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Management of benign tumors of the frontal sinus is a challenge that requires a balance between tumor resection and maintenance of sinus homeostasis. The management of such tumors is described here, as well as the procedure to remove them; this procedure combines established and innovative techniques to achieve a balance. The approach to the frontal sinus is achieved with an osteoplastic flap, which...
Surgical management of frontal sinus disease in children is often a challenge, given the wide variation in frontal sinus development. A thorough understanding of the embryology and anatomy of the frontal sinus is essential to safe surgical intervention. With current advances in technology including endoscopy and image guidance, new operative techniques are evolving to safely instrument the pediatric...
Instrument advances and improvements in endoscopic techniques offer rhinologists more choices in the surgical management of patients requiring revision after failing primary sinus surgery, especially in the area of the frontal recess and frontal sinus. The endoscopic modified Lothrop procedure creates a common nasofrontal drainage pathway by resecting the superior nasal septum and removing the frontal...
The surgical care of chronic frontal sinus disease presents a significant challenge to otolaryngologists. Most cases refractory to medical intervention can be successfully managed with an endoscopic intranasal frontal sinusotomy. In rare instances, the disease process cannot be adequately managed through an intranasal approach alone, and a frontal sinus trephination can be utilized with great success...
Frontal sinus pathology that is superiorly or laterally positioned may be difficult to manage with standard endoscopic techniques. With the assistance of computed tomography image-guidance systems, a directed trephination can be performed to reach these areas in lieu of performing an osteoplastic flap. The image-guided frontal trephination procedure offers a minimally invasive, mucosal-sparing technique...
Endoscopic frontal sinus surgery is still considered difficult, risky to perform, and likely to result in a high failure rate. We have previously reported on our technique of endoscopic frontal sinus surgery, stressing the importance of identification and preservation of natural outflow tract. Our study of frontal sinus anatomy shows that the mean frontal ostium anterior-posterior and transverse dimensions...
Frontal sinus malignancies are rare tumors of the paranasal sinuses. They often present as late-stage diseases and are most often caused by secondary involvement from an inferiorly based paranasal sinus tumor. Primary frontal sinus malignancies represent ~1% of paranasal sinus malignancies and are most commonly adenocarcinomas. A high index of suspicion must be maintained to diagnose these malignancies;...
The use of an intraoperative navigation device improves surgical accuracy, helps identify anatomic landmarks, and minimizes the risk of complications during surgery of the paranasal sinuses and skull base. Despite the benefits of image guidance, its use is limited by the headset, which precludes external surgical access. We report the successful use of a cranial pin placed into the outer table of...
The transnasal endoscopic approach is currently our surgical method of choice for the management of frontal sinus mucoceles. It is usually performed on an ambulatory basis; compared with open procedures, it significantly reduces morbidity. There is increasing epidemiologic, clinical, histologic, and physiologic evidence that this approach is successful, with recurrence rate at or close to 0%. Classification...
Techniques to successfully access the frontal sinus lesions in a minimally invasive remain elusive. We describe a method to access the frontal sinus in which a small osteoplastic flap is made through an extended Lynch incision. Use of this mini osteoplastic flap provides the surgeon with effective access to the frontal sinus and may avoid the development of postoperative morbidities associated with...
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...
A host of autogenous and synthetic materials ranging from free fat, muscle, and bone to methylmethacrylate, hydroxyapatite cement, and glass beads have been used to obliterate the frontal sinus. These materials carry an increased risk of donor-site morbidity, as well as the risk of resorption, infection, and local inflammatory reactions. The pericranial flap is a local flap that can be used to obliterate...
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