of frontal sinus ostium and group B: 40 patients candidate for anterior ethmoidectomy with identification of frontal sinus ostium. The study was conducted in the otolaryngology department faculty of medicine Cairo university.ResultsCT score and sinonasal endoscopy score were statistically significantly improved postoperatively compared to preoperative scores in both groups. There are no significant differences between the 2 groups regarding recurrence rate and complications.ConclusionEthmoidectomy without frontal sinusotomy is a potential substitute for frontal sinusotomy for the treatment of chronic frontal sinusitis with sinonasal polyposis, and it can achieve similar improvements in symptoms and radiological evidence of frontal sinusitis.

Dual Purpose of De-Epithelialized Latissimus Dorsi Musculocutaneous Flap for Treatment of Chronic Frontal Sinusitis and Frontal Bone Defect.

Treating frontal sinusitis refractory to endoscopic sinus surgery and complicating frontal bone defect remains a challenge. One surgical option determined is free flap transfer, which has the versatility to accommodate adequate sinus obliteration and reconstruct skin and bone defects. After successful free flap transfer, forehead recessus deformity can emerge as an esthetic problem for patients waiting for cranioplasty. Hence, the authors examine three cases in which they performed free latissimus dorsi musculocutaneous (LDM) flaps for chronic frontal sinusitis with frontal bone defect. All LDM flaps survived without complications, and all patients achieved passable forehead contours without cranioplasty and with no occurrence of infection. In our procedure, the muscle portion of the LDM flap was used to obliterate the frontal sinus, which is similar to conventional free LDM flap. Conversely, our procedure also uses the de-epithelialized skin paddle of the LDM flap filled with the frontal bone defect, which is distinct from conventional free LDM flap. Thus, preventing postoperative forehead recessus deformity has been the identified as primary advantage of our procedure. The use of the free de-epithelialized LDM flap transfer fulfills two goals: controlling chronic frontal sinusitis and restoring a passable forehead contour.

The novel Propel mini stent - Indications, surgical technique and first clinical experience

The treatment of chronic frontal sinusitis is often problematic due to the anatomically narrow drainage into the nasal cavity. In addition to conservative methods, many surgical therapy procedures have been analysed, with and without the use of placeholders, but without long term therapeutic success. The aim of this work was the clinical testing of the practicability and the short- and long-term therapeutic success of the novel bioresorbable Propel mini stent. In a prospective study on 21 patients with chronic rhinosinusitis and polyposis nasi, the surgical therapy and stent implantation during functional endoscopic surgery (FESS) were examined and the degradation of a total of 31 stents and the success of this therapy were endoscopically controlled and analysed over a period of 6 months. With regard to surgical practicability, the stent with insertion tool proved to be an uncomplicated and easy-to-use system. All stents were well tolerated by the patients. The average detectable absorption of the material lasted for 28 days. The patient collective showed a fully explorable neo-ostium of the frontal sinus in 94 % of cases after 3 months and in 87 % of cases after 6 months. Overall, the results of the prospective study show a good acceptance by the patients without complications as well as complete stent degradation. The follow-up examinations also showed satisfactory results over 6 months. Especially in terms of FESS, the stent system proved to be very practical.

Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study.

In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p < 0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy. The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.

Treatment of chronic frontal sinusitis with difficult anatomy: A hybrid balloon technique in four cases.

The presence of frontal cells poses unique challenges when using endoscopic approaches. This study describes the use of a balloon dilation system as an aid for functional endoscopic sinus surgery (FESS) to access the frontal sinus in cases that would traditionally require open approaches. We present a case series of four patients with chronic rhinosinusitis refractive to medical management who underwent FESS with the aid of a balloon dilation system at a tertiary referral center. All patients had variant forms of frontal sinus anatomy. Surgical techniques will be described and use of the balloon system will be reviewed. All patients (aged 13–68 years) successfully underwent fontal sinusotomies with the assistance of a balloon dilation system, which was used in a variety of ways: to dilate the narrow infundibulum of a high intersinus septal cell, to remove an anteriorly located type III frontal sinus cell, to expand the natural frontal ostium in the presence of excessive agger nasi pneumatization, and to remove a type IV frontal sinus cell. All patients were spared an osteoplastic flap or trephination, and there were no intraoperative complications. No postoperative bleeding, infection, or cerebral spinal fluid leaks were reported. Balloon dilation in combination with standard frontal sinus dissection techniques may be beneficial for a select group of patients with complex frontal anatomy. In this series of patients, the balloon dilation system was used as a tool during FESS and eliminated the need for open approaches.

Balloon Dilation of the Frontal Recess in Patients with Chronic Frontal Sinusitis and Advanced Sinus Disease: An Initial Report

Balloon dilation of the sinus ostia and transition spaces is a relatively new tool in the management of chronic rhinosinusitis. Although studies of its safety and application have been reported, its efficacy in specific indications has yet to be clearly defined. The purpose of this study was to evaluate the use of balloon dilation of the frontal recess for the treatment of chronic frontal sinusitis in patients with advanced sinus disease. This was a prospective study of 20 patients who presented with chronic frontal sinusitis that had failed medical therapy and required operative intervention. Balloon dilation of the frontal recess was performed to improve drainage and ventilation of the frontal sinus. Preoperative and postoperative computed tomography scans were compared for change in the radiologic stage of disease based both on the Lund-Mackay staging system and on the Lund grade (extent of mucosal thickening). Twenty patients met the inclusion criteria during the study period and were followed for several months after operation. All patients underwent a frontal sinus procedure with balloon dilation either alone or in concert with other minimally invasive techniques. A total of 29 sinuses were available for analysis. No significant complications resulted from the procedure. Pretreatment and posttreatment Lund-Mackay scores showed significant improvement in patients with certain subsets of chronic rhinosinusitis. Balloon dilation of the frontal recess is a relatively safe intervention that can be used in the treatment of chronic frontal sinusitis, even in patients with advanced disease.

Obliteración del seno frontal mediante injerto de tibia y plasma rico en plaquetas para el tratamiento de la osteomielitis crónica

The more successfully surgical treatment for the treatment of chronic frontal sinusitis complicated with chronic osteomielitis, is the cleaning and curettage of the sinus with obliteration of the sinus cavity and nasofrontal duct. Several autologous and alloplastics materials are used for this obliteration. We report the case of a patient previously operated on because of frontal sinus plasmocytoma who developed frontal sinusitis with chronic osteomielitis and cutaneous suppuration. He received surgical treatment with frontal sinus curettage and obliteration with tibial bone graft and platelet-rich plasma (PRP). Symptoms disappeared and there were no complications or recurrence. Obliteration of the frontal sinus with tibial bone graft and PRP after sinus cleaning and curettage can be a good alternative in the treatment of chronic frontal sinus osteomielitis.

Endoscopic Frontal Sinus Obliteration: A New Technique for the Treatment of Chronic Frontal Sinusitis

Patients who fail endoscopic drainage procedures for chronic frontal sinusitis often require obliteration of the frontal sinus with abdominal fat. The purpose of this study was to evaluate an endoscopic technique for frontal sinus obliteration. Retrospective case-control. Thirty-five patients underwent frontal sinus obliteration using either an endoscopic (n=10) or conventional osteoplastic flap (n=25) technique from 1994 to 2004 at an academic medical center. Patients undergoing endoscopic obliteration had less blood loss (P = 0.006), decreased operative time (P = 0.016), and a shorter hospital stay (P = 0.003) compared to osteoplastic control subjects. All 3 surgical complications occurred in the control group. No patients required additional surgery for frontal sinusitis. The endoscopic approach to frontal sinus obliteration appears to reduce patient morbidity and should be considered in the surgical management of advanced frontal sinus disease. This is the first report of a minimally-invasive technique for frontal sinus obliteration.

The Endoscopic Modified Lothrop: Long-Term Follow-Up on 44 Patients

The gold standard for surgical treatment of chronic frontal sinusitis has been the osteoplastic flap with obliteration. In an attempt to preserve the frontal sinus, we have been performing the endoscopic modified Lothrop orfrontal drill-out. Retrospective chart review. We performed the modified Lothrop on 54 patients between 1993 and 1998. The modified Lothrop was successful (no revision surgeries and only an occasional need for antibiotics) after one procedure in 68% (30/44) of patients followed up for > or =1 year. Six patients underwent successful revision, bringing the overall success rate to 82% (36/44). Eight patients (18%) eventually underwent osteoplastic flap with obliteration, three of those after attempted revision. Mean follow-up was 40 months with failures occurring a mean of 12 months after initial Lothrop. Overall complication rate was 11%. The modified Lothrop is a technically challenging operation that provides an acceptable alternative to the osteoplastic flap with obliteration.

Surgical treatment of chronic Frontal Sinusitis

Two cases of Frontal sinusitis have been described in which obliteration of the frontal sinuses was done by two different methods, in the first case by removing the anterior wall of the sinus, and in the second by osteoplastic flap technique after the other operations have failed. Both patients were cured but the Osteoplastic flap technique is preferable, because it gives an excellent view of the interior of the sinuses, and there is no resultant deformity.

Frontal sinus osteoma. Anterior wall osteoplastic approach.

Osteoma of the frontal sinus is a well-known clinical and pathological entity, and no attempt will be made to present it completely. These tumors when large are difficult to remove without sacrificing a considerable portion of the anterior wall of the sinus. This results in a postoperative deformity which requires plastic surgery. The purpose of this paper is to illustrate that the osteoplastic approach to the frontal sinus, as described by Goodale and Montgomery, 1 is ideal for the removal of these tumors. The anterior wall osteoplastic approach is not new; indeed, it is only one of many external approaches to the frontal sinus. Goodale and Montgomery recently presented their experiences with this operation for the treatment of chronic frontal sinusitis and gave an excellent step-by-step description of their technique. We followed their method in detail in our operation. We have not described the operative technique in this report, but

Present state of the surgical treatment of chronic frontal sinusitis.

PREFACE Chronic frontal sinusitis has been subject of deep concern among physicians, so much so that a French professor has called it the nightmare of specialists. Notwithstanding antibiotics, surgery still plays an important part in treatment of infections of paranasal cavities, and this is due to fact that when acute inflammation has become chronic antibiotics are not effective. The most important reason why an acute sinusitis becomes chronic is retention. Retention can be caused by something outside sinus region, such as a deviation of nasal septum, hypertrophy of middle turbinate, nasal polyposis, and constriction of nasofrontal duct. It can also be caused by something within sinus, and among latter causes one of most important is size of sinus. Large sinuses very frequently show deep diverticula, partial partition, and retention cells. The surgeon can act

Operation for chronic frontal sinusitis.

THE OPERATIVE treatment of chronic frontal sinusitis has given rise to much controversy among rhinologists. If one may judge from the many operations which have been devised, no single one of them is uniformly satisfactory. These operations range from the completely obliterative operation of the Riedel type at one end of the scale, to the simple drainage operation of the Howarth type at the other. Occupying the midposition we find the Killian operation and its modifications, making an effort at both obliteration and drainage. The obliterative type of operation cures the disease, but is ruled out of ordinary practice by the deformity it creates. The drainage type of operation produces no deformity, but leaves the disease still in situ, and is in fact frankly palliative, aiming at relieving the patient of his symptoms without eradicating the disease. Practically every writer on this subject emphasizes the necessity of preserving or enlarging

Surgical treatment of chronic frontal sinusitis.

Surgical treatment of chronic frontal sinusitis.

Operative Treatment of Chronic Frontal Sinusitis

Operative Treatment of Chronic Frontal Sinusitis

Surgical Treatment of Chronic Frontal Sinusitis

Surgical Treatment of Chronic Frontal Sinusitis

Surgical Treatment of Chronic Frontal Sinusitis

Surgical Treatment of Chronic Frontal Sinusitis

Causes of Failure in the Surgical Treatment of Chronic Frontal Sinusitis

Causes of Failure in the Surgical Treatment of Chronic Frontal Sinusitis

The Treatment of Chronic Frontal Sinusitis

The Treatment of Chronic Frontal Sinusitis

The Treatment of Chronic Frontal Sinusitis

The Treatment of Chronic Frontal Sinusitis