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Lin YH, Chen PF, Shiue YL. An Endoscopic Approach for Frontal Sinus Cutaneous Fistula With Completely Ossified Frontal Recess. EAR, NOSE & THROAT JOURNAL 2023:1455613231175330. [PMID: 37264900 DOI: 10.1177/01455613231175330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
A frontal sinus cutaneous fistula (FSCF) is a rare and challenging condition. Remarkable advancements in endonasal endoscopic surgery (EES) have enabled the treatment paradigm for a FSCF to gradually shift from open procedures to ESS. Nevertheless, the experience of EES for a post-trephination-related FSCF is rare, especially in patients with a pronounced frontal recess (FR) ossification. Here, we report an endoscopic strategy for successfully treating a post-trephination-related FSCF with complete ipsilateral FR neo-osteogenesis. Through two surgical corridors created by the modified mini-Lothrop procedure and an ipsilateral frontal osteotomy window, we established a patent drainage pathway from the affected side to the opposite side. This strategy may prevent potential orbital and cranial base injuries from affecting the ossified region of the ipsilateral FR. Moreover, in addition to the advantage of aesthetic outcomes, the procedure allows a single-stage surgery and facilitates the debridement and surveillance of the wound through the drainage pathway postoperatively. In conclusion, this technique could be a feasible endoscopic strategy for a FSCF, regardless of the severity of the FR ossification.
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Affiliation(s)
- Yu-Hsuan Lin
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- School of Medicine, Chung Shan Medical University, Taichung
| | - Po-Fu Chen
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung
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Haddad R, Khoueir N, Smaily H, Rassi S, Abou Hamad W. Safety and Efficacy of the Draf IIb Procedure: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:784-790. [PMID: 33820467 DOI: 10.1177/01945998211004237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps. DATA SOURCES Articles published until July 2019 on Medline and Cochrane databases. REVIEW METHODS After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate. RESULTS The main indication for Draf IIb was chronic frontal rhinosinusitis (61.82%). The postoperative patency rate was 87.85%. When flaps/grafts were applied, the rate was 93.5%, but their added value was not statistically significant. Stents could be an alternative for revision surgery. Treating frontal pathologies other than chronic rhinosinusitis was also satisfying. Safety was comparable to Draf III: no perioperative complications were reported, only a few postoperative ones (eyelid ecchymosis and periorbital cellulitis in 0.2% of the cases, hyposmia in 1.55%). CONCLUSION When properly indicated, Draf IIb frontal drilling is a safe and highly effective surgical technique for frontal pathology treatment, with efficiency and safety comparable to the Draf III, making it a valid option when a bilateral approach is not needed. More studies are required to confirm the added values of flaps, grafts, and stents.
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Affiliation(s)
- Ralph Haddad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadim Khoueir
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Hussein Smaily
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Simon Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Walid Abou Hamad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Crocetta FM, Farneti P, Sollini G, Castellucci A, Ghidini A, Spinosi MC, Fernandez IJ, Zoli M, Mazzatenta D, Pasquini E. Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature. Eur Arch Otorhinolaryngol 2020; 278:1035-1045. [PMID: 32880737 DOI: 10.1007/s00405-020-06335-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. METHODS We retrospectively evaluated 22 patients who referred to Sant'Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions. We reported our experience in the endoscopic management of such complications and we reviewed the current literature concerning the endoscopic treatment of these conditions. RESULTS In total, 14 frontal mucoceles, 4 cases of chronic frontal sinusitis, 2 mucopyoceles and 2 fungus ball of the frontal sinus were identified. Endoscopic surgical treatment included 7 DRAF IIa, 1 DRAF IIb, 11 DRAF III and 3 DRAF IIc (modified DRAF III) approaches. The success rate of the surgical procedure was 86% (19/22 patients). Recurrence of the initial pathology occurred in three patients (14%) requiring a conversion of previous frontal sinusotomy into a DRAF III sinusotomy. CONCLUSION Frontal sinusopathy can be a long-term complication following craniotomies and may lead to potentially severe pathological conditions, such as mucoceles and frontal sinus inflammation. Its management is still debated and requires recovery of the patency of nasal-frontal route. Our study confirms that the endoscopic endonasal approach may offer a valid solution with low morbidity avoiding re-opening of the craniotomic access. For selected cases, endoscopic approach could also be performed simultaneously to craniotomy as a combined surgery to reduce the risk of short- and long-term complications. Long-term follow-up is mandatory in patients with a history of opened and reconstructed frontal sinus and should include imaging and endoscopic outpatient evaluation.
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Affiliation(s)
- F M Crocetta
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. .,ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - P Farneti
- ENT Department, Santa Maria Della Scaletta Hospital, Imola, BO, Italy
| | - G Sollini
- ENT Department, Bellaria Hospital, Bologna, Italy
| | - A Castellucci
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - A Ghidini
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - M C Spinosi
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - I J Fernandez
- ENT Department, University Hospital of Modena, Modena, Italy
| | - M Zoli
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - D Mazzatenta
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - E Pasquini
- ENT Department, Bellaria Hospital, Bologna, Italy
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Sahu N, Casiano RR. Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus. Int Forum Allergy Rhinol 2019; 9:562-566. [PMID: 30609302 DOI: 10.1002/alr.22278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/17/2018] [Accepted: 11/29/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Frontal sinusotomy can be challenging when significant scarring or distorted anatomy is present. Identifying a reliable anatomic structure, when traditional landmarks or navigation are absent, may assist the surgeon in revision and complicated frontal sinusotomies via a midline approach. We aimed to characterize the anatomic relationship of the nasal branch of the anterior ethmoid artery (NBAEA) to the frontal infundibulum, specifically the first olfactory fili, posterior frontal infundibulum, and anterior cribriform plate. METHODS Dissection of the NBAEA was carried out in 11 cadaveric heads, resulting in a total of 21 dissections (1 aplastic frontal). Mean with standard deviation and a range were established for 7 relative measurements. RESULTS The total length of NBAEA cleft when present (mean 2.43 mm), the anterior edge of NBAEA cleft to anterior infundibulum coronal plane (mean 1.71 mm), the posterior edge of NBAEA cleft to posterior infundibulum coronal plane (mean 3.33 mm), the posterior edge of NBAEA cleft to 1st olfactory fili (mean 2.86 mm), and the first olfactory fili to posterior infundibulum coronal plane (mean 0.48 mm) were consistent measurements supporting the use of the NBAEA as a consistent anatomical landmark for the correct surgical coronal trajectory into the midline frontal sinus. CONCLUSION The NBAEA is a consistent anatomic landmark with minimal intercadaveric and intracadaveric variation. It can be used reliably as a "sentinel artery" notifying the surgeon when one is approaching the first olfactory fili, to determine the correct trajectory into the midline frontal sinus.
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Affiliation(s)
- Nivedita Sahu
- Department of Otolaryngology, Head and Neck Surgery, Miller School of Medicine, University of Miami, FL
| | - Roy R Casiano
- Department of Otolaryngology, Head and Neck Surgery, Miller School of Medicine, University of Miami, FL
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Al-Salman R, Thamboo A. Advances in Surgery for Chronic Rhinosinusitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choby G, Nayak JV. The "Cross-court draf IIb" procedure for advanced nasal septum or frontal sinus pathology and nasal septum pathology. Laryngoscope 2017; 128:1527-1530. [PMID: 29271490 DOI: 10.1002/lary.27016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Garret Choby
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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The efficacy of extended Draf IIb procedure by partial nasal septectomy: long-term follow up. Eur Arch Otorhinolaryngol 2017; 274:2793-2797. [PMID: 28374055 DOI: 10.1007/s00405-017-4542-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
Draf IIb procedure is mostly used in a very narrow frontal recess and in a revision frontal sinus surgery. In most cases, the contralateral sinus is not involved. In order to avoid Draf III procedure's reported disadvantages we have commenced the use of the extended Draf IIb procedures in our center. Patients treated with extended Draf IIb procedure at our center between the years 1997 and 2012 were retrospectively evaluated. This procedure includes further widening of the frontal ostium and recces by excising the adjacent most superior nasal septum. Included in our study were patients who have failed previous Draf IIb procedure or had a small and narrow frontal sinus. Collected data included demographics, prior sinus pathology, previous surgical treatment, surgical complications and further treatment if required. All were evaluated by the SNOT-22 questioner pre and post-operatively and all were endoscopically evaluated during the follow up period. 15 patients and 18 frontal sinuses were included in our study, eight males and seven females with a mean age of 50.3 years. The mean pre-operative SNOT-22 fell from 46 to 24 and all patients improved clinically. No surgical complications were reported except for one case of postoperative maxillary sinusitis. Only one patient required further surgical intervention. In most cases the patients had a patent frontal sinus ostium after a follow up of 3-8 years. Extended Draf IIb procedure is less traumatic, safe and effective in the treatment of persistent frontal sinus disease, without surgically involving the healthy contralateral frontal sinus, and may obviate the need for Draf III procedure.
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Saini AT, Govindaraj S. Evaluation and Decision Making in Frontal Sinus Surgery. Otolaryngol Clin North Am 2017; 49:911-25. [PMID: 27450615 DOI: 10.1016/j.otc.2016.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Management of frontal sinusitis can be challenging for even the most experienced otolaryngologists. A thorough understanding of the anatomy and pathophysiology of the frontal sinus is essential to properly manage disease affecting the frontal sinus. Being able to distinguish acute viral from acute bacterial and acute from chronic sinusitis is crucial because these distinctions guide appropriate management. Nasal endoscopy can confirm diagnosis, and radiologic imaging, including computed tomography and MRI, is often a necessary adjunct that aids in determining appropriate therapeutic decisions. One must be aware of the many procedures used in the surgical treatment of frontal sinusitis.
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Affiliation(s)
- Alok T Saini
- Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Satish Govindaraj
- Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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Eloy JA, Marchiano E, Vázquez A. Extended Endoscopic and Open Sinus Surgery for Refractory Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:165-182. [PMID: 27888912 DOI: 10.1016/j.otc.2016.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This review discusses extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Extended maxillary sinus surgery including endoscopic maxillary mega-antrostomy, endoscopic modified medial maxillectomy, and inferior meatal antrostomy are described. Total/complete ethmoidectomy with mucosal stripping (nasalization) is discussed. Extended endoscopic sphenoid sinus procedures as well as their indications and potential risks are reviewed. Extended endoscopic frontal sinus procedures, such the modified Lothrop procedure, are described. Extended open sinus surgical procedures, such as the Caldwell-Luc approach, frontal sinus trephine procedure, external frontoethmoidectomy, frontal sinus osteoplastic flap with or without obliteration, and cranialization, are discussed.
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Affiliation(s)
- Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
| | - Emily Marchiano
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Alejandro Vázquez
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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10
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Abstract
This review covers potential complications of frontal sinus surgical management and strategies for prevention of these complications. Accordingly, recent advances in frontal sinus surgical techniques are described, and the management of complications stemming both from these and traditional techniques are detailed.
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Abstract
The frontal sinus is the most complex of all paranasal sinuses. Given its proximity to the cranial vault and orbit, frontal sinus pathology can progress to involve these structures and lead to significant morbidity, or even mortality. Surgical management of the frontal sinus is technically challenging. Various open and endoscopic surgical techniques are available to the otolaryngologist. This article presents an overview of the major disease entities that affect the frontal sinus, with a special emphasis on treatment principles and surgical management.
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Eloy JA, Vázquez A, Liu JK, Baredes S. Endoscopic Approaches to the Frontal Sinus: Modifications of the Existing Techniques and Proposed Classification. Otolaryngol Clin North Am 2016; 49:1007-18. [PMID: 27329983 DOI: 10.1016/j.otc.2016.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Frontal sinus surgery has long been technically challenging in terms of access and chronic disease management. Decades of experience and advances in technology have led to the widespread use of various surgical approaches to the frontal sinus. Modifications to these existing procedures have been described to minimize unnecessarily invasive approaches. The lack of a classification that incorporates the newly described modifications prompts the proposal of a new classification. Eloy I-III incorporates all the previously described approaches as well as 3 recently published, and 1 newly described, procedures.
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Affiliation(s)
- Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
| | - Alejandro Vázquez
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - James K Liu
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
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Fiorini FR, Nogueira C, Verillaud B, Sama A, Herman P. Value of septoturbinal flap in the frontal sinus drill-out type IIb according to draf. Laryngoscope 2016; 126:2428-2432. [DOI: 10.1002/lary.25947] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Francesca Romana Fiorini
- Department of Medical and Surgical Pathology; Otorhinolaryngology Unit; Pisa University Hospital; Pisa Italy
| | - Claudia Nogueira
- ENT Department; University Hospitals of Leicester; Leicester United Kingdom
| | | | - Anshul Sama
- ENT Department; Nottingham University Hospital; Nottingham United Kingdom
| | - Philippe Herman
- Department of Otorhinolaryngology; Lariboisière Hospital; Paris France
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Chen PG, Wormald PJ, Payne SC, Gross WE, Gross CW. A golden experience: Fifty years of experience managing the frontal sinus. Laryngoscope 2015; 126:802-7. [PMID: 26393824 DOI: 10.1002/lary.25648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The frontal sinus is one of the most anatomically complex and inaccessible of the paranasal sinuses. As a result, surgeons have continually tried to improve surgical management of the frontal sinus. The senior author (c.w.g.) shares 50 years of experience managing the frontal sinus. DATA SOURCES PubMed literature search. REVIEW METHODS Review of the literature regarding landmark innovations in frontal sinus surgery. RESULTS Open approaches established that the frontal sinus is accessible, and in certain circumstances, such as with large osteoma or papilloma, are still required. The endoscope changed the surgical landscape and allowed for greater finesse and decreased morbidity. Sinus balloon dilation is the newest change in frontal sinus management and shows promise in properly selected cases. CONCLUSION Surgery of the frontal sinus continues to evolve and improve. Although there are new techniques, the older techniques are still pertinent.
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Affiliation(s)
- Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio (p.g.c.), San Antonio, Texas
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Spencer C Payne
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - William E Gross
- Murfreesboro Clinic Otolaryngology, Murfreesboro, Tennessee, U.S.A.; and
| | - Charles W Gross
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
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Extended draf IIb procedures in the treatment of frontal sinus pathology. Clin Exp Otorhinolaryngol 2015; 8:34-8. [PMID: 25729493 PMCID: PMC4338089 DOI: 10.3342/ceo.2015.8.1.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/17/2022] Open
Abstract
Objectives Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures. Methods Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed. Results Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications. Conclusion In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.
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Svider PF, Sekhsaria V, Cohen DS, Eloy JA, Setzen M, Folbe AJ. Geographic and temporal trends in frontal sinus surgery. Int Forum Allergy Rhinol 2014; 5:46-54. [PMID: 25367305 DOI: 10.1002/alr.21425] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/02/2014] [Accepted: 08/23/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate geographic and temporal trends in frontal sinus surgery procedures. METHODS Medicare Part B data files from 2000 to 2011 were examined for temporal trends in various frontal sinus procedures, and the most recent year containing geographic information (2010) was evaluated for Current Procedural Terminology (CPT) code use. Additionally, nationwide charges per procedure were recorded. Regional populations of individuals ≥ 65 years old were obtained from the 2010 U.S. Census, and surgical society websites were used to determine the number of practicing rhinologists and otolaryngologists in each region. RESULTS The use of open approaches declined by one third, while endoscopic procedures went from 6463 to 19262 annually, with the most marked increases occurring from 2006 through 2011. Geographic variation was noted, with practitioners in the South Atlantic states performing the greatest number of endoscopic procedures in 2010, whereas the East South Central states had the greatest number when controlling for population. There was an inverse relationship between endoscopic procedures performed and number of fellowship-trained rhinologists (controlling for regional populations) (R(2) = 0.66). The first year frontal sinus ballooning had a unique CPT code illustrated decreased reimbursements for non-balloon endoscopic surgery ($609) relative to balloon approaches ($2635). CONCLUSION Declines in open frontal sinus surgery and marked increases in endoscopic approaches have potential implications for residency training. Potential reasons for marked increases in endoscopic approaches include the rising popularity of balloon technologies, although this is speculative. Geographic variation exists in frontal sinus surgery patterns, including an inverse relationship between endoscopic approaches and the number of fellowship-trained rhinologists.
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Affiliation(s)
- Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI
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Eloy JA, Mady LJ, Kanumuri VV, Svider PF, Liu JK. Modified subtotal-Lothrop procedure for extended frontal sinus and anterior skull-base access: a case series. Int Forum Allergy Rhinol 2014; 4:517-21. [PMID: 24500861 DOI: 10.1002/alr.21296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/17/2013] [Accepted: 01/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The endoscopic modified Lothrop procedure (EMLP) is well established for resistant frontal sinus disease and anterior skull base (ASB) exposure. However, this technique may be unnecessarily aggressive by removing avoidable sinonasal structures in select cases. Previously, in a cadaveric study, we proposed a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the ASB and to address complex frontal sinus disease, for which access to the bilateral frontal sinus posterior table is required. This study provides a step-by-step description of this technique, and presents our experience in 5 patients who underwent this approach. METHODS A retrospective analysis was performed at a tertiary referral center on all patients undergoing endoscopic ASB resection and complex frontal sinus surgeries between May 2011 and May 2013. Of 8 patients identified who underwent an MSLP, 5 had at least 1-year follow-up. RESULTS All patients underwent successful ASB exposure via the MSLP without complications and preservation of one frontal sinus recess. Adequate access to the bilateral posterior frontal sinus table was achieved in all cases. A patent frontal sinus drainage pathway could be assessed endoscopically after a mean follow-up of 18.6 (range, 12-27) months. CONCLUSION The MSLP is a feasible approach for exposure of the ASB and accessing complex frontal sinus pathology. This modification provides adequate ASB exposure and surgical maneuverability similar to the EMLP, while preserving one frontal sinus recess. This modification was successful in providing adequate exposure and maneuverability as well as maintaining frontal sinus patency in this small cohort.
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Affiliation(s)
- Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
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Al Komser MK, Goldberg AN. Unilateral transnasal endoscopic approach to frontal sinuses: Draf IIc. ALLERGY & RHINOLOGY 2013; 4:e82-7. [PMID: 24124642 PMCID: PMC3793118 DOI: 10.2500/ar.2013.4.0058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For chronic sinusitis surgery, the Draf III approach provides a common median drainage pathway for bilateral frontal sinuses from orbit to orbit. The Draf IIb provides unilateral drainage from orbit to septum. In several cases, inclusion of the nasal and frontal sinus septum in a Draf IIb was advantageous without extension to the opposite frontal recess. The proposed nomenclature is Draf IIc. This study was designed to (1) develop a surgical option for chronic frontal sinusitis where access to one frontal recess is limited or unnecessary and (2) minimize unnecessary surgical manipulation of uninvolved areas. Revision endoscopic frontal sinus surgery was performed on two patients with persistent frontal sinus opacification. Surgery crossed midline including one frontal recess with resection of the superior nasal septum. The surgical result was assessed on endoscopy and computed tomography (CT). The postoperative course was unremarkable with relief of frontal pressure. Postoperative CT scan showed well-aerated frontal sinuses with a widely patent common drainage pathway. Postoperative nasal endoscopy revealed normal mucosa with no exposed bone or edema. The Draf IIc extends the Draf IIb across the midline, without including the opposite frontal recess. This can be accomplished most easily using an interfrontal sinus septal cell or an eccentric interfrontal sinus septum. The Draf IIc is a surgical option in cases of chronic or recalcitrant frontal sinus diseases, including unilateral or bilateral obstruction, where access to the ipsilateral frontal recess is limited or favorable anatomy allows drainage with reduced manipulation of an uninvolved side.
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Affiliation(s)
- Mohammed K Al Komser
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California
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Eloy JA, Shukla PA, Choudhry OJ, Eloy JD, Langer PD. In-office balloon dilation and drainage of frontal sinus mucocele. ALLERGY & RHINOLOGY 2013; 4:e36-40. [PMID: 23772325 PMCID: PMC3679566 DOI: 10.2500/ar.2013.4.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Recently, there has been an increased interest in in-office procedures in otolaryngology because of patient satisfaction and substantial savings of time and cost for both patients and physicians. Similarly, the past few years have witnessed an increased use of balloon dilation devices in sinus surgery. Previously, we have described the in-office use of this device in treating patients who failed prior conventional frontal sinusotomy in the operating room. In this report, we describe our step-by-step in-office experience using this tool for drainage of a large frontal sinus mucocele.
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Affiliation(s)
- Jean Anderson Eloy
- Departments of Otolaryngology-Head and Neck Surgery and ; Neurological Surgery, ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, and
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Eloy JA, Liu JK, Choudhry OJ, Anstead AS, Tessema B, Folbe AJ, Casiano RR. Modified subtotal lothrop procedure for extended frontal sinus and anterior skull base access: a cadaveric feasibility study with clinical correlates. J Neurol Surg B Skull Base 2013; 74:130-5. [PMID: 24436902 DOI: 10.1055/s-0033-1338264] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022] Open
Abstract
Objective The endoscopic modified Lothrop procedure (EMLP) is an established approach for recalcitrant frontal sinus disease and anterior skull base exposure. However, in select cases, this technique may involve unnecessary resection of sinonasal structures. In this study, we propose a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the anterior skull base and complex frontal sinus disease for which access to the bilateral frontal sinus posterior table is required. Methods A cadaveric dissection with photo documentation was performed at an academic medical center on four cadaver heads using standard endoscopic techniques to demonstrate the MSLP and its feasibility. Results The endoscopic MSLP allowed ample access for instrumentation in each of the dissections using a 30- or 70-degree endoscope. Adequate bilateral access to the posterior table of the frontal sinus was gained in all cases without the need for dissection of the contralateral frontal sinus recess (FSR). Conclusion The MSLP appears to be a feasible technique for exposure of the anterior skull base and accessing complex frontal sinus pathology. This modification provides similar anterior skull base exposure and surgical maneuverability as the EMLP while limiting surgical dissection to one FSR, thereby preserving as much of the natural mucociliary drainage pathways as possible.
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Affiliation(s)
- Jean Anderson Eloy
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
| | - James K Liu
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
| | - Osamah J Choudhry
- Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
| | - Amy S Anstead
- Department of Otolaryngoogy, Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Belachew Tessema
- Division of Otolaryngology, Head and Neck Surgery Connecticut Sinus Institute, University of Connecticut, Farmington, Connecticut, USA
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Leonard Miller School of Medicine, Miami, Florida, USA
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Eloy JA, Neskey DM, Vivero RJ, Ruiz JW, Choudhry OJ, Casiano RR. High-resolution computed tomography analysis of the frontal sinus ostium: a pilot study. Am J Otolaryngol 2013; 34:99-102. [PMID: 23102967 DOI: 10.1016/j.amjoto.2012.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/24/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Identification and exposure of the frontal sinus recess (FSR) during endoscopic sinus surgery (ESS) are challenging due to the variable anatomy, the narrow opening of the frontal sinus ostium (FSO), and the proximity of vital anatomic structures. Hence, a strong understanding of frontal sinus anatomy is required to prevent intracranial entry. Consistent and easily identifiable landmarks and measurements could assist safe entry into the FSO. In this study, we determine the distances from the columella and anterior nasal spine (ANS) to the nasofrontal beak (NFB) and anterior skull base (ASB) using high-resolution computed tomography (HRCT) scans. METHODS A radiographic analysis was performed at a tertiary care medical center. Measurements from the ANS to the NFB and ASB, and from the columella to the NFB and ASB were made using sagittal HRCT. Thirty-two HRCT scans were analyzed by three observers, and the mean distances and standard deviations were calculated. RESULTS The mean distance from the ANS to the NFB was 52.3±3.4mm in men and 47.7±3.5mm in women (p<0.0001). Mean distance from the ANS to the ASB was 61.8±4.1mm in men and 56.5±4.1mm in women (p<0.0001). Mean distance from the columella to the NFB was 58.9±2.3mm in men and 53.0±3.3mm in women (p<0.0001), and from the columella to the ASB was 67.9±3.7 mm in men and 61.3±4.1mm in women (p<0.0001). CONCLUSION While performing FSR exposure in ESS, it is recommended to stay a distance of less than 66.9 mm in men and 60.6mm in women from the columella to minimize intracranial complications.
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