scholarly journals Treatment of Chronic Frontal Sinusitis with Difficult Anatomy: A Hybrid Balloon Technique in Four Cases

2014 ◽  
Vol 5 (3) ◽  
pp. ar.2014.5.0096 ◽  
Author(s):  
Gitanjali M. Fleischman ◽  
Justin D. Miller ◽  
Grace G. Kim ◽  
Adam M. Zanation ◽  
Charles S. Ebert
Keyword(s):  
Frontal Sinus ◽  
Intraoperative Complications ◽  
Postoperative Bleeding ◽  
Balloon Dilation ◽  
Surgical Techniques ◽  
Case Series ◽  
Sinus Surgery ◽  
Tertiary Referral Center ◽  
Type Iv ◽  
Select Group

The presence of frontal cells poses unique challenges when using endoscopic approaches. This study describes the use of a balloon dilation system as an aid for functional endoscopic sinus surgery (FESS) to access the frontal sinus in cases that would traditionally require open approaches. We present a case series of four patients with chronic rhinosinusitis refractive to medical management who underwent FESS with the aid of a balloon dilation system at a tertiary referral center. All patients had variant forms of frontal sinus anatomy. Surgical techniques will be described and use of the balloon system will be reviewed. All patients (aged 13–68 years) successfully underwent fontal sinusotomies with the assistance of a balloon dilation system, which was used in a variety of ways: to dilate the narrow infundibulum of a high intersinus septal cell, to remove an anteriorly located type III frontal sinus cell, to expand the natural frontal ostium in the presence of excessive agger nasi pneumatization, and to remove a type IV frontal sinus cell. All patients were spared an osteoplastic flap or trephination, and there were no intraoperative complications. No postoperative bleeding, infection, or cerebral spinal fluid leaks were reported. Balloon dilation in combination with standard frontal sinus dissection techniques may be beneficial for a select group of patients with complex frontal anatomy. In this series of patients, the balloon dilation system was used as a tool during FESS and eliminated the need for open approaches.

scholarly journals Draf III frontal sinus surgery for the treatment of Pott’s puffy tumour in adults: our case series and a review of frontal sinus anatomy risk factors

2020 ◽  
Vol 277 (8) ◽  
pp. 2271-2278
Author(s):  
Alfonso Luca Pendolino ◽  
Foteini Stefania Koumpa ◽  
Henry Zhang ◽  
Samuel C. Leong ◽  
Peter J. Andrews
Keyword(s):  
Risk Factors ◽  
Frontal Sinus ◽  
Case Series ◽  
Sinus Surgery ◽  
Frontal Sinus Surgery ◽  
Draf Iii

Long-term stenting for chronic frontal sinus disease: case series and literature review

2010 ◽  
Vol 124 (11) ◽  
pp. 1216-1222 ◽  
Author(s):  
B Hunter ◽  
S Silva ◽  
R Youngs ◽  
A Saeed ◽  
V Varadarajan
Keyword(s):  
Frontal Sinus ◽  
Relevant Literature ◽  
Case Series ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Narrow Channels ◽  
Co Morbidity ◽  
Disease Case

AbstractObjective:The frontal sinus outflow tract consists anatomically of narrow channels prone to stenosis. Following both endonasal and external approach surgery, up to 30 per cent of patients suffer post-operative re-stenosis of the frontal sinus outflow tract, with recurrent frontal sinus disease. This paper proposes the surgical placement of a long-term frontal sinus stent to maintain fronto-nasal patency, as an alternative to more aggressive surgical procedures such as frontal sinus obliteration and modified Lothrop procedures.Design:We present a series of three patients with frontal sinus disease and significant co-morbidity, the latter making extensive surgery a significant health risk. We also review the relevant literature and discuss the use of long-term frontal sinus stenting.Results:These three cases were successfully treated with long-term frontal sinus stenting. Stents remained in situ for a period ranging from 48 to over 60 months.Conclusion:Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

scholarly journals The Bifurcated Frontal Sinus

OTO Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 2473974X1876487
Author(s):  
Edward D. McCoul ◽  
Kiranya E. Tipirneni
Keyword(s):  
Frontal Sinus ◽  
Residual Disease ◽  
Case Series ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Consecutive Series ◽  
Endoscopic Techniques ◽  
Common Wall ◽  
Computed Tomography Scans ◽  
Extent Of Surgery

Objectives Frontal sinus anatomy is complex, and multiple variations of ethmoid pneumatization have been described that affect the frontal outflow tract. In addition, the lumen proper of the frontal sinus may exist as 2 separate parallel cavities that share an ipsilateral outflow tract. This variant has not been previously described and may have implications for surgical management. Study Design Case series. Setting Tertiary rhinology practice. Subjects and Methods Cases with radiographic and intraoperative findings of separate parallel tracts within a unilateral frontal sinus were identified from a consecutive series of 186 patients who underwent endoscopic sinus surgery between May 2015 and July 2016. Data were recorded including sinusitis phenotype, coexisting frontal cells, and extent of surgery. Results Ten patients (5.4%) were identified with computed tomography scans demonstrating bifurcation of the frontal sinus into distinct medial and lateral lumens. All cases were treated with Draf 2a or 2b frontal sinusotomy with partial removal of the common wall to create a unified ipsilateral frontal ostium. Eleven sides had a coexisting ipsilateral agger nasi cell, 7 had a supra-agger cell, 8 had a suprabullar cell, and 1 had a frontal septal cell. There were no significant complications. Conclusion The bifurcated frontal sinus is an anatomic variant that the surgeon should recognize to optimize surgical outcomes. Failure to do so may result in incomplete clearance of the sinus and residual disease. The bifurcated sinus may occur with other types of frontal sinus cells and may be safely treated with endoscopic techniques.

scholarly journals In-office Balloon Dilation and Drainage of Frontal Sinus Mucocele

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0041 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Jean Daniel Eloy ◽  
Paul D. Langer
Keyword(s):  
Patient Satisfaction ◽  
Operating Room ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Balloon Dilation ◽  
Sinus Surgery ◽  
Surgical Drainage ◽  
Sinus Disease ◽  
The Past ◽  
Office Procedures

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.

Hybrid Frontal Sinus Surgery with Balloon Dilation and Microdebrider Resection

2015 ◽  
Vol 94 (8) ◽  
pp. 304-305
Author(s):  
Dewey A. Christmas ◽  
Joseph P. Mirante ◽  
Eiji Yanagisawa
Keyword(s):  
Frontal Sinus ◽  
Balloon Dilation ◽  
Sinus Surgery ◽  
Frontal Sinus Surgery

The Horizon Sign and Frontal Bar: Two Topographic Landmarks to Confirm Endoscopic Frontal Sinusotomy

2019 ◽  
Vol 160 (4) ◽  
pp. 740-743
Author(s):  
Evan S. Walgama ◽  
Andrew Thamboo ◽  
Navarat Tangbumrungtham ◽  
Noel Ayoub ◽  
Zara M. Patel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Case Series ◽  
Acute Angle ◽  
Sinus Surgery ◽  
Consecutive Case ◽  
Landmark Identification ◽  
Frontal Sinuses ◽  
Anterior Posterior

Confirming a thorough dissection of the frontal sinus during endoscopic sinus surgery can be challenging, and some surgeons would benefit from reliable topographic landmark identification to ensure completion of this sinus dissection. We defined (1) the “horizon sign” as the curvilinear shadow of the posterior table cast superiorly upon the anterior table of the frontal sinus at the acute angle of their meeting point and (2) the “frontal bar” as a sagittal septation at the union of the anterior/posterior tables. A cadaveric study, followed by an intraoperative consecutive case series, was performed to evaluate these 2 landmarks as indicators of complete dissection. The horizon sign was extremely reliable, identified in 100% of cadaveric frontal sinuses and intraoperative frontal sinuses. The frontal bar was present in only 67% of frontal sinuses by computed tomography. In live patients, the sensitivity and specificity of the frontal bar were 62% and 95%, respectively.

NASAL POLYPS;

2018 ◽  
Vol 25 (08) ◽  
pp. 1213-1217
Author(s):  
Farhan Salam ◽  
Damish Arslan ◽  
Muhammad Salman Haider Qureshi ◽  
Ejaz Ahmad
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Nasal Polyposis ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Operational Definition ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Male Patients ◽  
Age Of Majority

Introduction: Functional Endoscopic Sinus Surgery (FESS) is now undoubtedlythe procedure of choice for surgical treatment of chronic sinusitis and nasal polyposis afterfailure of medical treatment. In order to present the formation of synechie nasal packing isperformed. Moreover, it also helps in supporting the process of wound healing and preventionof postoperative bleeding. Objectives: To determine the frequency of synechiae formation afterfunctional endoscopic sinus surgery (FESS) in patients presenting with nasal polyps. StudyDesign: Descriptive case series. Setting: Department of Otorhinolaryngology at ServicesHospital Lahore. Period: Six months from 03-10-2013 to 02-04-2014. Methodology: A total of150 cases were included in this study. Patients were treated by functional endoscopic sinussurgery (FESS) and were followed at the end of 1st, 2nd, 3rd and 4th week postoperatively forthe development of synechiae (as per operational definition). Results: The age of majority ofpatients was from 20 to 40 years and minimum patients were < 20 years old. Mean age of thepatients was 35.30±10.54 years. Male patients were 80 (53.3%) while female patients were 70(46.7%). Synechiae formation was observed in 28 patients (18.7%). Conclusion: Synechiaeformation was developed in 18.4% of the patients after functional endoscopic sinus surgery.

Balloon Catheter Dilatation for Frontal Sinus Ostium Stenosis in the Office Setting

2008 ◽  
Vol 22 (6) ◽  
pp. 621-624 ◽  
Author(s):  
Amber Luong ◽  
Pete S. Batra ◽  
Samer Fakhri ◽  
Martin J. Citardi
Keyword(s):  
Frontal Sinus ◽  
Balloon Catheter ◽  
Case Series ◽  
Sinus Surgery ◽  
Office Setting ◽  
Revision Sinus Surgery ◽  
Feasible Alternative ◽  
Sinus Ostium ◽  
Catheter Dilatation

Background Frontal sinus ostium stenosis (FSOS) is problematic even for expert surgeons. Balloon catheter (BC) technology has been recently introduced to rhinology. The aim of this study is to assess technical feasibility and effectiveness of BC dilatation of FSOS in the office setting. Methods This retrospective, multi-institutional case series describes all patients who underwent BC dilatation of FSOS in the office setting in the year ending December 31, 2007. Results Six adult patients underwent a total of seven BC dilatations of FSOS in the clinical setting. The pretreatment ostium size was 1-2 mm. Four of the dilatations were performed with a 5-mm lacrimal BC (LacriCATH, Quest Medical, Allen, TX) and three dilatations were executed with a 7-mm sinus BC (SinuCATH, Quest Medical). All procedures were performed using topical anesthesia only. No complications occurred. Five of the six dilated FSOS dilatations were deemed successful after one BC dilatation. One ostium contracted >50% and required repeat BC dilatation. All ostia have remained patent with a follow-up range of 4-9 months. No subject has required formal surgical revision. Conclusion This preliminary report describes BC of FSOS in the office setting. The technique may serve as a safe and feasible alternative, potentially avoiding formal revision sinus surgery in select patients.

scholarly journals Utility of Intraoperative Flexible Endoscopy in Frontal Sinus Surgery

2017 ◽  
Vol 8 (2) ◽  
pp. ar.2017.8.0205 ◽  
Author(s):  
Eric T. Carniol ◽  
Alejandro Vázquez ◽  
Tapan D. Patel ◽  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Surgical Management ◽  
Frontal Sinus ◽  
Surgical Techniques ◽  
Disease Process ◽  
Flexible Endoscopy ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Frontal Sinus Surgery ◽  
Far Lateral ◽  
Draf Iii

Background Surgical management of the frontal sinus can be challenging. Extensive frontal sinus pneumatization may form a far lateral or supraorbital recess that can be difficult to reach by conventional endoscopic surgical techniques, requiring extended approaches such as the Draf III (or endoscopic modified Lothrop) procedure. Rigid endoscopes may not allow visualization of these lateral limits to ensure full evacuation of the disease process. Methods Here we describe the utility of intraoperative flexible endoscopy in two patients with far lateral frontal sinus disease. Results In both cases, flexible endoscopy allowed confirmation of complete evacuation of pathologic material, thereby obviating more extensive surgical dissection. Conclusion In cases where visualization of the far lateral frontal sinus is inadequate with rigid endoscopes, flexible endoscopy can be used to determine the need for more extensive dissection.

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