The diagnosis of suppurative intracranial complications of sinusitis requires a high index of suspicion and confirmation by imaging. Central to the success of treatment is the management of the primary source of sepsis within the paranasal sinuses in combination with neurosurgical drainage and intravenous antibiotics. This approach has resulted in a mortality rate of 7% and morbidity of 13%, which compare favorably with previous series.

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.

The transnasal endoscopic route offers excellent visualization of the posterior choana and, hence, the ability to open the defect widely with a high surgical success rate. Newer powered instrumentation further enhances the ability to perform this technique cleanly.

Although the management of cranionasal fistulae has historically plagued otolaryngologists, recent reports of endoscopic techniques for repair of these lesions offer promising results. We present our series of 42 patients whose cranionasal fistulae were managed endoscopically between December 1989 and August 1995. Follow-up ranged from 5 to 68 months, thereby including long-term results from our previously reported series of 29 cases. Resolution of cerebrospinal fluid rhinorrhea was achieved in 35 (83.3%) of 42 patients with one endoscopic procedure, and 3 patients had successful closure at a second surgery. All five cephaloceles were successfully treated with one procedure. We have refined our technique to include specific indications for the use of free grafts depending on the location and size of the cranionasal fistula.

The intranasal endoscopic approach is an effective and safe technique in the surgical management of anterior skull base CSF rhinorrhea. Long-term success rate in our patient population was 92%.

This paper addresses the issue of forecasting individual items within a product line; where each line includes several independent but closely related products. The purpose of the research was to reduce the overall forecasting burden by developing and assessing schemes of disaggregating forecasts of a total product line to the related individual items. Measures were developed to determine appropriate disaggregated methodologies and to compare the forecast accuracy of individual product forecasts versus disaggregated totals. Several of the procedures used were based upon extensions of the combination of forecast research and applied to disaggregations of total forecasts of product lines. The objective was to identify situations when it was advantageous to produce disaggregated forecasts, and if advantageous, which method of disaggregation to utilize. This involved identification of the general conceptual characteristics within a set of product line data that might cause a disaggregation method to produce relatively accurate forecasts. These conceptual characteristics provided guidelines for forecasters on how to select a disaggregation method and under what conditions a particular method is applicable. Perhaps the greatest forecasting effort stems from the generation of these disaggregate forecasts due to the very large number of forecasts potentially involved. To illustrate, a firm 0277-6693/90/030233-22$11 .OO

Functional endonasal sinus surgery (FESS) is an effective treatment for chronic or recurrent sinusitis in children, most of whom have failed more conservative medical treatment. The endoscopes used in FESS allow direct visualization of the diseased tissue and restoration of physiologic mucociliary clearance, enabling the sinus mucosa to return to its normal condition after the procedure. For a period of 3 to 36 months, we followed the recovery of 210 children who underwent FESS between 1986 and 1989. The age range of the children at the time of the procedure was 14 months to 16 years. Eighty percent of these patients had improvement of their sinusitis. There were no major complications. Eight percent of the 210 children needed revision surgery. Pediatric FESS is a two-stage operation requiring follow-up nasal cleaning under general anesthesia. The most common findings during the second-stage endoscopy were adhesions and granulation formation.

Aggressive endoscopic resection of IP by experienced rhinologists is an acceptable treatment.