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Khafagy Y, Ghonim M, Elgendy A, Elzayat S. The preoperative radiological findings associated with failure of frontal sinusotomy: A prospective study. Clin Otolaryngol 2021; 46:834-840. [PMID: 33655644 DOI: 10.1111/coa.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The study aimed to assess the association between the preoperative CT findings and the patency outcome of the frontal sinus after endoscopic frontal sinusotomy in the early follow-up period. DESIGN A prospective cohort study. SETTING Tertiary hospital centre. MAIN OUTCOME MEASURES The study measures the association between the frontal sinusotomy outcome and the standard preoperative radiological scores, including Harvard, Kennedy and Lund-Mackay. It also measures the impact of the degree of sinus mucosal thickness on the outcome. Furthermore, it measures the effect of the anteroposterior lengths of both the frontal sinus ostium and the frontal recess on postoperative frontal sinus patency. RESULTS Harvard, Kennedy and modified Lund-Mackay scores showed no evidence of association with the frontal sinusotomy patency outcome (P-values .397, .487 and .501), respectively. Still, the Lund-Mackay score showed a negative correlation with symptom improvement. Sinuses with a high-grade mucosal thickness on CT scan were associated with high failure rates (P-value: .009*). The anteroposterior length of the frontal sinus ostium significantly affects the outcome (P-value: .001*). In contrast, there was no association between the anteroposterior length of the frontal recess and the outcome (P-value: .965). CONCLUSION The Harvard, Kennedy and Lund-Mackay scores could not predict the frontal sinusotomy patency outcome. Failed cases were associated with advanced degrees of mucosal pathology in the preoperative CT scan. Sinuses ostia with anteroposterior diameters less than 5.36 mm showed more susceptibility for sinus restenosis postoperatively. The variability of the anteroposterior length of the frontal recess did not affect the surgical outcome.
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Affiliation(s)
- Yasser Khafagy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonim
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Elgendy
- Department of Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Saad Elzayat
- Department of Otorhinolaryngology, Faculty of medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Reeve NH, Ching HH, Kim Y, Schroeder WW. Possible Skull Base Erosion After Prolonged Frontal Sinus Stenting. EAR, NOSE & THROAT JOURNAL 2019; 100:NP218-NP221. [PMID: 31565983 DOI: 10.1177/0145561319878951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Frontal sinus stenting is widely used with the goal of maintaining nasofrontal duct patency after sinus surgery. The general recommendation is to leave stents in place for 6 months; however, prolonged stenting up to 6 years has been reported with no complication. We present the first reported case of frontal sinus posterior table and skull base erosion following prolonged frontal sinus stenting. A 57-year-old female presented with chronic sinusitis and nasal obstruction. Imaging revealed pansinusitis with retained stents in each frontal sinus that were placed 8 years prior. On the right, there was an area of skull base erosion at the tip of the stent. The patient underwent functional endoscopic sinus surgery with polypectomy. The stents were removed, revealing posterior table erosion on the right side but intact mucosa. Two months after surgery, there were no signs or symptoms of cerebrospinal fluid leak or other complications. Recent literature has suggested that prolonged stenting is safe; however, this case highlights a complication with potentially serious outcomes that can result from prolonged stenting. We recommend stent removal once stable nasofrontal duct patency has been achieved. If prolonged stenting is utilized, patients should be closely monitored and consideration should be given to periodic imaging to evaluate stent position.
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Affiliation(s)
- Nathaniel H Reeve
- Department of Otolaryngology-Head and Neck Surgery, 14722University of Nevada Las Vegas School of Medicine, NV, USA
| | - Harry H Ching
- Department of Otolaryngology-Head and Neck Surgery, 12219University of California, Irvine School of Medicine, CA, USA
| | - Yuna Kim
- Department of Otolaryngology-Head and Neck Surgery, 14722University of Nevada Las Vegas School of Medicine, NV, USA
| | - Walter W Schroeder
- Department of Otolaryngology-Head and Neck Surgery, 14722University of Nevada Las Vegas School of Medicine, NV, USA
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Dutton JM, Bumsted RM. Safety of Steroid Injections in the Treatment of Nasofrontal Recess Obstruction. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240101500607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective review was undertaken to determine if steroid injection is a safe and effective intervention in the management of chronic nasofrontal recess obstruction. Seventy-four patients were identified who had undergone prior endoscopic sinus surgery and subsequently developed nasofrontal recess obstruction that was treated with injection of Kenalog 20 mg/mL (Bristol-Myers Squibb Co., Princeton, NJ) directly into the polyps or fibrosis. The study included 38 men and 36 women with a mean age of 45.4 years. These patients collectively underwent 687 injections, an average of 9.3 injections per patient. The indication was polyposis in 70 patients and fibrosis in 17 patients, with 13 sharing both indications. These patients also required 112 office procedures to maintain nasofrontal recess patency, an average of 1.5 procedures per patient. Three patients eventually required frontal sinus obliteration. The mean follow-up period from the initial injection was 50.1 months, and no complications were reported. Therefore, nasofrontal steroid injection appears to be safe and effective in the treatment of nasofrontal recess obstruction.
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Affiliation(s)
- Jay M. Dutton
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, Illinois
| | - Robert M. Bumsted
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, Illinois
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Benkhatar H, Khettab I, Sultanik P, Laccourreye O, Bonfils P. Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis. Auris Nasus Larynx 2017; 45:740-746. [PMID: 29150349 DOI: 10.1016/j.anl.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/21/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. METHODS Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele. Univariate and multivariate analysis incorporating clinical and radiological variables were performed. RESULTS The frontal sinus revision rate was 6.5% (10/153). The mean time between the initial procedure and revision surgery was 3 years, 10 months. Osteitis around the frontal sinus outflow tract (FSOT) was associated with a higher risk of frontal sinus revision surgery (p=0.01). Asthma and aspirin intolerance did not increase the risk, as well as frontal sinus ostium diameter or residual frontoethmoid cells. Among revised patients, 60% required multiple procedures and 70% required frontal sinus ostium enlargement. CONCLUSIONS Our long-term study reports that NP surgery including FRC and MT is associated with a low frontal sinus revision rate (6.5%). Patients developing osteitis around the FSOT have a higher risk of frontal sinus revision surgery. As mucosal damage can lead to osteitis, FSOT mucosa should be preserved during initial NP surgery. However, as multiple procedures are common among NP patients requiring frontal sinus revision, frontal sinus ostium enlargement should be considered during first revision in the hope of reducing the need of further revisions.
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Affiliation(s)
- Hakim Benkhatar
- ENT - Head and Neck Surgery Department, European Hospital Georges Pompidou, AP-HP, Paris, France; Faculty of Medicine Paris Descartes, University Paris V, Paris, France.
| | - Idir Khettab
- Department of Radiology, European Hospital Georges Pompidou, AP-HP, Paris, France
| | - Philippe Sultanik
- Faculty of Medicine Paris Descartes, University Paris V, Paris, France
| | - Ollivier Laccourreye
- ENT - Head and Neck Surgery Department, European Hospital Georges Pompidou, AP-HP, Paris, France; Faculty of Medicine Paris Descartes, University Paris V, Paris, France
| | - Pierre Bonfils
- ENT - Head and Neck Surgery Department, European Hospital Georges Pompidou, AP-HP, Paris, France; Faculty of Medicine Paris Descartes, University Paris V, Paris, France
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Barham HP, Ramakrishnan VR, Knisely A, Do TQP, Chan LS, Gunaratne DA, Weston JD, Seneviratne S, Marcells GN, Sacks R, Harvey RJ. Frontal sinus surgery and sinus distribution of nasal irrigation. Int Forum Allergy Rhinol 2016; 6:238-42. [PMID: 26750306 DOI: 10.1002/alr.21686] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/15/2015] [Accepted: 10/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Effective mucus lavage and delivery of topical pharmaceuticals are central to successful management of chronic rhinosinusitis (CRS). The frontal sinus remains difficult to penetrate with topical therapies. This study evaluates the benefit of Draf III frontal dissection compared to traditional Draf IIa for distribution of topical therapies. METHODS Fresh human cadaver heads were dissected sequentially with Draf IIa frontal sinusotomy and then Draf III procedures. Each cavity was irrigated with pediatric (120 mL) and adult (240 mL) irrigation bottles with 1/1000 10% fluorescein-labeled free water in 2 fixed positions (vertex and Frankfort horizontal). An endoscope at a fixed position within the frontal sinus recorded frontal sinus and frontal recess penetration. The images then underwent blinded evaluation of fluid distribution scored as 0 to 4 (nasal cavity only, frontal recess, medial one-half, lateral one-half, and lavage). Ordinal distribution score was analyzed with Kendall's tau-b. RESULTS Eight specimens (age 76 ± 11.2 years; 50% female) were assessed. Draf III was superior to Draf IIa in ability to achieve frontal sinus distribution of irrigation (90.6% vs 50.1%, p < 0.001). Vertex head position improved distribution (90.6% vs 50.1%, p < 0.001), was synergistic with Draf III (100% with 87.5% lavage, p < 0.001), but was unable to overcome Draf IIa (81.2% with 25% lavage, p < 0.001). Irrigation volume trended toward improved distribution with larger volume irrigations. CONCLUSION Successful treatment of sinonasal disease may require postoperative delivery of topical therapies. Draf III frontal sinusotomy achieves superior topical access, and access to the frontal sinus with Draf IIa appears limited, despite large volumes and positioning.
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Affiliation(s)
- Henry P Barham
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, New Orleans, LA.,Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | | | - Anna Knisely
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Timothy Quy-Phong Do
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Lyndon S Chan
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Dakshika A Gunaratne
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jared D Weston
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Sheran Seneviratne
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - George N Marcells
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raymond Sacks
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Otolaryngology, University of Sydney, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Valdes CJ, Bogado M, Samaha M. Causes of failure in endoscopic frontal sinus surgery in chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2014; 4:502-6. [PMID: 24616299 DOI: 10.1002/alr.21307] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/31/2013] [Accepted: 01/21/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The frontal sinus is the most challenging area to address in endoscopic sinus surgery (ESS). Incomplete surgery or iatrogenic injury in the narrow space of the frontal recess with synechia formation can lead to recurrence or persistence of disease. The goal of this study was to identify causes of failure of endoscopic frontal sinus surgery and to determine complication rates. METHODS A cross-sectional retrospective study was conducted. Charts and preoperative sinus computed tomography (CT) scans of patients who underwent revision frontal ESS for chronic frontal rhinosinusitis, between 2006 and 2012 were reviewed. RESULTS Of 829 patients who underwent ESS during the study period, 740 had the frontal recess dissected and frontal sinus opened. Of these, 66 patients had revision surgery of the frontal sinus, with a total of 109 frontal sinuses. The mean ± standard deviation (SD) age was 52 ± 12.9 years. Forty patients were male (59.1%). The most common findings were the following: edematous or hypertrophic mucosa (92.7%); retained agger nasi cell (73.4%); neo-osteogenesis within the frontal recess (45.9%); lateral scarring of the middle turbinate (47.7%); residual anterior ethmoid air cell (32.1.%); and residual frontal cells (24.8%). CONCLUSION With the exception of mucosal disease and neo-osteogenesis, all identified causes of failure of frontal sinus surgery are a result of surgical technique. Careful preoperative planning and meticulous and complete surgical execution are therefore critical for a successful surgical outcome in primary frontal sinus surgery.
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Affiliation(s)
- Constanza J Valdes
- Department of Otolaryngology-Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Santiago, Chile
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Abstract
OBJECTIVES Stenting of the frontal sinus outflow tract is occasionally used following surgery to prevent stenosis. The optimal length of stent retention has not been defined and some experts advocate up to 6 months prior to removal. The tolerance of even longer periods of stenting is unknown. STUDY DESIGN Retrospective review. METHODS We identified adult patients in a tertiary rhinology practice with frontal sinus stents placed between July 2000 and December 2006 and in place at least 6 months. Length of stenting and condition at last follow-up were determined. RESULTS : During the 6-year study period, 10 frontal sinus stents were placed out of over 450 endoscopic frontal sinus surgery procedures. Each patient had only one stent placed. Of these 10 patients, one was excluded because the stent was electively removed at eight weeks. None of the remaining nine has been lost to follow-up. The mean length of stenting was 32.6 months (median 17, range 11 to 73). One patient had the stent removed at 61 months because of infection. Another had the stent removed at 11 months because of pain and edema. The remaining seven patients remain asymptomatic with patent stents and no granulation tissue seen on nasal endoscopy. CONCLUSIONS In this group, long-term frontal stenting was rarely used but relatively well tolerated with only two of nine patients requiring removal up to 6 years after placement. With the optimal length for frontal stenting unknown, risks and benefits of removal at each evaluation point must be weighed.
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Affiliation(s)
- Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
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Han JK, Ghanem T, Lee B, Gross CW. Various causes for frontal sinus obstruction. Am J Otolaryngol 2009; 30:80-2. [PMID: 19239947 DOI: 10.1016/j.amjoto.2008.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 02/14/2008] [Accepted: 02/17/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE A variety of inflammatory and structural conditions can cause frontal sinusitis. The present study was conducted as pilot study to determine the primary cause of frontal sinusitis at the time of endoscopic sinus surgery. MATERIALS AND METHODS Retrospective chart review was performed from 1997 to 2004 of patients who underwent endoscopic frontal sinus surgery at the University of Virginia. Demographic data, intraoperative frontal recess findings, and history of prior sinus procedures were collected. RESULTS There were 102 patients, and 176 endoscopic frontal sinus surgeries were performed with mean follow-up of 29 months. The major causes for frontal sinusitis were polyp (53%), frontal recess synechia (21%), agger nasi cell (12%), and narrow osteomeatal complex (5%). Frontal recess synechia was present only in patients who had prior surgery. CONCLUSIONS Inflammatory polyps, followed by synechia, were the most common causes of chronic frontal sinusitis requiring frontal sinus surgery. Further investigation is warranted to identify the sources of frontal recess synechia and to develop preventative strategies of this iatrogenic problem.
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Huang BY, Lloyd KM, DelGaudio JM, Jablonowski E, Hudgins PA. Failed Endoscopic Sinus Surgery: Spectrum of CT Findings in the Frontal Recess. Radiographics 2009; 29:177-95. [DOI: 10.1148/rg.291085118] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bhattacharyya N. The completely opacified frontal or sphenoid sinus: a marker of more severe disease in chronic rhinosinusitis? Laryngoscope 2006; 115:2123-6. [PMID: 16369155 DOI: 10.1097/01.mlg.0000183229.20452.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine whether complete opacification of the sphenoid or frontal sinus is associated with increased clinical severity of chronic rhinosinusitis (CRS). METHODS Adult patients undergoing evaluation for CRS prospectively completed the rhinosinusitis symptom inventory (RSI) and underwent computed tomography of the paranasal sinuses. A cohort with at least one completely opacified frontal sinus was identified. To each patient in this opacified cohort, a control patient without complete frontal sinus opacification was matched with corresponding Lund score. Symptom scores for headache, facial pressure, RSI symptom domains, and medical resource consumption were statistically compared. Similar analysis was conducted for patients with complete sphenoid sinus opacification. RESULTS Fifty-four patients with at least one completely opacified frontal sinus were matched for Lund score to the control group (mean Lund score 17.1). There was no statistically significant difference in headache (2.1 vs. 2.8) or pressure scores (2.0 vs. 2.3) or in the RSI symptom domains between those patients with completely opacified frontal sinuses and controls, respectively. Although completely opacified patients received more antibiotic treatment and missed more workdays, only the increased numbers of physicians visits (4.0 vs. 2.1, P = .02) was significant. Thirty-four of 35 completely opacified sphenoid patients were matched to control patients (mean Lund score 16.7). Again, differences in symptom scores for headache (2.5 vs. 2.5), facial pressure (2.3 vs. 2.3), and RSI symptom domains were not statistically significant. Increased use of antibiotics (9.6 vs. 3.9, P = .036) and physician visits (5.8 vs. 1.8, P = .024) for sphenoid opacification patients was statistically significant. CONCLUSIONS Patients with a completely opacified sphenoid or frontal sinus do not necessarily manifest more severe clinical symptoms of CRS. Thus, a higher radiographic stage should not be automatically assigned to patients with a completely opacified sphenoid of frontal sinus in CRS.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women's Hospital, and the Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Pomar Blanco P, Martín Villares C, San Román Carbajo J, Fernández Pello M, Tapia Risueño M. Cirugía mínimamente invasiva para el tratamiento de la sinusitis fronto-etmoidal complicada. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:252-6. [PMID: 15999791 DOI: 10.1016/s0001-6519(05)78610-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Functional endoscopic sinus surgery (FESS) is nowadays the "gold standard" for frontal sinus pathologies, but management of acute situations and the aproach and/or the extent of the surgery perfomed in the frontal recess remains controversial nowadays. MATERIAL AND METHODS We report our experience in 4 patients with orbital celulitis due to frontal sinusitis who underwent combined external surgery (mini-trephination) and endoscopic sinus surgery. RESULTS All patients managed sinus patency without any complications. CONCLUSIONS We found this combined sinusotomy as an easy, effective and reproductible technique in order to resolve the difficult surgical management of complicated frontal sinusitis.
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Benoit CM, Duncavage JA. Combined external and endoscopic frontal sinusotomy with stent placement: a retrospective review. Laryngoscope 2001; 111:1246-9. [PMID: 11568548 DOI: 10.1097/00005537-200107000-00019] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the long-term results of combined external and endoscopic frontal sinusotomy using frontal sinus stents and to compare our results with those reported for the endoscopic Lothrop procedure. STUDY DESIGN We performed a retrospective review of 40 patients with chronic frontal sinusitis refractory to medical management who underwent a total of 62 combined external and endoscopic frontal sinusotomies with stent placement. All procedures were performed by the senior author at Vanderbilt University Medical Center. MAIN OUTCOME MEASURES Postoperative nasofrontal duct patency and subjective patient improvement based on the last clinical examination. RESULTS The overall patency rate of the nasofrontal duct was 79% (95% confidence interval [CI] of +/-10%.) The overall subjective patient improvement rate was 78% (95% CI of +/-14%.). The average length of stent placement was 5 weeks. The mean patient follow-up time was 12 months. There were no surgical complications. The nasofrontal duct patency rate and patient improvement rate from our study did not differ statistically from results reported by other authors using the endoscopic Lothrop procedure. CONCLUSION We have found endoscopic frontal sinusotomy, in conjunction with external frontal sinusotomy and placement of frontal sinus stents, to be as effective in obtaining frontal sinus patency rates and overall patient improvement rates as the endoscopic Lothrop procedure.
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Affiliation(s)
- C M Benoit
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Abstract
Frontal sinusitis following functional endoscopic sinus surgery may represent persistent, recurrent, or iatrogenic disease. The narrow frontal recess is unforgiving of technical errors, and surgery within its confines requires ample training, skill, and patience. Revision surgery in this area, compromised by scarring and long-standing mucosal disease, demands even more of the endoscopic sinus surgeon. While successful treatment of this condition is a formidable task, strict attention to principles of proper medical and surgical therapy can increase the chances of a favorable outcome.
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Affiliation(s)
- R R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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