Frontal Sinus Fractures

2021 ◽  
Author(s):  
Dale J. Podolsky ◽  
Kris S. Moe
Keyword(s):  
Frontal Sinus ◽  
Intervention Studies ◽  
Surgical Intervention ◽  
Treatment Protocol ◽  
Outflow Tract ◽  
Endoscopic Techniques

AbstractManagement of frontal sinus fractures is controversial with no universally accepted treatment protocol. Goals of management are to correct aesthetic deformity, preserve sinus function when it is deemed salvageable, prevent sequela related to the injury, and minimize complications associated with intervention. Studies suggest that frontal sinus injuries, including disruption of the nasofrontal outflow tract (NFOT), can be managed nonoperatively in many cases. Advances in the utilization of endoscopic techniques have led to an evolution in management that reduces the need for open procedures, which have increased morbidity compared with endoscopic approaches. We employ a minimally disruptive protocol that treats the majority of fractures nonoperatively with serial clinical and radiographic examinations to assess for sinus aeration. Surgical intervention is reserved for the most severely displaced and comminuted posterior table fractures and unsalvageable NFOTs utilizing endoscopic approaches whenever possible.

scholarly journals The Bifurcated Frontal Sinus

OTO Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 2473974X1876487
Author(s):  
Edward D. McCoul ◽  
Kiranya E. Tipirneni
Keyword(s):  
Frontal Sinus ◽  
Residual Disease ◽  
Case Series ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Consecutive Series ◽  
Endoscopic Techniques ◽  
Common Wall ◽  
Computed Tomography Scans ◽  
Extent Of Surgery

Objectives Frontal sinus anatomy is complex, and multiple variations of ethmoid pneumatization have been described that affect the frontal outflow tract. In addition, the lumen proper of the frontal sinus may exist as 2 separate parallel cavities that share an ipsilateral outflow tract. This variant has not been previously described and may have implications for surgical management. Study Design Case series. Setting Tertiary rhinology practice. Subjects and Methods Cases with radiographic and intraoperative findings of separate parallel tracts within a unilateral frontal sinus were identified from a consecutive series of 186 patients who underwent endoscopic sinus surgery between May 2015 and July 2016. Data were recorded including sinusitis phenotype, coexisting frontal cells, and extent of surgery. Results Ten patients (5.4%) were identified with computed tomography scans demonstrating bifurcation of the frontal sinus into distinct medial and lateral lumens. All cases were treated with Draf 2a or 2b frontal sinusotomy with partial removal of the common wall to create a unified ipsilateral frontal ostium. Eleven sides had a coexisting ipsilateral agger nasi cell, 7 had a supra-agger cell, 8 had a suprabullar cell, and 1 had a frontal septal cell. There were no significant complications. Conclusion The bifurcated frontal sinus is an anatomic variant that the surgeon should recognize to optimize surgical outcomes. Failure to do so may result in incomplete clearance of the sinus and residual disease. The bifurcated sinus may occur with other types of frontal sinus cells and may be safely treated with endoscopic techniques.

scholarly journals Long term outcomes for adults with complete atrioventricular septal defects

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Seitler ◽  
N Al-Sakini ◽  
A Lacerna ◽  
C Flick ◽  
C West ◽  
...  
Keyword(s):  
Heart Block ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Systolic Dysfunction ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Systolic Dysfunction ◽  
Long Term Outcomes

Abstract Background/Introduction Complete Atrio-Ventricular septal defect (AVSD) is a complex congenital cardiac disease, characterised by malformation at the atrio-ventricular junction and AV valve abnormalities. Long- term outcome data is limited. Purpose We sought to describe the long-term outcomes of adults with repaired complete AVSD in a tertiary adult congenital heart centre. Methods We retrospectively recruited patients with complete AVSD who underwent surgical repair between 1973 and 2001 in our centre. All clinical and echocardiographic data were collected and analysed for evidence of atrio-ventricular valve (AVV) deterioration, or cardiac dysfunction. We also assessed for the requirement for further surgical intervention throughout the follow up period. Results A total of 345 patients with AVSD were identified, partial AVSD 211, unrepaired 82. Fifty-two with repaired complete AVSD formed study group, female 36 (69%) and male 16 (31%), Trisomy 21 (23, 44%). Mean age at initial repair was 44 months (median 12, IQR 31.5). Mean follow up was 25.3 years (Median 24, IQR 9.75). Clinical status: At the latest follow-up, most patient were asymptomatic with NYHA I-II (n=46) Majority (n=36, 69%) required only initial repair and no further intervention. Further surgeries were performed in 16 patients including AVV repair (n=9) and LVOTO relief (n=3). Permanent pacemaker insertion needed in 6 (12%), all for heart block following valve repair. 7 patients (14%) had documented arrythmia, 4 (8%) requiring ablations and only 1 had endocarditis. Echo findings: AV Valve dysfunction was more commonly regurgitant rather than stenotic. More than moderate AVV regurgitation was present in 83% of patients, Left AVV (n=25, 48%), Right AVV (n=18, 35%) compared to 4% stenosis (LAVV n=1, RAVV n=1). Ventricular outflow tract obstruction was present in 8% of patients, RVOT obstruction (2, one native, one secondary to prior banding), LVOT obstruction (2, both native, one requiring surgical intervention). Right ventricular systolic dysfunction was present in 6% of patients (n=3), with mean TAPSE 14.1mm (SD± 3.1mm). Left ventricular dysfunction was present in 4% (n=2), mean LVEF 58.9% (SD±7.1%) and mean LV EDVi 55.06mL/m2 (SD±13.2 mL/m2). Only one patient had significant pulmonary hypertension (Mean PAP 48 mmHg). Conclusion Long-term outcomes of surgically repaired AVSD are highly favourable. Left AVV regurgitation is the most common residual lesion requiring further surgical intervention. Ventricular outflow tract obstruction was much less common, as was ventricular systolic dysfunction. Complete heart block was associated with surgical repair and arrhythmias were potential late complications. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Management of villous adenoma - beyond endoscopic techniques

2019 ◽  
pp. 87-89
Author(s):  
B. . Sisir ◽  
S. . Sankar ◽  
Balu Jagan ◽  
Kumar G. Santhosh ◽  
M. N.V. Neelendra
Keyword(s):  
Clinical Picture ◽  
Villous Adenoma ◽  
Surgical Intervention ◽  
Benign Neoplasm ◽  
Complete Removal ◽  
Histological Diagnosis ◽  
Endoscopic Appearance ◽  
Epithelial Surface ◽  
Endoscopic Techniques ◽  
Descriptive Term

Polyp’ is a descriptive term for abnormal projection above an epithelial surface and is not a histological diagnosis. Adenoma is a benign neoplasm of glandular origin and is significant because they are cancers in making. Once a polyp is found, it must be removed in total. Attempts at estimating the polyp histology by endoscopic appearance are often incorrect. With recent advances in endoscopic techniques, most of the polyps are removable through endoscopy. However, there remain a few situations depending on location, size of the lesion and endoscopic expertise available, where complete removal of the polyp requires surgical intervention especially so for large sessile adenomas. We are presenting here four cases of villous adenoma requiring surgical intervention each managed differently depending on presentation and overall clinical picture.

Tension pneumocephalus with cerebrospinal fluid rhinorrhoea in a post craniotomy patient

2010 ◽  
Vol 9 (1) ◽  
pp. 13-14
Author(s):  
Nicholas H Smallwood ◽  
◽  
Sreenivasan Shiva ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Features ◽  
Frontal Sinus ◽  
Surgical Intervention ◽  
Csf Leak ◽  
Dural Tear ◽  
Tension Pneumocephalus ◽  
Neurological Signs ◽  
Important Complication ◽  
Csf Rhinorrhoea

Tension pneumocephalus is an uncommon but important complication of neurosurgery, often requiring urgent surgical intervention. It should be considered in any patient presenting with neurological symptoms after recent craniotomy, particularly if they also have clinical features consistent with cerebrospinal fluid (CSF) leak. We describe a patient who presented four weeks post-craniotomy with fluctuating neurological signs and CSF rhinorrhoea, who made a full recovery following repair of a frontal sinus defect and dural tear.

Surgical Intervention for Enneking Stage-III Vertebral Hemangiomas and Literature Review

2021 ◽  
pp. 10
Author(s):  
Monerah Annaim
Keyword(s):  
Surgical Intervention ◽  
Treatment Protocol ◽  
Stage Iii ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Comprehensive Treatment ◽  
Treatment Protocols ◽  
Enneking Stage ◽  
Vertebral Hemangiomas

Introduction: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking stage-III vertebral hemangiomas. However, it is still controversial and a comprehensive treatment protocol is still lacking. Methodology: A retrospective clinical review was conducted on patients diagnosed with Enneking stage-III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia between 2010 and 2020. Result: A total of 11 patients with Enneking stage-III vertebral hemangiomas were included. The mean follow-up period was 47.5 ± 24.1 (9–120 months) months. All patients were symptomatic; the most common presentations were neurological deficit and/or myelopathy (n = 7). Ten patients underwent surgical intervention. Six patients had preoperative embolization, with a mean blood loss of 880.00 ± 334.46 ml. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during follow-up. No recurrence was reported. Conclusion: Intralesional spondylectomy showed good results in treating Enneking Stage-III vertebral hemangiomas. However, larger studies comparing treatment methods are needed to reach a gold standard approach.

Utility of Sagittal Reformatted Computerized Tomographic Images in the Evaluation of the Frontal Sinus Outflow Tract

2005 ◽  
Vol 19 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Seth J. Kanowitz ◽  
Deborah R. Shatzkes ◽  
Bidyut K. Pramanik ◽  
James S. Babb ◽  
Joseph B. Jacobs ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Multidetector Ct ◽  
Ct Scanning ◽  
Outflow Tract ◽  
Ct Scans ◽  
Mucosal Disease ◽  
Radiologic Evaluation ◽  
Degree Of Confidence ◽  
The Difference ◽  
Simultaneous Reading

Background Anatomic and mucosal obstruction of the frontal sinus outflow tract (FSOT) can result in frontal sinusitis often associated with frontal headache. Thorough evaluation of symptomatic patients requires axial and coronal computerized tomographic (CT) scans of the paranasal sinuses (PNS). With the advent of multichannel multidetector CT scanning, the availability of high-quality sagittal images has become increasingly widespread. However, the utility of these images in the assessment of FSOT patency has not yet been established. Methods A retrospective review of coronal and sagittal images from 25 PNS CT scans (50 sides) were randomized, blinded, and independently evaluated by two neuroradiologists. FSOT obstruction by agger nasi cells, the ethmoid bulla, and mucosal disease was assessed. A degree of confidence was rendered for each of these findings. The results were then compared against a consensus diagnosis, which was rendered based upon simultaneous reading of the coronal and sagittal images. Generalized estimating equations were used to assess the difference between sagittal and coronal images in terms of reader confidence and diagnostic concordance with the consensus. Results Review of sagittal images had a higher degree of concordance with the consensus than did coronal images, and was highest for mucosal disease. Both readers were more confident in rendering a diagnosis based upon the sagittal images. Conclusion Sagittal reformatted CT images of the PNS are helpful in the radiologic evaluation of the FSOT. Experienced neuroradiologists had a higher degree of confidence in the diagnosis of the obstruction of the FSOT using sagittal reformatted images.

Long-term stenting for chronic frontal sinus disease: case series and literature review

2010 ◽  
Vol 124 (11) ◽  
pp. 1216-1222 ◽  
Author(s):  
B Hunter ◽  
S Silva ◽  
R Youngs ◽  
A Saeed ◽  
V Varadarajan
Keyword(s):  
Frontal Sinus ◽  
Relevant Literature ◽  
Case Series ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Narrow Channels ◽  
Co Morbidity ◽  
Disease Case

AbstractObjective:The frontal sinus outflow tract consists anatomically of narrow channels prone to stenosis. Following both endonasal and external approach surgery, up to 30 per cent of patients suffer post-operative re-stenosis of the frontal sinus outflow tract, with recurrent frontal sinus disease. This paper proposes the surgical placement of a long-term frontal sinus stent to maintain fronto-nasal patency, as an alternative to more aggressive surgical procedures such as frontal sinus obliteration and modified Lothrop procedures.Design:We present a series of three patients with frontal sinus disease and significant co-morbidity, the latter making extensive surgery a significant health risk. We also review the relevant literature and discuss the use of long-term frontal sinus stenting.Results:These three cases were successfully treated with long-term frontal sinus stenting. Stents remained in situ for a period ranging from 48 to over 60 months.Conclusion:Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

Frontal sinus fractures with suspected outflow tract obstruction: A new approach for sinus preservation

2015 ◽  
Vol 43 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Tarek Abdelzaher Emara ◽  
Ismail Seddik Elnashar ◽  
Tharwat Abdelzaher Omara ◽  
Waleed Mohamed Basha ◽  
Ahmad Mohamad Anany
Keyword(s):  
Frontal Sinus ◽  
Outflow Tract ◽  
New Approach

Surgical Revision of the Failed Obliterated Frontal Sinus

2005 ◽  
Vol 19 (5) ◽  
pp. 425-429 ◽  
Author(s):  
Peter H. Hwang ◽  
Joseph K. Han ◽  
Evan J. Bilstrom ◽  
Todd T. Kingdom ◽  
Karen J. Fong
Keyword(s):  
Frontal Sinus ◽  
Retrospective Chart Review ◽  
Surgical Revision ◽  
Fat Graft ◽  
Endoscopic Management ◽  
Persistent Disease ◽  
Endoscopic Techniques ◽  
Management Algorithm ◽  
Sinus Obliteration

Background Surgical revision of failed frontal sinus obliteration, traditionally, has been limited to repeat obliteration. However, endoscopic techniques may be successful in selected cases. We review our experience in surgical revision of failed frontal obliteration and propose a management algorithm. Methods Retrospective chart review was performed over a 5-year period for patients who presented for surgical revision of a previously obliterated frontal sinus. Indications for surgery, radiological findings, and surgical approach were reviewed. Results Nineteen patients were identified, presenting an average of 9.7 years from the initial obliteration. Eighty-four percent (n = 16) were approached endoscopically and 16% (n = 3) were approached by revision obliteration. The mean follow-up was 25 months. In the endoscopic group, patients had either mucoceles in the inferomedial aspect of the frontal sinus or incomplete obliteration with persistent disease in the pneumatized frontal remnant. Eighty-one percent (13/16) were managed successfully with a single endoscopic procedure. Nineteen percent (3/16) had persistent disease requiring either a subsequent obliteration or Riedel ablation because of infected fat graft or frontal osteomyelitis. All patients who were managed successfully endoscopically remained free of disease with patent frontal sinusotomies throughout the follow-up period. The endoscopic failures required one to two additional external procedures to achieve disease resolution. In the revision obliteration group, all patients had mucoceles in either the lateral or the superior frontal sinus. All three patients had resolution of disease after a single procedure and remained free of disease throughout the follow-up period. Conclusion Selected patients undergoing revision of frontal obliteration may benefit from endoscopic approaches. If disease is localized in the frontal recess or inferomedial frontal sinus, endoscopic management may be successful in the majority of patients. Superior or lateral frontal disease appears to be best approached externally. Patients undergoing endoscopic salvage should be counseled about the possible need for revision obliteration if disease persists.

scholarly journals Frontal sinus outflow tract evaluation by sagittal computed tomography in frontal sinus fracture

2013 ◽  
Vol 44 (2) ◽  
pp. 209-213
Author(s):  
Mohammad Waheed El-Anwar ◽  
Hosam Nabil Almassry ◽  
Inas Elfiki ◽  
Ghada Abdulmonaem
Keyword(s):  
Computed Tomography ◽  
Frontal Sinus ◽  
Outflow Tract ◽  
Frontal Sinus Fracture
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