Combined Endoscopic Trephination and Endoscopic Frontal Sinusotomy for Management of Complex Frontal Sinus Pathology

2005 ◽  
Vol 19 (5) ◽  
pp. 435-441 ◽  
Author(s):  
Pete S. Batra ◽  
Martin J. Citardi ◽  
Donald C. Lanza
Keyword(s):  
Frontal Sinus ◽  
Demographic Data ◽  
Symptom Relief ◽  
Subjective Symptom ◽  
Sinus Surgery ◽  
Combined Approach ◽  
Sinus Disease ◽  
Endoscopic Techniques ◽  
Difficult Cases

Background The advances in endoscopic sinus surgery have revolutionized the management of frontal sinus disease. Despite the successes, the purely endoscopic approach has its limitations, especially in patients with alterations in anatomy caused by previous surgical intervention or complex frontal sinus pneumatization patterns. The purpose of this study was to evaluate the efficacy of combined endoscopic trephination and endoscopic frontal sinusotomy (the above and below approach) in the management of these difficult cases. Methods Chart review was performed on patients undergoing the combined approach from October 1999 to June 2004. Demographic data, symptomatology, comorbidity, previous surgery, and primary pathology were determined. Outcome was assessed based on subjective symptom relief and objective endoscopic patency. Results Twenty-two patients with a mean age of 49.2 years underwent the combined approach. The primary pathology included mucoceles (15 patients), frontal sinusitis (2 patients), inverted papilloma (2 patients), osteoma (1 patient), fibrous dysplasia (1 patient), and pneumocephalus (1 patient). A total of 25 above and below procedures (22 primary and 3 revision procedures) were performed to manage the pathology. Postoperatively, headaches resolved in 47%, improved in 35%, and remained unchanged in 18% of the patients. Orbital symptoms resolved in 63%, improved in 25%, and remained unchanged in 12% of the patients. Endoscopic patency of the frontal sinusotomy was confirmed in 19 of 22 cases (86%) at a mean follow-up of 16.2 months. Conclusion Management of complex frontal sinus pathology may require adjunct approaches in conjunction to the standard endoscopic techniques. In this series, the above and below approach was used successfully in 22 patients. The combined approach may serve as an important adjunct for management of complex frontal sinus disease.

Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles

1994 ◽  
Vol 8 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Thomas L. Kennedy
Keyword(s):  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Ethmoid Sinus ◽  
Endoscopic Approach ◽  
Sinus Surgery ◽  
Difficult Cases

Seven patients with frontal and ethmoid mucoceles treated by endoscopic sinus surgery were reviewed. Five cases were successfully managed, with two requiring a trephine procedure in combination with the intranasal endoscopic approach. Follow-up ranged from 3 to 33 months with a mean of 17.8 months. The use of endoscopic instruments through a trephine incision is recommended in difficult cases to assure patency of the frontal sinus recess. When a large frontal sinus mucocele extends into the anterior ethmoid, the endoscopic approach becomes ideal. Sinus mucoceles can be handled safely and successfully by endoscopic surgery and may eliminate the need for more traditional external procedures.

Minitrephination as an Adjunctive Measure in the Endoscopic Management of Complex Frontal Sinus Disease

2007 ◽  
Vol 21 (5) ◽  
pp. 629-636 ◽  
Author(s):  
Alen N. Cohen ◽  
Marilene B. Wang
Keyword(s):  
Los Angeles ◽  
Frontal Sinus ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Sinus Surgery ◽  
Endoscopic Management ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Sinus Disease

Background Frontal sinus disease and its surgical management continues to remain an area of controversy among rhinologists. This is evidenced by the multitude of surgical procedures, both external and endoscopic, that have been developed in its management. This study was performed to evaluate the safety and efficacy of frontal sinus minitrephination in combination with endoscopic frontal sinus exploration for the management of complex frontal sinus disease. Methods A retrospective chart review identified 13 patients treated with minitrephination, in conjunction with endoscopic frontal sinus exploration, at the University of California at Los Angeles Medical Center or West Los Angeles VA Medical Center from July 2004 to October 2005. Results Thirteen patients with diagnoses of chronic sinusitis (n = 10), nasal polyposis (n = 7), frontal mucocele (n = 4), allergic fungal sinusitis (n = 3), and inverting papilloma (n = 1) underwent either unilateral (n = 9) or bilateral (n = 4) minitrephination during primary or revision functional endoscopic sinus surgery. Median follow-up was 14.2 months. There were no complications attributed to the procedure, and all patients had improvement of their sinus symptoms and displayed no evidence of recurrence of their frontal sinus disease at last follow-up. Conclusion Minitrephination is a safe and effective adjunct in the management of complex frontal sinus disease, as it allows identification of the frontal recess and vigorous irrigation of the sinus contents.

scholarly journals Implication of osteoplastic flap for frontal sinus surgery in the endoscopic era

2019 ◽  
Vol 5 (6) ◽  
pp. 1717
Author(s):  
Aishwarya Raj Pillai Devaraj ◽  
Kothegala Chandrashekariah Prasad ◽  
Abhilasha Karunasagar ◽  
Manna Jose Pappanacherry ◽  
Harshitha Naganna Gowda ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Traffic Accident ◽  
Road Traffic ◽  
Nasal Bone ◽  
Case Series ◽  
Anterior Wall ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Good Cosmesis

<p class="abstract">In the present era where functional endoscopic sinus surgery is the mainstay of management for any frontal sinus disease, we present a case series comprising six cases of various frontal sinus pathology that were managed with an external approach using a bicoronal osteoplastic flap technique of which three cases were of inverted papilloma, one case of allergic fungal rhinosinusitis, one case of frontal mucocele and a case of road traffic accident with frontal bone and nasal bone fracture. The cases had a mean follow-up period of 6 months. There was no recurrence of disease and no significant postoperative complications have been reported during the follow-up period so far. Osteoplastic anterior wall approach to the frontal sinus has proved to be one of the most effective, simple, and reliable procedures with excellent success rate and good cosmesis.</p>

scholarly journals Extended endoscopic frontal nasal sinus surgery in management of chronic and recurrent frontal sinus diseases

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Sobhi Abdelaal ◽  
Mohamed Kamel Al Awady ◽  
Tawfik Abdelaty Elkholy
Keyword(s):  
Frontal Sinus ◽  
Anatomical Variation ◽  
Sinus Surgery ◽  
Frontal Sinusitis ◽  
Office Visits ◽  
Nasal Sinus ◽  
Frontal Sinus Surgery ◽  
Operative Care ◽  
Intimate Relation

Abstract Background The anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases. Results The neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations. Conclusion The chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

Role of the Agger Nasi Cell in Chronic Frontal Sinusitis

1996 ◽  
Vol 105 (9) ◽  
pp. 694-700 ◽  
Author(s):  
Joseph B. Jacobs ◽  
Barry A. Shpizner ◽  
Eugenie Brunner ◽  
Richard A. Lebowitz ◽  
Roy A. Holliday
Keyword(s):  
Frontal Sinus ◽  
Clinical History ◽  
Sinus Surgery ◽  
Frontal Sinusitis ◽  
Sinus Disease ◽  
Computed Tomographic ◽  
Mucosal Disease ◽  
Region Data ◽  
History Of

Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease.

Surgical Management of Sinus Disease in Children

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 42-45 ◽  
Author(s):  
Scott C. Manning
Keyword(s):  
Chronic Disease ◽  
Care Setting ◽  
Pediatric Patients ◽  
Underlying Disease ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Endoscopic Techniques ◽  
The Past ◽  
Disease States ◽  
Societal Pressure

In the past few years, interest in pediatric sinus surgery has increased in response to the introduction of new endoscopic techniques and to mounting societal pressure to resolve the problem of persistent rhinosinusitis in the day-care setting. As yet, there are no prospective controlled studies demonstrating efficacy of sinus surgery in children with uncomplicated acute or recurrent acute sinusitis, and medical management overwhelmingly remains the treatment of choice for these patients. Sinus surgery may be indicated, however, for three groups of pediatric patients: those with true chronic disease, those with serious underlying disease states aggravated by recurrent sinusitis, and those with suppurative complications of sinusitis.

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.

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 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 Role of Osteoplastic Frontal Sinus Obliteration in the Era of Endoscopic Sinus Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Joshua B. Silverman ◽  
Stacey T. Gray ◽  
Nicolas Y. Busaba
Keyword(s):  
Frontal Sinus ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Salvage Procedure ◽  
Frontal Sinusitis ◽  
First Line ◽  
Total Study Population ◽  
Sinus Disease ◽  
History Of ◽  
Sinus Obliteration

Objective. Determining the indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease.Study Design. Retrospective case series from a single tertiary care facility.Methods. Thirty-four patients who underwent OFSO for chronic frontal sinusitis () and frontal sinus mucocele () comprised our study group. Data reviewed included demographics, history of prior frontal sinus operation(s), imaging, diagnosis, and operative complications.Results. The age range was 19 to 76 years. Seventy percent of patients with chronic frontal sinusitis underwent OFSO as a salvage surgery after previous frontal sinus surgery failures, while 30% underwent OFSO as a primary surgery. For those in whom OFSO was a salvage procedure, the failed surgeries were endoscopic approaches to the frontal sinus (69%), Lynch procedure (12%), and OFSO outside this study period (19%). For patients with frontal sinus mucocele, 72% had OFSO as a first-line surgery. Within the total study population, 15% of patients presented for OFSO with history of prior obliteration, with a range of 3 to 30 years between representations.Conclusions. Osteoplastic frontal sinus obliteration remains a key surgical treatment for chronic inflammatory frontal sinus disease both as a salvage procedure and first-line surgical therapy.

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