151
|
Langton-Hewer CD, Wormald PJ. Endoscopic sinus surgery rescue of failed osteoplastic flap with fat obliteration. Curr Opin Otolaryngol Head Neck Surg 2005; 13:45-9. [PMID: 15654215 DOI: 10.1097/00020840-200502000-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The modified endoscopic Lothrop procedure has been used as an alternative to osteoplastic flap with obliteration in the management of chronic frontal sinusitis. More recently it has been used to rescue cases of failed osteoplastic flap. This article reviews the recent literature regarding endoscopic rescue of failed osteoplastic flap with obliteration. RECENT FINDINGS Endoscopic sinus surgery is indicated in cases of osteoplastic flap failure when there is objective evidence of mucocele formation. All patients require CT and MR imaging preoperatively. Clinical improvement can be achieved in up to 89% of patients in the first 12 to 18 months postoperatively. SUMMARY The modified endoscopic Lothrop procedure is effective in the management of failed osteoplastic flap with obliteration in the short term. Long-term evaluation of this technique is still required. Endoscopic rescue is technically challenging and requires an experienced surgeon, ideally with access to image guidance equipment.
Collapse
Affiliation(s)
- Claire D Langton-Hewer
- Department of Surgery-Otolaryngology, Head and Neck Surgery, The University of Adelaide and Flinders University, Adelaide, South Australia
| | | |
Collapse
|
152
|
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.
Collapse
|
153
|
Chandra RK, Palmer JN, Tangsujarittham T, Kennedy DW. Factors associated with failure of frontal sinusotomy in the early follow-up period. Otolaryngol Head Neck Surg 2004; 131:514-8. [PMID: 15467628 DOI: 10.1016/j.otohns.2004.03.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To understand factors associated with failure of endoscopic frontal sinusotomy. METHODS Retrospective review of 130 consecutive frontal sinusotomies. The preoperative extent of disease was graded radiologically in each frontal sinus as total opacification, partial opacification, or mucosal thickening. Records were also reviewed to determine the incidence of comorbid conditions. RESULTS Patency at most recent follow-up was observed in 117/130 (90%). Patency was achieved after our first procedure in 107 sinusotomies. These were considered successes. Ten required revision surgery, and an additional 13 were not patent at last follow-up. These 23 sinusotomies were considered failures. Among those failing our initial surgery, 19/23 (83%) were partially or totally opacified preoperatively. In contrast, only 47/107 (44%) in the success group contained partial or total opacification preoperatively (P = 0.003), with the majority exhibiting mucosal thickening only. Mean follow-up was 8.3 months for the successes and 10.7 months for the failures (P = NS). No significant differences were observed between the success and failure groups with respect to the prevalence of asthma, aspirin sensitivity, or allergic fungal disease. Patients in the failure group, however, had a higher mean number of prior surgeries before undergoing frontal sinusotomy at our institution (1.8 vs 0.9, P = 0.033). CONCLUSIONS During the early follow-up period, failure of endoscopic frontal sinusotomy is associated with advanced degrees of preoperative disease within the sinus and is also more likely in patients who have failed prior surgical management.
Collapse
Affiliation(s)
- Rakesh K Chandra
- Department of Otolarygology-Head and Neck Surgery, University of Tennessee School of Medicine, Memphis, USA.
| | | | | | | |
Collapse
|
154
|
Bradley DT, Kountakis SE. The role of agger nasi air cells in patients requiring revision endoscopic frontal sinus surgery. Otolaryngol Head Neck Surg 2004; 131:525-7. [PMID: 15467630 DOI: 10.1016/j.otohns.2004.03.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the association of agger nasi air cell disease with frontal rhinosinusitis, assessed by computed tomography (CT), in patients who require revision functional endoscopic sinus surgery (FESS). METHODS We prospectively collected data on patients undergoing revision FESS at a tertiary care medical center over an 18-month period. Sinus CT scans were graded as per Lund-Mackay. Frontal sinus findings on CT scan were correlated with the presence or absence of disease in agger nasi air cells. RESULTS Eighty patients underwent revision FESS in an 18-month period. A total of 160 sides were evaluated by sinus CT scan with agger nasi being present in all but 11 sides (93%). One patient did not have a pneumatized frontal sinus on 1 side and so 148 sides were available for study. Frontal sinus disease was present in 119 and absent in 29 sides. The average CT grade of patients with frontal rhinosinusitis was 8.4 while it was only 3.0 in patients without frontal rhinosinusitis (P = 0.000). Agger nasi air cell disease was present in only 3 of 29 (10%) sides in patients without frontal rhinosinusitis and was present in all 119 (100%) sides of patients with frontal rhinosinusitis (P = 0.0000). CONCLUSION Agger nasi air cells are a common anatomic feature, present in 93% of our patients. Agger nasi air cell disease correlates strongly with frontal sinus disease as assessed by sinus CT scan in patients undergoing revision FESS. In addition, frontal sinus disease correlates with the severity of overall sinus disease as determined by sinus CT scan.
Collapse
Affiliation(s)
- Dewayne T Bradley
- Department of Otolarygology, University of Virginia, Charlottesville, USA
| | | |
Collapse
|
155
|
Affiliation(s)
- Alexander G Chiu
- Stanford Sinus Center, Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA
| | | |
Collapse
|
156
|
Manolidis S. Frontal sinus injuries: associated injuries and surgical management of 93 patients. J Oral Maxillofac Surg 2004; 62:882-91. [PMID: 15218570 DOI: 10.1016/j.joms.2003.04.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Spiros Manolidis
- Department of Otolaryngology--Head & Neck Surgery, Columbia University, New York, NY, USA.
| |
Collapse
|
157
|
Chandra RK, Schlosser R, Kennedy DW. Use of the 70-degree diamond burr in the management of complicated frontal sinus disease. Laryngoscope 2004; 114:188-92. [PMID: 14755187 DOI: 10.1097/00005537-200402000-00002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. STUDY DESIGN Retrospective review. METHODS The authors describe the use of a 70-degree diamond burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. RESULTS The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing frontoethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). CONCLUSION Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree diamond burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches.
Collapse
Affiliation(s)
- Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee School of Medicine, 956 Court Avenue, Suite B226, Memphis, TN 38163, USA.
| | | | | |
Collapse
|
158
|
Han JK, Hwang PH. Image-guided trephination of the frontal sinus: an adjunct to endoscopic technique. ACTA ACUST UNITED AC 2004. [DOI: 10.1053/j.otot.2003.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
159
|
Salamone FN, Seiden AM. Modern techniques in osteoplastic flap surgery of the frontal sinus. ACTA ACUST UNITED AC 2004. [DOI: 10.1053/j.otot.2004.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
160
|
Wormald PJ, Ananda A, Nair S. Modified endoscopic lothrop as a salvage for the failed osteoplastic flap with obliteration. Laryngoscope 2003; 113:1988-92. [PMID: 14603061 DOI: 10.1097/00005537-200311000-00025] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the modified endoscopic Lothrop (MEL) procedure for the management of failed osteoplastic flap (OPF) with obliteration of the frontal sinuses. SETTING Adelaide University Academic Hospital Complex. STUDY TYPE Prospective case study of 16 patients presenting with symptoms after OPF with obliteration of the frontal sinuses. MATERIALS AND METHODS Sixteen patients presented with symptoms of frontal sinus pain after having previously undergone OPF and fat obliteration of the frontal sinuses. All patients underwent computed tomography scanning; 13 underwent magnetic resonance imaging scanning, and 6 underwent a bone scan with technetium to exclude frontal osteitis. All patients underwent exploration of the frontal sinuses by way of the MEL procedure. RESULTS Fifteen patients were found to have a frontal sinus mucocele, whereas one patient had no mucocele with only new bone and fibrous tissue found at the MEL procedure. Twelve of the 16 patients with mucoceles had resolution of their frontal headaches, with 15 having a patent and healthy communication between the mucocele and the nasal cavity. The one patient without a mucocele continues to have frontal pain. One patient underwent a successful MEL procedure but had persistent symptoms until a supraorbital ethmoid mucocele was removed at a revision procedure. Two other patients continued to have frontal headaches and pain despite a healthy ostium into the frontal sinus mucocele. CONCLUSIONS MEL is a viable alternative to revision OPF for symptomatic patients who are shown to have a mucocele of the frontal sinuses.
Collapse
Affiliation(s)
- Peter John Wormald
- Department of Surgery, Otolaryngology Head and Neck Surgery, Adelaide University, South Australia, Australia.
| | | | | |
Collapse
|
161
|
López Llames A, Llorente Pendás JL, Suárez Fente V, Burón Martínez G, Suárez Nieto C. [Osteoplastic flap: our experience]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:429-34. [PMID: 14567077 DOI: 10.1016/s0001-6519(03)78432-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Despite the advances of endoscopic surgical techniques, the frontal sinus obliteration via the osteoplastic flap (OPF) remains the treatment option for frontal sinus pathologies. The aim of this study is to evaluate indications, procedures and results of this technique. MATERIAL AND METHODS Retrospective study of thirty one patients that underwent OPF procedure between 1986 and 1999. RESULTS The average patient's age was 42 years. The treated pathologies were: 12 mucoceles, 8 fractures, 4 osteomas, 4 sinutisis, 1 frontal abscess, 1 frontal osteomielitis and 1 orbital celullitis. The main clinical symptoms were headache (32%) and nasal obstruction (29%). The surgical approaches es used were: brow incision in 24 patients (78%), bicoronal in 5 (16%) and through the frontal wound in 2 traumatic cases (6%). Endonasal surgical procedures were associated in 8 patients (25%). Frontal sinus obliteration was performed in 23 patients (74%). Surgical revision was necessary in two cases. The were no serious complications. The overall esthetic and functional outcome was good. CONCLUSIONS OPF with fat obliteration is an useful technique in patients who had frontal sinus disease refractary to other methods.
Collapse
Affiliation(s)
- A López Llames
- Servicio de ORL, Hospital Central de Asturias, Oviedo, Asturias.
| | | | | | | | | |
Collapse
|
162
|
Metson R. Symposium: masters in otolaryngology--update in rhinology. Laryngoscope 2003; 113:1466-9. [PMID: 12972915 DOI: 10.1097/00005537-200309000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The past few years have witnessed several noteworthy advances in the field of rhinology in general and in the treatment of chronic sinusitis in particular. Many of these advances can be classified into three major trends: technology, techniques, and tissue eosinophilia.
Collapse
Affiliation(s)
- Ralph Metson
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA.
| |
Collapse
|
163
|
Wormald PJ, Ananda A, Nair S. The modified endoscopic Lothrop procedure in the treatment of complicated chronic frontal sinusitis. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2003; 28:215-20. [PMID: 12755759 DOI: 10.1046/j.1365-2273.2003.00692.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the modified endoscopic Lothrop procedure in the management of complicated frontal sinus disease which has breached the confines of the sinus walls and extended into the cranial cavity or orbit. Fourteen patients with radiological evidence of 17 complications of frontal sinus disease presented over a 23-month period. CT scan and MRI scans revealed the presence of posterior table erosion and extension of the frontal sinus disease into the anterior cranial fossa in 10 patients. In addition, seven patients had intraorbital complications, with three patients having both intracranial and orbital complications. All patients underwent a modified endoscopic Lothrop procedure as part of the management of the complication. In addition, one patient required an orbital abscess drainage and repair of an encephalocele, with a second patient requiring drainage of an orbital subperiosteal abscess. At follow-up, all patients were asymptomatic and had patent frontal sinus ostia. Follow-up ranged from 8 months to 38 months with a median of 25 months. Three patients required a revision of their frontal ostium. Two patients had allergic fungal sinusitis with aggressive polyp recurrence and ostial re-stenosis while one patient developed recurrent orbital infections from a retained frontal sinus cell. Currently, all have patent ostia, with an average size of 14.6 x 11 mm. The modified endoscopic Lothrop procedure is an effective form of treatment in the management of complicated frontal sinus disease. The results are comparable to those achieved with other surgical approaches such as the osteoplastic flap with obliteration.
Collapse
Affiliation(s)
- P J Wormald
- Department of Surgery - Otolaryngology Head & Neck Surgery, Adelaide and Flinders Universities, South Australia.
| | | | | |
Collapse
|
164
|
Abstract
With continued surgical instrument advancement, endoscopic sinus surgery techniques continue to evolve with an overall improvement of our ability to offer surgical treatment for a variety of surgical disorders of the sinuses and anterior skull base. Frontal sinusitis and the extent of surgery performed in the frontal recess once medical management fails are constantly debated in the literature. It seems that even though instrumentation has greatly improved, surgical management of frontal sinusitis remains a frustrating endeavor for otolaryngologists. Open approaches to the frontal sinus, including the osteoplastic flap with frontal sinus obliteration using adipose tissue, have been the gold standard, but require external incisions and complete removal of sinus mucosa with destruction of the frontal sinus. The endoscopic modified Lothrop technique involves removal of the frontal sinus floor bilaterally with frontal septectomy and resection of the nasal septum to create a large nasofrontal communication. Recent postoperative results of this technique rival the results after frontal sinus obliteration in selected patients while avoiding the morbidity associated with the open destructive approach.
Collapse
Affiliation(s)
- Stilianos E Kountakis
- University of Virginia Health System, PO Box 800713, Charlottesville, VA 22901, USA.
| | | |
Collapse
|
165
|
Tawfilis AR, Beckley ML, Farhood VW. Subperiosteal endoscopic cranial augmentation (SECA): endoscopic approach to cranioplasty. J Oral Maxillofac Surg 2003; 61:145-7. [PMID: 12524625 DOI: 10.1053/joms.2003.50024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adel R Tawfilis
- Department of Oral and Maxillofacial Surgery, Alameda County Medical Center (Highland Campus), Oakland, CA 94611, USA.
| | | | | |
Collapse
|
166
|
Abstract
Functional endoscopic sinus surgery (FESS) is the standard of care for the surgical management of sinonasal inflammatory disease. This group of procedures focuses on the sinus outflow tract, and is designed to improve sinus function by restoring sinonasal physiology. Use of the monocular endoscope is associated with a range of unique surgical complications that often require cross-sectional imaging. Many patients considering sinus surgery today have had surgical procedures in the past that were directed at removing diseased mucosa, rather than improving sinus drainage, and have a different appearance on CT. This report addresses the spectrum of surgical changes found on postoperative imaging of the paranasal sinuses, and the surgical complications that may occur during endoscopic sinus surgery.
Collapse
Affiliation(s)
- Barbara Zeifer
- Department of Radiology, Northwestern University, 676 North Saint Clair, Suite 800, Chicago, IL 60611, USA
| |
Collapse
|
167
|
Stamm AC, Pignatari S, Sebusiani BB, Galati MC, Mitsuda S, Haetinger RG. Cirurgia Endoscópica Nasossinusal e da Base do Crânio Guiada por Computador. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0034-72992002000400008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introdução: Apesar de nas últimas décadas, as cirurgias dos seios paranasais e base de crânio terem apresentado grande progresso, principalmente com o advento dos novos instrumentais, visualização endoscópica e estudos por imagem, ainda apresentam complicações de graus variáveis. A cirurgia guiada por computador (CGC), tecnologia introduzida há poucos anos, foi idealizada para auxiliar o cirurgião na localização precisa de estruturas anatômicas durante o ato cirúrgico, proporcionando mais segurança para o paciente e para o médico. Objetivo: O objetivo deste estudo foi fazer uma avaliação global da utilidade, indicações e segurança desta tecnologia, apresentando a nossa experiência com este sistema. Forma de estudo: Clínico retrospectivo. Material e Método: Foram estudados 20 pacientes portadores de doenças nasossinusais e base de crânio, submetidos à cirurgia endoscópica dos seios paranasais e base de crânio, utilizando o sistema de navegação no período de novembro de 2000 a setembro de 2001 no Centro de Otorrinolaringologia e Fonoaudiologia de São Paulo. Dos 20 pacientes operados, onze (55%) eram do sexo feminino e 9 (45%), do sexo masculino, idades entre 16 e 74 anos, sendo a idade média de 46 anos. As avaliações da utilidade, indicações e segurança, foram baseadas em critérios subjetivos e objetivos. 1. Utilidade: foi avaliada segundo a necessidade ou não do auxílio do sistema pelo cirurgião durante as cirurgias - nenhuma, pouca, moderada, muita. 2. Indicações mais importantes: baseadas nas cirurgias ou nas áreas cirúrgicas onde o cirurgião mais necessitou do sistema. 3. Segurança: avaliada pela ocorrência ou não de complicações intra e pós-operatórias. Resultados: O sistema foi utilizado em todas as cirurgias, embora não com a mesma freqüência ou necessidade. As cirurgias que tiveram maior necessidade do sistema foram as de base de crânio, poliposes revisionais com anatomia alterada e na região do recesso frontal. Não houve nenhuma complicação intra ou pós-operatória nos pacientes operados referentes ao método empregado. Conclusão: O sistema de navegação associado à cirurgia video-endoscópica mostrou-se bastante útil e seguro nas cirurgias de base de crânio e nasossinusais, mas não essencial. O sistema se mostrou particularmente útil nas doenças do recesso e seio frontal, seio esfenoidal, doenças extensas, pacientes com alterações anatômicas, cirurgias revisionais e lesões de base de crânio.
Collapse
Affiliation(s)
| | - Shirley Pignatari
- Hospital Professor Edmundo Vasconcelos; Universidade Federal de S.Paulo
| | | | | | | | | |
Collapse
|
168
|
|
169
|
|