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Ralph Metson - One of the best experts on this subject based on the ideXlab platform.
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Image-Guided Frontal Sinus Surgery
Otolaryngologic clinics of North America, 2005Co-Authors: Raj Sindwani, Ralph MetsonAbstract:The application of image-guidance technology to Sinus surgery has demonstrated continued growth since its introduction in the mid-1990s [1–3]. The use of surgical navigation is especially advantageous in Frontal Sinus surgery because of the complex anatomical relationships of the Frontal Sinus outflow tract. The narrow confines of the Frontal recess and the close proximity of the orbit and skull base demand a high degree of technical precision and provide little room for error. Because of its anterior superior location within the nasal cavity, angled endoscopes are often required during approaches to the Frontal Sinus, which increases the possibility of disorientation during surgery. The potential for complications increases when surgical landmarks are absent as a result of extensive disease or previous surgery, and in the presence of significant intraoperative bleeding. The ability of image-guidance systems to provide the surgeon with enhanced anatomic localization during Frontal Sinus surgery offers the potential for fewer intraoperative complications and improved clinical outcome. Anatomy of Frontal Sinus drainage The course of the Frontal Sinus outflow tract is variable [4] and its shape and patency may be influenced by adjacent sinonasal structures [5]. The Frontal Sinus and its drainage pathway can be visualized as an hourglass configuration, with the isthmus or point of narrowest diameter being the Frontal ostium. The ostium opens inferiorly into an anatomic region known as the Frontal recess. This recess, through which the Frontal Sinus drains, is
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Endoscopic Frontal Sinus drillout in 100 patients.
Archives of otolaryngology--head & neck surgery, 2003Co-Authors: Mark Samaha, Mathew J. Cosenza, Ralph MetsonAbstract:Results: Frontal Sinus patency with control of symptoms was achieved in 80% of patients. There were no intraoperative complications. Postoperative epistaxis occurredin4%ofpatients.Ofthe20patientswhodeveloped restenosis of the Frontal Sinus ostium, 11 underwent revision Frontal Sinus drillout and 9 proceeded to Frontal Sinus obliteration. The success rate was comparable for the image-guidance and non–image-guidance groups (83.1% vs 74.3%, respectively; P=.56). Conclusions: Frontal Sinus drillout performed with or without an image-guidance system appears to be a safe and effective surgery for the treatment of patients with advanceddiseaseoftheFrontalSinus.Thisprocedureprovides a reasonable alternative to Frontal Sinus obliteration, which remains a treatment option for patients who fail Frontal drillout.
Bradford A Woodworth - One of the best experts on this subject based on the ideXlab platform.
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changing paradigms in Frontal Sinus cerebrospinal fluid leak repair
International Forum of Allergy & Rhinology, 2012Co-Authors: Virginia L Jones, Kristen O Riley, Frank W Virgin, Bradford A WoodworthAbstract:Background: Frontal Sinus cerebrospinal fluid (CSF) leaks have traditionally been repaired via open procedures (eg, osteoplastic flap or cranialization). Advancements in instrumentation, technique, and experience have improved the feasibility of repairing Frontal Sinus skull-base defects using an endoscopic approach. This study describes endoscopic closure of Frontal Sinus CSF leaks focusing on management, surgical technique, and outcomes. Methods: Prospective evaluation of patients with skull-base defects involving the Frontal Sinus was performed. Demographics, size of skull-base defect, length involving the posterior table, successful closure, Frontal Sinus patency, and complications were recorded. Results: Over 3.5 years, 37 patients (average age 46 years) were treated for CSF leaks involving the Frontal Sinus by a single otolaryngologist. Etiologies included spontaneous (13), tumor (13), and trauma (11). Average defect size (length vs width) was 16.9 mm × 10.7 mm and average length involving the posterior table was 6.9 mm (range, 1–30 mm). Success rate on first attempt was 91.9% (34/37), but improved to 97.3% on subsequent endoscopic revision. One patient required a cranialization. The average follow-up was 48 weeks. The nasoseptal flap was used for reconstruction in 27 patients. A Draf III procedure (ie, bilateral resection of the Frontal Sinus floor) was required in 14 subjects. Three patients were referred as a result of unsuccessful closure following cranializations; their CSF leaks were successfully repaired using endoscopic approaches. Two individuals required a subsequent endoscopic Frontal Sinus procedure, but have maintained long-term patency following revision. Conclusion: Frontal Sinus CSF leaks were successfully closed in 97.3% of individuals. Our data supports the routine use of endoscopic repair in the treatment algorithm for Frontal Sinus skull-base defects. © 2012 ARS-AAOA, LLC.
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endoscopic repair of Frontal Sinus cerebrospinal fluid leaks
Journal of Laryngology and Otology, 2005Co-Authors: Bradford A Woodworth, Rodney J Schlosser, James N PalmerAbstract:Objective To describe endoscopic management of Frontal Sinus cerebrospinal fluid (CSF) leaks. Study design Retrospective. Methods We reviewed all Frontal Sinus CSF leaks treated using an endoscopic approach at our institutions from 1998 to 2003. CSF leaks originated immediately adjacent to or within the Frontal recess or Frontal Sinus proper for inclusion in the study. Data collected included demographics, presenting signs and symptoms, site and size of skull-base defect, surgical approach, repair technique, and clinical follow up. Results Seven Frontal Sinus CSF leaks in six patients were repaired endoscopically. Average age of presentation was 45 years (range 25-65 years). Aetiology was idiopathic (three), congenital (one), accidental trauma (one), and surgical trauma (two). All patients presented with CSF rhinorrhea; two patients presented with meningitis. Four defects originated in the Frontal recess, while two others involved the posterior table and Frontal Sinus outflow tract. Four patients had associated encephaloceles. We performed endoscopic repair in all six patients with one patient requiring an adjuvant osteoplastic flap without obliteration. All repairs were successful at the first attempt with a mean follow up of 13 months. All Frontal Sinuses remained patent on both post-operative endoscopic and radiographic exam. Conclusions Endoscopic repair of Frontal Sinus CSF leaks and encephaloceles can be an effective method if meticulous attention is directed toward preservation of the Frontal Sinus outflow tract, thus avoiding an osteoplastic flap and obliteration. The major limiting factor for an endoscopic approach is extreme extension superiorly or laterally within the posterior table beyond the reach of current instrumentation.
Peter-john Wormald - One of the best experts on this subject based on the ideXlab platform.
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the international Frontal Sinus anatomy classification ifac and classification of the extent of endoscopic Frontal Sinus surgery efss
International Forum of Allergy & Rhinology, 2016Co-Authors: Peter-john Wormald, Brent A, Peter H. Hwang, Timothy L. Smith, Martin J. Citardi, David W. Kennedy, Werner Hoseman, Claudio Callejas, R Weber, Richard R OrlandiAbstract:The Frontal recess and Frontal Sinus anatomy can vary from simple to complex. The variations in the anatomy of the Frontal recess and Frontal Sinus are considerable but almost all variations can be classified if the various cell patterns are analyzed. This consensus document was developed to improve the ability of the surgeon to understand these possible variations, plan the surgery, and communicate these complexities when teaching or reporting outcomes. Once the surgeon understands the anatomical pattern of the Frontal Sinus and recess cells, the extent of surgery can be planned. This document presents a classification of the extent of surgery based on the anatomical classification.
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endoscopic management of Frontal Sinus osteomas revisited
American Journal of Rhinology & Allergy, 2009Co-Authors: Kristin A Seiberling, Steve Floreani, Simon Robinson, Peter-john WormaldAbstract:BACKGROUND Recent articles have published guidelines regarding the role of endoscopic surgery in the removal of Frontal Sinus osteomas. These guidelines recommend the endoscopic approach for small osteomas but recommend an osteoplastic flap for larger tumors. This study presents a series of endoscopically resected tumors both large and small. METHODS Retrospective chart reviews were performed. Charts were reviewed of all patients who underwent surgical resection of a Frontal Sinus osteoma from 1998 to 2008. Sinus CT scans were reviewed and each tumor was staged according to Kennedy's grading system proposed in 2005. RESULTS Twenty-three patients, 8 with a grade IV tumor, 6 with a grade III tumor, and the remaining with a grade I or II tumor, underwent endoscopic resection of a Frontal Sinus osteoma. In 15 patients a modified Lothrop procedure was performed for tumor removal. In addition, a blepharoplasty incision was used in one patient for removal of a large orbital extension of the tumor and another underwent an enlarged Frontal Sinus trephine performed via a browline incision. In the remaining patients a Frontal Sinusotomy with minitrephination provided enough access for tumor removal. Over an average follow-up of 36 months no recurrences were noted. Symptoms improved in all but one patient. There were no postoperative complications. CONCLUSION Endoscopic resection of both large and small Frontal Sinus osteomas is feasible. In this article we have shown successful removal of large osteomas that fill the entire Frontal Sinus with the modified Lothrop procedure.
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Surgery of the Frontal recess and Frontal Sinus.
Rhinology, 2005Co-Authors: Peter-john WormaldAbstract:Surgery on the Frontal recess and Frontal Sinus remains a challenge for endoscopic Sinus surgeons. This paper examines the philosophy behind such surgery and presents a technqiue for 3-dimensional reconstruction of the anatomy of the Frontal recess and Frontal Sinus. Utilizing this anatomical reconstruction the surgeon is encouraged to develop a pre-operative step-by-step surgical plan for each cell identified within the Frontal recess and Frontal Sinus and thereby predict the anatomy of this region before surgery is undertaken. An increased understanding of the anatomy of this region should improve the surgeon's surgical confidence and ability to remove all the obstructing cells from the Frontal Sinus ostium.
Jannis Constantinidis - One of the best experts on this subject based on the ideXlab platform.
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Therapy of invasive mucoceles of the Frontal Sinus.
Rhinology, 2001Co-Authors: Jannis Constantinidis, H. Steinhart, K. Schwerdtfeger, Johannes Zenk, Heinrich IroAbstract:Mucoceles of the Frontal Sinus that extend into the orbits and the anterior cranial fossa can, in certain cases, be difficult to manage therapeutically and may lead to lethal complications. The surgeon will have to make a decision between an endonasal and an extranasal, transfacial procedure to provide an adequate access. Between 1995 and 1998 we treated 12 patients suffering from invasive mucoceles of the Frontal Sinus. The mucocele was localized medially in 7 cases and in the lateral part of the Frontal Sinus in 5 cases. Five of the patients exhibited destruction of the orbital roof and in 7 cases combined destruction of the orbital roof and the floor of the Frontal Sinus were noted. The posterior wall of the Frontal Sinus was destructed in 6 patients, with one patient additionally showing partial destruction of the anterior Frontal Sinus wall. The causes of mucocele formation were previous Frontal Sinus operations (n = 8) and Frontal Sinus fractures (n = 3). In one case the cause remained unknown. In 7 cases with a medially localized mucocele the mucocele was marsupialized using an endonasal access. The mucoceles with a lateral localization were osteoplastically operated via an external access. Here we performed median drainage in 3 cases and, in one case each, obliteration and cranialization of the Frontal Sinus. The follow-up period was 2.8 years on average. All patients were free of complaints immediately after the operation. Mucocele recurrence or other complications did not arise. The cosmetic results were satisfactory in all cases.
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Cranialization of the Frontal Sinus. Indications, technique and results
HNO, 2000Co-Authors: Jannis Constantinidis, Wolfgang Draf, Rainer Weber, M. Brune, Heinrich IroAbstract:The osteoplastic Frontal Sinus surgery with obliteration of the Sinus has been established in the therapy of Frontal Sinus diseases that can not be drainaged permanently or healed through an endonasal access. The obliteration of the Frontal Sinus is endangered in cases of multiple fracturing of the posterior Frontal Sinus wall or if it has been destroyed by an inflammatory process. In these problematic cases obliteration bears the danger of complications and cranialization of the Frontal Sinus is therefore the method of choice. We review 8 patients who were operated on using the cranialization technique. Indications for surgery were a combined fracture of the anterior and posterior Frontal Sinus wall (3), a pyocele of the Frontal Sinus with extensive destruction of the posterior wall (4) and a large osteoma of the posterior Frontal Sinus wall (1). The Frontal Sinus was exposed through a coronal incision, the mucosa and the posterior wall were completely removed and the Frontal Sinus obliterated with fat tissue. The anterior Sinus wall was replaced after obliteration of the Sinus or reconstructed with calvarian bone transplants. The follow up period was 1.8 years (11 months to 8 years). All patients underwent postoperatively a clinical ENT-examination and radiological assessment by CT-Scan or MRI. The overall functional and esthetic outcome was excellent. There were no serious complications nor any recurrence. The cranialization of the Frontal Sinus is a reliable and safe variation of the classical osteoplastic Frontal Sinus surgery with fat obliteration.
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Current aspects of Frontal Sinus surgery. II: External Frontal Sinus operation--osteoplastic approach
HNO, 1995Co-Authors: Rainer Weber, Wolfgang Draf, R. Keerl, Jannis ConstantinidisAbstract:Most inflammatory diseases of the Frontal Sinus requiring surgery can now be managed successfully by endonasal procedures. There remain, however, a number of problematic cases in which optimal exposure of the entire Frontal Sinus is required with possible complete removal of the mucous membrane and Sinus obliteration. These remain indications for osteoplastic Frontal Sinus surgery. Depending on the individual situation, incisions can be chosen that are bicoronal, placed in a Frontal crease or positioned below the eye-brow. Surgical techniques are described in detail. Osteoplastic surgery of the Frontal Sinus with fat obliteration is a reliable and safe method, particularly for management of so-called "difficult" Frontal Sinuses.
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Current aspects of Frontal Sinus surgery. IV: On therapy of Frontal Sinus osteoma
HNO, 1995Co-Authors: Rainer Weber, Wolfgang Draf, Jannis Constantinidis, R. KeerlAbstract: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.
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Aspects of Frontal Sinus surgery. III: Indications and results of osteoplastic Frontal Sinus operation
HNO, 1995Co-Authors: Rainer Weber, Wolfgang Draf, R. Keerl, Jannis ConstantinidisAbstract: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.
Larry H. Hollier - One of the best experts on this subject based on the ideXlab platform.
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Frontal Sinus fractures.
Seminars in plastic surgery, 2010Co-Authors: Anthony Echo, Jared S. Troy, Larry H. HollierAbstract:The management of Frontal Sinus fractures has changed over the past 20 years. Whereas the indications for an invasive procedure had been much broader in the past, it has become more common to treat these fractures conservatively, due to improved imaging modalities, the advent of endoscopic surgical treatment of the nasoFrontal outflow tracts, and the improved understanding of Frontal Sinus physiology. A variety of algorithms have been proposed for the management of Frontal Sinus fractures; however, we present a simplified treatment algorithm, which uses cranialization, obliteration, reconstruction, observation, and endoscopic Sinus surgery.
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Management of Frontal Sinus fractures.
Plastic and Reconstructive Surgery, 2007Co-Authors: Spiros Manolidis, Larry H. HollierAbstract:Frontal Sinus fractures are relatively uncommon maxillofacial injuries, making up only 5 to 12 percent of all facial fractures. Associated intracranial, ophthalmologic, and other maxillofacial injuries are very common because of the force of injury required to fracture the Frontal bone. High-resolution computed tomography of the Frontal region in multiple planes is essential for predicting the degree of Frontal injury, associated injuries, and the type of procedure indicated. Exploration of the Frontal Sinus with reduction alone is reserved for a small minority of very simple fractures. Most Frontal Sinus fractures will require the obliteration of the Sinus. This is achieved in the majority of instances with preservation of the posterior wall. Those with more extensive injuries and the presence of a cerebrospinal fluid leak will require Frontal Sinus cranialization after repair of the dural injuries. In rare instances, primary bone grafts will be required. In both cranialization and obliteration procedures, the nasoFrontal ducts must be managed appropriately to avoid complications. Newer techniques involving endoscopic image-guided surgery may offer an alternative for a small subset of patients with Frontal Sinus injury.
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Management of Frontal Sinus fractures. Changing concepts.
Clinics in plastic surgery, 1992Co-Authors: Rod J. Rohrich, Larry H. HollierAbstract:Since the turn of the century, surgeons have handled Frontal Sinus fractures with a variety of different procedures. The optimal management procedure remains controversial. We have presented a graduated anatomic algorithm for treatment of Frontal Sinus fractures based on the degree of fracture displacement and nasoFrontal duct involvement and presence of CSF leak. Nondisplaced fractures are best handled conservatively, without operative intervention. However, the majority of Frontal Sinus fractures require operative correction. Uncomplicated anterior table displacement with an aesthetic deformity is treated by fragment reduction and stabilization with miniplates or microplates or wires. NasoFrontal duct obstruction is usually managed by Sinus obliteration with spontaneous osteoneogenesis or autologous bone grafting. Finally, comminuted, displaced anterior and posterior table fractures, especially those with persistent CSF leakage and associated nasoFrontal duct involvement, are best handled with Frontal Sinus cranialization. The presented algorithm is simply a treatment guideline. Frontal Sinus fracture management must be individualized. However, this graduated anatomic approach provides a pragmatic framework for decision making and understanding this complex and controversial topic.
