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PubMed2006

Preservation of natural frontal sinus outflow in the management of frontal sinus osteomas.

INTRODUCTION: Management of frontal sinus tumors has traditionally been through open approaches with obliteration of the sinus. Recently, increased comfort with endoscopic techniques has made endoscopic resection an alternative to more morbid approaches. However, many skilled endoscopists still champion obliteration of the frontal sinus after the open treatment of large osteomas. METHODS: A retrospective review of the senior author's experience with frontal sinus osteomas was performed. RESULTS: Twelve frontal sinus osteomas were treated surgically without obliteration. All patients with greater than 2 cm vertical extension of their tumor into the frontal sinus required an open approach (n = 4), whereas the remainder (n = 8) were treated endoscopically. Frontal ostia were stented if greater that 40% of the mucosa of the frontal recess was denuded. Eleven of 12 patients had patent, functional frontal sinuses. CONCLUSION: Successful resection of frontal sinus osteomas can be performed with preservation of the natural drainage of the frontal sinus in almost all cases. EBM RATING: C-4.

Adult↗
PubMed1995

[Current aspects of frontal sinus surgery. IV: On therapy of frontal sinus osteoma].

Osteomas are the most common benign tumors of frontal sinus. We evaluated 15 patients with osteomas of the frontal sinus who were managed between 1979 and 1992. The average duration of follow-up was 33 months. In 4 cases osteomas were removed completely via the endonasal route using a microscope and endoscope. We recommend performing a frontal sinus drainage-type 3 primarily. Indications are osteomas of the posterior wall of the frontal sinus located close to the infundibulum. For osteomas of the anterior wall and those located laterally or for very large osteomas we prefer the osteoplastic approach. Apart from the excellent exposure this latter procedure also provides good aesthetic results after carefully placed incisions and precise replacement of the bone flap. We recommend the bicoronal incision in patients with large frontal sinuses, women, or in the presence of good hair growth. Incisions are best placed in a frontal crease in patients with hair loss or a, small frontal sinus.

Adult↗
PubMed1995

Percutaneous endoscopic sinus surgery for frontal sinusitis or a cyst.

Using percutaneous endoscopic surgery, we achieved good results in patients with frontal sinus cyst. The surgical procedure is described and discussed. The endoscopic system consisted of a needle-shaped rigid fiberscope (direct-vision and angle-vision types [30 degrees, 90 degrees]) 1.7 mm in diameter with a light source. A small incision was made at the eyebrow, the sinus was cleaned, and an opposite hole was made through the existing wound. This procedure permitted less invasive surgery under direct view of the surgical field compared with conventional percutaneous transnasal frontal sinus procedures. Postoperative patency of the sinus was also satisfactory. This percutaneous endoscopic procedure was designed for surgical maneuvers in the frontal sinus through a small, 3- to 5-mm incision. This technique is considered effective for the treatment of inflammatory disorders of the frontal sinus caused by positional abnormalities after trauma or recurrence after conservative transnasal surgery.

Adult↗
PubMed1997

[20-year experience in obliteration of the frontal sinuses with formalinized allobrephobone in chronic frontal sinusitis].

Outcomes of surgical treatment of chronic recurrent frontal sinusis (FS) using obliteration of the frontal sinuses with allobrephobone in 228 patients (190 males and 38 females aged 15-71 years) are presented. 45 of them had undergone surgery on the frontal sinuses with reestablishment of the frontonasal shunt. Obliteration consists in removal granulations and polyps from the frontal sinus through the anterior wall followed by sinus mucosa scraching and the sinus separation from the nasal cavity with filling with small pieces of formalized allobrephobone. The technique is simple, postoperative period usually uneventful.

Adolescent↗
PubMed2001

Rhino-frontal sinuseptotomy (RFS): a combined intra-extra nasal approach for the surgical treatment of severely diseased frontal sinuses.

OBJECTIVES: Frontal sinus surgery is a challenge to those involved in the treatment of recurrent frontal sinusitis. The purpose of this report is to describe the technique and to present the results of a combined endoscopic and external approach to the frontal sinus (rhino-frontal sinuseptotomy [RFS]). MATERIAL: RFS was performed in 45 patients by the author; 41 of these patients had a follow-up over 12 months and were included in this series. Indications for RFS were severe chronic frontal sinusitis (n = 23), mucoceles (n = 12), in two cases each with osteoma, inverting papilloma, and malignant tumors of the frontal sinus, respectively. The surgical technique is started with an external approach according to Jansen-Ritter and includes the resection of the interfrontal septum, partial resection of the nasal septum, bilateral subtotal resection of the middle turbinates, bilateral endoscopic ethmoidectomy, and resection of the frontal sinus floor. The nasofrontal communication is epithelialized with free mucosal grafts and fixed with fibrin clue. RESULTS: After a mean follow-up of 62 months, 40 patients (98%) had a widely patent epithelialized nasofrontal communication. Ninety-one percent of the patients with chronic frontal sinusitis or mucoceles noted complete relief of their frontal discomfort within 1 week after RFS. No patient required revision surgery of the nasofrontal outflow tract after RFS. Only one severe complication was recognized (cerebrospinal fluid leakage). CONCLUSION: The results reported here with the RFS technique are superior to those reported on external procedures and endoscopic drill-out procedures. The key to successful management is the creation of a large nasofrontal communication, and direct epithelialization with free mucosal grafts obtained from the septum and turbinates.

Adolescent↗
PubMed1995

[Aspects of frontal sinus surgery. III: Indications and results of osteoplastic frontal sinus operation].

The osteoplastic approach is indicated for frontal sinus surgery if optimal exposure of the entire frontal sinus is required for possibly complete removal of the mucous membrane and sinus obliteration. In a retrospective study we evaluated 75 patients whose osteoplastic frontal sinus operations were performed in Fulda between 1979 and 1992 and examined indications for surgery, complications and outcome. All patients were examined clinically and subjective complaints were recorded. Indications for surgery were trauma (43), acute and chronic infections (19), tumors (11) and sinus pneumatoceles (2). The overall aesthetic and functional outcome was excellent. Revision was necessary in one only patient, who had forced air into his frontal sinus by nose-blowing too early to create a threat of infection. No serious complications occurred, such as surgery-related meningeal injury or impaired or double vision. One patient needed a blood transfusion because of hemorrhage due to operation (1.3%). The main advantage of the coronal incision used was preservation of the supraorbital nerve bundle without subsequent nerve dysfunctions. Besides optimal exposure of the whole frontal sinus, precise replacement of the osteoplastic flap and choice of incision also lead to a good aesthetic result.

Abscess↗
PubMed2005

Multiplanar computed tomographic analysis of frontal recess cells: effect on frontal isthmus size and frontal sinusitis.

BACKGROUND: Frontal recess anatomy can be very complex, with accessory cells such as frontal, agger nasi, and intersinus septal cells encroaching on the frontal recess and possibly contributing to obstruction of the frontal sinus. In this study, we determined the prevalence of these cells and their relationship to frontal sinusitis in patients who have (revision group) and have not (primary group) had previous sinus surgery. DESIGN: Multiplanar computed tomographic images were reconstructed on a computer workstation to determine the presence of frontal, agger nasi, and intersinus septal cells and frontal sinusitis. We also measured the diameter and area of the frontal isthmus for each sinonasal cavity. We were able to retrieve 106 of 117 images from a surgical database encompassing the previous 2 years. SETTING: Tertiary care academic practice of the senior author. RESULTS: Frontal cells were found in 25.5% of frontal recesses, including 29.6% of sides in the primary group and 21.9% of sides in the revision group. We identified 33.0% of patients as having unilateral or bilateral frontal cells. Type I cells were the most common cell (18.4% of primary sinuses). The presence of frontal sinusitis and the diameter and area of the frontal isthmus were not significantly different for those patients with compared with patients without frontal cells. Intact agger nasi cells were identified in 86.7% of primary sinuses and 53.5% of revision sinuses. There was no increased incidence of frontal sinusitis in patients with persistent agger nasi cells in the revision group. CONCLUSIONS: When we evaluated multiplanar reconstructions, we identified frontal cells in 33.0% of patients overall, which was more common than previously reported. The findings of agger nasi cells indicated that these cells were likely addressed in less than half of previous sinus procedures. However, frontal cells and retained agger nasi cells were not associated with a higher incidence of frontal sinusitis, and there was no association between the size of the frontal isthmus and the presence of frontal sinusitis. Although anatomic variations in the frontal recess are likely to play a role in frontal sinusitis, mucosal inflammatory processes are likely to be a much more important etiologic factor.

Cohort Studies↗
PubMed2005

Endoscopic frontal sinus obliteration: a new technique for the treatment of chronic frontal sinusitis.

OBJECTIVES: 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. STUDY DESIGN AND SETTING: 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. RESULTS: 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. CONCLUSIONS: 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. SIGNIFICANCE: This is the first report of a minimally-invasive technique for frontal sinus obliteration.

Adult↗
PubMed1999

Quality-of-life outcomes after osteoplastic frontal sinus obliteration.

Frontal sinusitis and its treatment remain controversial. Although several authors have evaluated the results of traditional endoscopic sinus surgery, few have assessed patient outcomes and quality of life after osteoplastic frontal sinus obliteration. This retrospective study evaluates these outcomes in a postoperative review and questionnaire of 39 patients treated at the University of Washington from 1991 to 1994. Most patients were satisfied with the results of this procedure, had significant improvements in their Chronic Sinusitis Survey scores, and reported decreased clinic visits and antibiotic use. However, approximately half thought nonsurgical treatments were more effective and continued to require other medical therapy; 30% required additional surgical intervention. Such outcomes may reflect the ineffectiveness of frontal sinus obliteration to treat the chronic symptoms of patients affected by the refractory underlying disease process of chronic sinusitis; however, despite these mixed results, we found a significant decrease in annual days of lost work or activity in this study group after osteoplastic obliteration.

Absenteeism↗
PubMed1997

Frontal sinus fractures.

Frontal sinus fractures are rare in children, uncommon in adolescents, and most commonly the result of high-impact collisions of the face with an immovable object. Most are associated with other facial and head injuries; intracranial injury should be considered an invariable concomitant of any frontal sinus fracture that involves the posterior sinus wall. Proper management of frontal sinus fractures requires a multidisciplinary team approach.

Frontal Sinus↗
PubMed2003

Assessment of the accuracy and safety of the different methods used in mapping the frontal sinus.

INTRODUCTION: Frontal sinus obliteration continues to be the gold standard for frontal disease control and is often employed as a last resort of treatment after more conservative therapies fail. Different methods of sinus mapping have been previously reported and include (1) 6-foot Caldwell radiography, (2) sinus probing, and (3) sinus transillumination. Image-guided technology was recently introduced to clinical practice, but its utility in frontal sinus mapping has not been evaluated. OBJECTIVE: To assess the accuracy and safety of the previously reported methods of frontal sinus mapping and compare them with image-guided mapping. STUDY DESIGN: Five cadaveric heads were used. The four mapping methods were applied to each head along five different axes of the frontal bone: 0, 45, 90, 135, and 180 degrees. The true frontal sinus margin was ascertained. Measurements were made from the true sinus limits to the margin points estimated by the four frontal sinus mapping methods. RESULTS: The image-guided mapping method provided was the most accurate when compared with the other mapping methods (p < .01). The image-guided mapping method was also the least likely to overshoot the real margin compared with the other mapping methods (p < .001). The template method was the least accurate and least safe method. CONCLUSIONS: Image-guided mapping is the most accurate and safest method of mapping the frontal sinus margins.

Cadaver↗
PubMed2002

[Surgery of frontal sinus osteoma].

Frontal sinus osteomas are 57% of all paranasal sinus osteomas, with an incidence of 00.1 to 3%. Surgical removal of the frontal sinus osteomas is done in symptomatic patients. Asymptomatic patients can be managed conservatively or submitted to surgery in spite of its location or extension. Five patients having the diagnosis of frontal sinus osteoma were operated on between 1995 and 1999. Medium age was 38.4 years (from 12 to 55 years), 3 male and 2 female. Symptoms occurred from 6 months to 3 years, average of 10.5 months. Four patients had previous headache and one had epistaxis. All patients had standard radiological exams and computed tomography with coronal and axial studies of paranasal sinus. In two patients the diameter of the osteoma was larger than 3 cm and in three smaller than 3 cm. The choice between coronal and supraciliar approach was made according to esthetics, supraciliar approach was made in only one bald patient even with the tumor being large and extending to ethmoidal sinus. Any intra operative difficulty was related to the choice of the approach. Naso-frontal ostium was not obstructed in intra operative course. Minimal postoperative follow up was of two years. Osteomas were radically removed in all patients with no recurrence or residual tumor. Clinical findings, radiological exams and surgical approaches are discussed. No postoperative complications occurred.

Adolescent↗