Analyzing the results, the trephination may be performed at variable points of the frontal sinus, but the distance of 1 cm from midline appears to be safer and shows better aesthetic results.
The complex anatomy of the frontoethmoidal recess, as well as its anatomical relationship with the vital adjacent structures in the region explain the reason for considerable surgical care to protect these structures and minimize complications related to healing. Trephination is an accepted procedure to access the frontal sinus. Aim: Discuss the best location for performing frontal sinus trephination. Methods: Measuring sinus frontal depth at 3 points equidistant to the midline (crista galli) through the axial tomographic sections. Results: We measured 138 frontal sinus (69 patients). Frontal sinus depth at 0,5 cm was statistically larger than 1 cm and 1,5 cm, as well as the 1 cm trephine point was significantly larger than 1,5 cm (12,22±4,25 vs 11,78±4,65 p<0,05; 12,22±4,25 vs 10,78±5,98 p<0,001; 11,78±4,65 vs 10,78±5,98 p<0,05). The trephine set used (maximum depth of penetration of 0,7 cm) is safe to be applied in approximately 80% of the patients. Conclusion: Analizing the results, the trephination may be performed at variable points of the frontalsinus, but the distance of 1 cm from midline appears to be safer and shows better aestethic results.
To lay down a plan for treating traumatic and delayed spontaneous CSF rhinorrhoea and thereby establishing that transnasal endoscopic repair is a minimally invasive and efficient approach. METHODS: This is a retrospective study conducted at a 1,800 bed tertiary university hospital where approximately 200 patients visit the ENT outpatient department daily. RESULTS: Between 1999 and 2005, 76 patients (34 traumatic immediate onset, 28 spontaneous delayed onset) with CSF rhinorrhoea were treated. Fourteen patients had undergone neurosurgical intervention for an anterior skull base lesion. A remote history of head and nose trauma was illustrated in 57.1% of patients with late onset leaks; 14.2% of patients had varying episodes of meningitis before diagnosis of CSF rhinorrhoea. Investigations included CT, MRI, and immunofixation of beta 2 transferrin. Transnasal endoscopic repair using fat as a plugging material, fascia lata as an overlay graft, and finally fibrin glue was used in all cases. 92.8% of patients had no further episodes of CSF leak. Two patients underwent revision external surgery for closure. There were no major complications, though olfaction was lost in all patients except those with sphenoid leaks. CONCLUSIONS: The results of transnasal endoscopic repair now make it the treatment of choice for most anterior cranial and sphenoid CSF leaks, with the exception of some defects in the frontal sinus. We lay down an algorithm for managing CSF rhinorrhoea in which endoscopic repair should be the initial surgical treatment in the majority of cases. A neurosurgical approach should be reserved for revision cases.
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