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Charles W Gross - One of the best experts on this subject based on the ideXlab platform.
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initial surgical treatment for chronic Frontal Sinusitis a pilot study
Annals of Otology Rhinology and Laryngology, 2007Co-Authors: Samuel S Becker, Joseph K Han, Thuyanh Nguyen, Charles W GrossAbstract:Objectives: The initial surgical treatment for chronic Frontal Sinusitis is not well defined. Our objective was to determine the effectiveness of anterior ethmoidectomy for chronic Frontal Sinusitis. Methods: Patients with chronic Frontal Sinusitis who underwent anterior ethmoidectomy as initial surgical treatment were reviewed. Data were collected from computed tomography scans with use of the Lund-Mackay scale. Data on demographics, comorbidities, management, postoperative recovery, and follow-up were collected. Results: Seventy-seven patients representing 121 diseased Frontal sinuses met the inclusion criteria. The respiratory co-morbidities were asthma alone (8.3%), asthma and polyps (6.6%), aspirin triad (5.8%), and cystic fibrosis (0.8%). Nineteen of 121 Frontal sinuses (15.7%) belonged to smokers. Fourteen of 121 Frontal sinuses (11.5%) exhibited postoperative evidence of disease. Of these 14 Frontal sinuses, 10 (8.3%) underwent revision surgery. Frontal sinuses of patients with aspirin triad, with both nasal polyposis and asthma, or with inter-Frontal sinus septal cells were more likely to fail Draf I surgery (p <.05). Conclusions: Anterior ethmoidectomy for drainage of Frontal sinuses appears to be effective initial surgical treatment for chronic Frontal Sinusitis. Patients with aspirin triad, both asthma and polyposis, or inter-Frontal sinus septal cells are more likely to fail this procedure.
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microbiology of chronic Frontal Sinusitis
Laryngoscope, 2001Co-Authors: Rodney J Schlosser, Scott D London, Jack M Gwaltney, Charles W GrossAbstract:Objectives: To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic Frontal Sinusitis. Study Design: Retrospective, nonrandomized study. Methods: Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by Frontal sinus trephination performed on 30 consecutive patients with chronic Frontal Sinusitis. Results: Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the Frontal sinus/recess, and the third group included 5 patients who had undergone prior Frontal sinus/ recess surgery. Preoperative computed tomography scan of the Frontal sinuses revealed complete opacification in 63% (29/46 Frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase-negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase-negative Staphylococcus was most common in patients undergoing revision Frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision Frontal sinus surgery, revision functional endoscopic sinus surgery without prior Frontal surgery, and primary surgery. Conclusions: This study suggests that organisms involved in chronic inflammatory disease of the Frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase-negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.
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surgical treatments for symptomatic chronic Frontal Sinusitis
Archives of Otolaryngology-head & Neck Surgery, 2000Co-Authors: Charles W Gross, Ronald B KuppersmithAbstract:The author has made an admirable attempt to address the presented hypothesis. He has sufficiently reviewed the different surgical procedures currently applied to the treatment of symptomatic Frontal Sinusitis, and he presents arguments pro and con for the various procedures. He notes that there are definite indications for an osteoplastic flap procedure with obliteration, and few knowledgeable, experienced sinus surgeons would disagree with him. However, arguments beyond this leave room for much discussion. Indeed, it is not possible to adequately discuss this basic hypothesis in a short communication. Those conversant with the many current presentations on the Frontal sinuses are aware of this. No simple guidelines are available for the proper surgical management of chronic Frontal Sinusitis. Before any surgical recommendation can be given, detailed information must be obtained from a thorough review of the patient’s medical history. Are there any indications of clinically significant underlying allergies, immune disorders (including acquired immunodeficiency syndrome), diabetes, sarcoidosis, the aspirin-asthma-Sinusitis triad, or other conditions? Was the patient’s previous medical and/or surgical treatment adequate? After a thorough review of the history, a complete endonasal examination must be performed with the 0° and 30° nasal endoscopes, during which the overall state of the nasal mucosa should be noted. A detailed examination of the intranasal anatomical features
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the role of mini trephination in the management of Frontal Sinusitis
American Journal of Rhinology, 1999Co-Authors: Richard M Gallagher, Charles W GrossAbstract:The surgical management of chronic Frontal Sinusitis remains an area of controversy. Since the introduction of endoscopic sinus surgery, many novel approaches to this difficult problem have been developed. Recently at the University of Virginia, mini-trephination of the Frontal sinus has been used in combination with endoscopic Frontal sinusotomy. This technique has enabled confident and precise identification of the Frontal sinus ostium, culture of sinus contents, and irrigation of the Frontal sinus. A retrospective review of 22 minitrephinations since November 1997 was performed. The short term results are encouraging with a Frontal sinus patency rate of 90%; however, long-term follow-up is required. We conclude that the technique is reliable and reproducible.
Wenhung Wang - One of the best experts on this subject based on the ideXlab platform.
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computed tomographic analysis of Frontal recess anatomy and its effect on the development of Frontal Sinusitis
Laryngoscope, 2010Co-Authors: Chingfeng Lien, Hsuhuei Weng, Yuchien Chang, Yenchun Lin, Wenhung WangAbstract:Objectives/Hypothesis: To use computed tomography to determine the association of Frontal recess cells with the development of Frontal Sinusitis. Study Design: Retrospective analysis. Methods: We retrospectively analyzed various Frontal recess cells on spiral computed tomographic images of sinuses between November 2007 and May 2009. Exclusion criteria included previous sinus surgery, sinonasal polyposis, age younger than 18 years, maxillofacial fracture, incomplete sections of computed tomography, and sinonasal malignancy. We used logistic regression analysis to compare the distribution of various Frontal recess cells in patients with Frontal Sinusitis and those without Frontal Sinusitis. Results: A total of 192 patients met the criteria, and only 363 sides were distinguishable. The presence of suprabullar cells, supraorbital ethmoid cells, Frontal bullar cells, and recessus terminalis was significantly associated with the development of Frontal Sinusitis by multiple logistic regression models. Conclusions: The frequency of Frontal recess cells analyzed in Taiwanese adult patients was similar to that analyzed in other Asian adult populations (Chinese and Korean). The frontoethmoid cells posterior and posterolateral to the Frontal recess (suprabullar cells, Frontal bullar cells, and supraorbital ethmoid cells) might reveal a more significant association with the development of Frontal Sinusitis than those anterior to the Frontal recess (agger nasi cells, Frontal cell types 1–3). The presence of supraorbital ethmoid cells on computed tomographic images might indicate the highest odds of Frontal Sinusitis, followed by the presence of suprabullar cells, Frontal bullar cells, and recessus terminalis. Laryngoscope, 2010
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extensive subgaleal abscess and epidural empyema in a patient with acute Frontal Sinusitis
Journal of the Formosan Medical Association, 2003Co-Authors: Wenhung Wang, Tzerzen HwangAbstract:Acute Frontal Sinusitis can be a serious condition because of its potential life-threatening complications. These complications, including spread of infection to the Frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality. We report a case of acute Frontal Sinusitis in a 16-year-old girl who presented with fever, severe headache, and vomiting of 3 days' duration. Generalized fluctuant swelling of the nasal root, and bilateral supraorbital and frontoparietal regions was noted. Computed tomography (CT) demonstrated left panSinusitis, extensive subgaleal abscess and epidural empyema with osteomyelitis of the Frontal bone. External frontoethmoidectomy with mucoperiostectomy were performed. Endoscopic sinus surgery was then conducted for intranasal ethmoidectomy. Intraoperative cultures grew viridans streptococci, coagulase-negative staphylococci and Peptostreptococcus micros. The patient received 3 weeks of treatment with intravenous antibiotics (penicillin 3 MU 4-hourly, ceftriaxone 500 mg 12-hourly, metronidazole 500 mg 6-hourly) and was discharged uneventfully and prescribed additional oral antibiotics for 5 weeks (clindamycin 150 mg 6-hourly and chloramphenicol 250 mg 6-hourly). CT revealed complete resolution of the abscess and clear maxillary and ethmoid sinuses at 7 weeks posttreatment. The patient was free of sinus infection at 4-years follow-up, without noticeable cosmetic deformity.
Ralph Metson - One of the best experts on this subject based on the ideXlab platform.
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endoscopic Frontal sinus obliteration a new technique for the treatment of chronic Frontal Sinusitis
Otolaryngology-Head and Neck Surgery, 2005Co-Authors: Feodor Ung, Ralph Metson, Raj SindwaniAbstract: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.
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endoscopic surgery for Frontal Sinusitis a graduated approach
Otolaryngologic Clinics of North America, 2004Co-Authors: Ralph Metson, Raj SindwaniAbstract:Contemporary surgical treatment of patients with Frontal Sinusitis is based on a graduated approach determined by the patient's history and the extent of disease present. Most patients with inflammatory disease of the Frontal sinus respond well to an anterior ethmoidectomy and clearing of agger nasi cells encroaching upon the Frontal recess. In more advanced cases, a Frontal sinusotomy with enlargement of the ostium may be performed to facilitate Frontal sinus drainage and ventilation. For patients in whom conventional endoscopic techniques have not been successful, the floor of the Frontal sinus is removed with a drill, usually with the assistance of image-guidance technology. Frontal sinus obliteration is reserved for patients with advanced disease for whom endoscopic management has been unsuccessful. Although patients with refractory Frontal Sinusitis can present a therapeutic challenge, proper surgical management usually results in successful control of symptoms and overall improvement in quality of life.
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clinical outcome of endoscopic surgery for Frontal Sinusitis
Archives of Otolaryngology-head & Neck Surgery, 1998Co-Authors: Ralph Metson, Richard E GliklichAbstract:Objective To determine the efficacy of endoscopic surgery for chronic Frontal Sinusitis. Design A prospective analysis of established measures of clinical outcome (Chronic Sinusitis Survey and Short Form 36) that was administered to patients before Frontal sinus surgery and at intervals of 3 months, 6 months, and 1 year after surgery. Interventions For limited disease, the Frontal recess was opened and the Frontal ostium probed or enlarged. For more severe cases, a drill was used to resect the Frontal sinus floor and interFrontal septum. Setting Private and institutional-based practices at an academic medical center. Subjects Eighty-seven patients who underwent endoscopic surgery for Frontal Sinusitis, including 24 patients with severe disease who underwent a Frontal sinus drillout procedure. Main Outcome Measures Scores on the Chronic Sinusitis Survey, Short Form 36, and surgical revision rate. Results Significant improvement in facial pain, nasal drainage, and congestion was observed 1 year after surgery ( P P P Conclusions Although the long-term results of endoscopic surgery for Frontal Sinusitis are unknown, this approach appears to be effective for most patients and may provide a reasonable alternative to Frontal sinus obliteration surgery in selected cases.
Ronald B Kuppersmith - One of the best experts on this subject based on the ideXlab platform.
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surgical treatments for symptomatic chronic Frontal Sinusitis
Archives of Otolaryngology-head & Neck Surgery, 2000Co-Authors: Charles W Gross, Ronald B KuppersmithAbstract:The author has made an admirable attempt to address the presented hypothesis. He has sufficiently reviewed the different surgical procedures currently applied to the treatment of symptomatic Frontal Sinusitis, and he presents arguments pro and con for the various procedures. He notes that there are definite indications for an osteoplastic flap procedure with obliteration, and few knowledgeable, experienced sinus surgeons would disagree with him. However, arguments beyond this leave room for much discussion. Indeed, it is not possible to adequately discuss this basic hypothesis in a short communication. Those conversant with the many current presentations on the Frontal sinuses are aware of this. No simple guidelines are available for the proper surgical management of chronic Frontal Sinusitis. Before any surgical recommendation can be given, detailed information must be obtained from a thorough review of the patient’s medical history. Are there any indications of clinically significant underlying allergies, immune disorders (including acquired immunodeficiency syndrome), diabetes, sarcoidosis, the aspirin-asthma-Sinusitis triad, or other conditions? Was the patient’s previous medical and/or surgical treatment adequate? After a thorough review of the history, a complete endonasal examination must be performed with the 0° and 30° nasal endoscopes, during which the overall state of the nasal mucosa should be noted. A detailed examination of the intranasal anatomical features
J. Suonpää - One of the best experts on this subject based on the ideXlab platform.
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Operative Treatment of Frontal Sinusitis
Acta oto-laryngologica. Supplementum, 1997Co-Authors: J. Suonpää, Jukka Sipilä, K. Aitasalo, Jukka Antila, K. WideAbstract:When the medical therapy fails trephination is the primary operation indicated in acute eroding Sinusitis when drainage is necessary to avoid severe complications. In recent years also endoscopic transnasal surgery has been recommended for exenteration of the underlying disease in the ostiomeatal unit as well as for opening of the obstructed nasoFrontal duct in acute phase of the disease. In Turku University Central Hospital endoscopic Frontal sinus surgery is still reserved for cases with prolonged or delayed disease performed as a secondary operation after trephination and CT examination. Failures are common after these operations and both types of surgical treatment may be needed. Three percent of our patients developed a persistent chronic infection inside the Frontal sinus. In these cases external osteoplastic approach is recommended. In these operations we have used bioactive glass as obliteration material with promising clinical results.
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bacteriological evaluation of 194 adult patients with acute Frontal Sinusitis and findings of simultaneous maxillary Sinusitis
Acta Oto-laryngologica, 1997Co-Authors: Jukka Antila, J. Suonpää, Ollipekka LehtonenAbstract:In a prospective study bacteriological findings from Frontal and maxillary sinus secretes were analyzed. Frontal sinus trephination was performed to 103 and maxillary irrigation to 192 patients. Main pathogens in the Frontal as well as in the maxillary sinus secretes were Haemophilus influenzae and Streptococcus pneurnoniae. β-lactamase production of H. influenzae was found in 17% of Frontal and in 16% of maxillary sinus samples. Bacteriological findings were supported by the staining results. The portion of anaerobic pathogens in cultures were poor, though Bacteroides fragilis antigen was detected in 8 Frontal and 6 maxillary sinus samples. The acute Frontal Sinusitis should be treated with respective antibiotics. Complications seem not to develop in the acute phase and the disease can primarily be treated conservatively. It should however be controlled properly to avoid prolonged disease and late complications.
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Prediction of the Clinical Outcome of Acute Frontal Sinusitis With Ventilation Measurement of the NasoFrontal Duct After Trephination: A Long-Term Follow-up Study
The Laryngoscope, 1996Co-Authors: Jukka Sipilä, J. Suonpää, K. Wide, P. SilvoniemiAbstract:Acute Frontal Sinusitis has become an increasing clinical problem in the region that is served by the hospital represented by the authors of this study. The standard surgical treatment protocol after the failure of conservative therapy has been to perform trephination of the involved Frontal sinus. More sophisticated procedures have been used in patients with prolonged or recurrent disease. The authors have developed a simple ventilation test of the nasoFrontal duct that can be used to determine which patients require further surgery. In a long-term follow-up study of 85 patients, this ventilation test was shown to predict the cases that would heal uneventfully after trephination and the cases that would require further surgery because of an obstructed nasoFrontal duct. The findings of this study are of special interest for modern functional endoscopic sinus surgery, the purpose of which is to open up the nasoFrontal region.
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The value of computerised rhinomanometry and a simple manometry with saline in predicting the outcome of patients with acute trephined Frontal Sinusitis.
Rhinology, 1996Co-Authors: K. Wide, Jukka Sipilä, J. SuonpääAbstract:Infection of the anterior ethmoids and recessus Frontalis causes swelling of the mucosa and obstruction of the nasoFrontal duct, impairing the drainage of the Frontal sinus. During the healing process the obstruction diminishes gradually. Prolongation of this process can lead to chronic infection of the nasoFrontal region causing recurrent or chronic Frontal Sinusitis. In our everyday work we need a simple and reliable method to evaluate the patency of the nasoFrontal duct, in order to be able to assess the recovery and to find those patients whose disease tends to become chronic. For this purpose we have measured the patency of the nasoFrontal duct in 58 patients with Frontal Sinusitis after trephination with computerized rhinomanometry (RM) and with a simple salinemanometry (SM). The validity of the two methods to predict the further outcome of the patients has been compared in order to find out if SM would prove to be at least almost as reliable as rhinomanometry. Our statistics prove that SM is a useful aid in assessing the short-term recovery process of the patients. The long-term predictive value still remains to be seen.
