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At least 55 records · Page 3Linked to original sources
PubMed1989

Radionuclide bone scan in frontal sinus osteoma.

Frontal sinus osteomas, whether cortical or cancellous by morphologic radiologic appearance, appear to represent metaplasia rather than neoplasia occurring at the frontal-ethmoid suture line. These osteomas are not infrequently found completely or partially within the frontal sinus or adjacent ethmoid complex. Regardless of specific anatomic site, they occur at the embryologic junction of enchondral and membranous frontal bone. Those osteomas which produce mechanical complications (ostial obstruction or facial deformity or proptosis) give clear indication for surgical intervention. A much larger group of osteomas, however, is detected on routine plan radiographic examinations carried out for other reasons. Unfortunately, the singular conventional radiographic finding of an osteoma has, in the past, frequently been the sole and primary indication for surgical intervention. The purpose of the present paper was to review the experience with 10 frontal sinus osteomas managed expectantly over the past 11 years. All were imaged serially with morphologic studies, including conventional X-rays and computerized tomography scans. A radionuclide bone scan was carried out in all patients at the time of initial presentation. Those identified as producing mechanical complications clinically, or a 'hot' bone scan by radionuclide study, were regarded as appropriate for osteoplastic frontal sinusectomy for removal of the osteoma; three cases were approached in this way. On the other hand, utilizing this physiologic imaging parameter, a 'cold' bone scan indicated the presence of a relatively insert osteoma, in terms of biologic growth activity. Thus, adopting a non-operative approach, and following these patients over the 4-11 year period appears to have been validated.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1994

The use of cancellous bone for frontal sinus obliteration and reconstruction of frontal bony defects.

OBJECTIVE: The objective of this report is to review our experience and indications for the use of cancellous bone in frontal sinus obliteration and reconstruction of frontal defects. We also describe a method of minimizing iliac crest donor-site morbidity. DESIGN: Case series. SETTING: Patients treated on the Facial Plastics and Trauma Service at the University of Cincinnati (Ohio) Medical Center. PATIENTS: Ten patients were selected for frontal sinus obliteration and reconstruction of frontal defects with cancellous bone based on the following criteria: (1) complex frontal bony defects involving the frontal sinus; (2) acute trauma with loss or comminution of more than 40% of either anterior or posterior sinus wall; and (3) failure of previous frontal sinus obliteration for either chronic sinusitis or trauma. INTERVENTION: The use of cancellous bone grafts for frontal sinus obliteration and reconstruction of frontal defects. MAIN OUTCOME MEASURE: Success of cancellous bone grafts in frontal sinus obliteration and reconstruction of frontal defects. RESULTS: Follow-up averaged 26 months. Follow-up computed tomographic scans showed good maintenance of graft volume and complete frontal sinus obliteration in all patients. Seven of 10 patients reported minimal donor-site discomfort and three patients had moderate pain. CONCLUSION: Cancellous bone grafts are effective, with acceptable donor-site morbidity, for frontal sinus obliteration and frontal reconstruction in patients in whom adipose grafts would have a significant chance of complications or long-term failure.

Adipose Tissue↗
PubMed1995

Management of frontal sinus fractures.

Frontal sinus fractures have been reported in 2 to 12 percent of all cranial fractures and, according to one study, in 8 percent of all facial fractures. Although immediate frontal bone reconstruction is not universally accepted, it is rapidly becoming the standard of care in treating cranial facial fractures, even in the face of gross contamination. This article presents a historical overview of fracture management, a review of the relevant anatomy, and a discussion of appropriate management principles. Three case studies are presented to demonstrate appropriate techniques for the management of frontal sinus fractures.

Adipose Tissue↗
PubMed2003

Extensive subgaleal abscess and epidural empyema in a patient with acute frontal sinusitis.

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.

Abscess↗
PubMed1998

Frontal sinus fractures.

Frontal sinus fractures usually occur in trauma situations involving substantial force and are frequently accompanied by other, sometimes life threatening, injuries. Early recognition of this injury is important to prevent serious complications as well as to restore cosmesis. This paper reviews the incidence, pathophysiology, classification, and controversial management of frontal sinus fractures.

Adolescent↗
PubMed2006

Endoscopic repair of anterior table--frontal sinus fractures.

Frontal sinus fractures account for 5% to 15% of all maxillofacial injuries. Historically, a large percentage of these injuries were treated aggressively because of the long term risk of mucocele formation. This required a coronal incision with the associated surgical sequelae including a large scar, alopecia, and paresthesias. In light of these sequelae and recent advances in CT diagnosis and endoscopic treatment of mucoceles, some surgeons are starting to manage isolated anterior table fractures through an endoscopic approach. The endoscopic repair significantly reduces patient morbidity because it requires only 2 small incisions behind the frontal hairline. The endoscopic approach can be divided into two types: acute fracture reduction (covered elsewhere in this issue) and fracture camouflage. This article reviews the indications, techniques, and advantages of frontal sinus fracture camouflage.

Bone Substitutes↗
PubMed1989

Use of a Foley catheter for short-term drainage in frontal sinus surgery.

Frontal sinus surgery for chronic disease presents a variety of problems, in particular that of drainage. No matter how successful the surgical technique is in clearing disease from the sinus, it is still important that the fronto-nasal duct is kept patent unless the procedure is an obliterative one. Usually a tube is inserted for drainage and has to be kept in place for several weeks or months. This paper presents a study of 16 patients, suffering from frontal sinus disease, in whom a short-term drainage technique using a Foley catheter was employed between 1979 and 1988 at Lagos University Teaching Hospital, Nigeria. This type of drainage allows effective anchorage and irrigation with a decongestant. It has been found to give satisfactory results after 14 days in place and has had no unusual complications. It is therefore recommended for use in such cases.

Catheterization↗
PubMed2001

Frontal sinus malignancies.

Frontal sinus malignancies comprise 2% to 3% of those occurring in the paranasal region. Patients commonly present with forehead pain and swelling, orbital disturbances, epistaxis, and nasal purulence. A combination of CT and MR imaging delineate the tumor and its relationship with the adjacent dura and periorbita. Low-grade malignancies are addressed with en bloc extirpation, with lower frontal sinus and adjacent ethmoid lesions approached through a superior rhinotomy, and more extensive lesions through a combination of a bicoronal flap and rhinotomy. Postoperative irradiation is appropriate for medium- to high-grade lesions. Small to medium defects are closed with local rotation flaps and larger defects with free flaps. Bony reconstruction can range from a split calvarial bone graft to mini plates and wire mesh.

Combined Modality Therapy↗
PubMedDate not supplied

Endoscopically guided frontal sinus beclomethasone instillation for refractory frontal sinus/recess mucosal edema and polyposis.

Despite its metabolic complications, systemic corticosteroid therapy remains a mainstay in the treatment of refractory polyposis after endoscopic frontal sinusotomy. Furthermore, topical nasal corticosteroids often fail, presumably due to the relatively small dosage actually absorbed by the polyps. In order to minimize steroid complications while increasing the locally absorbed dose, beclomethasone (approximately 1 cc, 84 mcg/100 microliters) was instilled under endoscopic guidance directly into the frontal sinus in 31 instances in 16 patients with postoperative frontal recess/sinus polyposis and mucosal edema. The frontal recess/sinus polyposis/edema resolved completely in 9 frontal sinuses, improved considerably in 7 frontal sinuses, improved minimally in 5 frontal sinuses, and remained unchanged in 10 frontal sinuses. No complications were noted. AM cortisol levels remained in the normal range. Endoscopically guided frontal sinus beclomethasone instillation should be considered for the treatment of refractory postoperative frontal sinus/recess polyposis/edema. Further basic and clinical research into the pathophysiology of the nasal mucosa is also warranted.

Absorption↗
PubMed1995

Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration.

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Adult↗
PubMed2006

Use of anteriorly based pericranial flap in frontal sinus obliteration.

OBJECTIVE: In an era of endoscopic sinus surgery, frontal sinus obliteration continues to remain an important treatment option in chronic frontal sinus disease. Numerous avascular obliterative materials including fat, muscle, cancellous bone, and hydroxyapatite have been used in this procedure. In this article, we describe a vascularized anteriorly based pericranial flap to obliterate frontal sinus. STUDY DESIGN: Retrospective chart review of patients referred to tertiary care hospital between 1996 and 2003. METHODS: Records of the patients who underwent this procedure were reviewed. Demographics, indications, and immediate and late complications were recorded. A phone questionnaire was used to assess patient satisfaction with the outcome. RESULTS: A total of 12 patients underwent frontal sinus obliteration with this technique. Mean follow-up was 40 months. None of the patients developed recurrent frontal sinusitis. All of the patients were pleased with the outcome. CONCLUSION: Pericranial flap is a highly vascularized flap that is easily harvested and is an effective and viable modality for obliterating frontal sinus. EBM RATING: C-4.

Adult↗
PubMedDate not supplied

Endoscopic management of failed frontal sinus obliteration.

BACKGROUND: Frontal sinus obliteration (FSO) traditionally has represented the final stage in the algorithm for difficult to manage frontal sinus disease. In addition, FSO has been used in selected cases of frontal sinus trauma. However, this procedure has been associated with failure in 5-10% of cases. Advances in surgical instrumentation and image-guided surgical navigation have permitted endoscopic management of these failures. METHODS: Eleven patients presenting with failure of a previously performed FSO were managed endoscopically with the assistance of image-guided surgical navigation. RESULTS: Initial frontal sinus pathology included chronic inflammatory disease in six patients and frontal sinus trauma in two patients. Two patients underwent obliteration after neurosurgical frontal craniotomy and one patient underwent obliteration after curettage of a frontal sinus ossifying fibroma. Frontal sinuses were obliterated with fat in eight cases, bone chips in two cases, and bone cement in one case. The mean time interval to FSO failure was 11.1 years (range, 4 months-35 years). The etiology of failure included mucocele in eight patients, chronic frontal sinusitis in two patients, and Pott's puffy tumor in one patient. All 11 patients were managed endoscopically, of which 3 patients underwent a trans-septal frontal sinusotomy. Two patients required revision endoscopic surgery, but all were patent at last follow-up (mean, 14.8 months). CONCLUSION: Endoscopic management of failed FSO may be performed safely. These approaches are viable alternatives to open revision procedures in the management of failed FSO.

Adult↗
PubMed1995

Endoscopic surgery of the frontal sinus.

Endoscopic intranasal frontal sinusotomy represents a relatively new technique for approaching disease in the frontal sinus. As with all "new" techniques, it has not withstood the scrutiny of time. It does represent, however, a significant alternative to external obliterative procedures for the frontal sinus. The frontal sinus can be visualized with office nasal endoscopy, and the difficult evaluation of the obliterated cavity can be avoided. With an in-depth understanding of frontal sinus anatomy and the application of advanced endoscopic techniques, the frontal sinus surgeon may achieve satisfying results while producing minimal morbidity.

Adult↗