No abstract

The ultimate success orfailure offro ntal sinus surg ical procedures, wliether they be endonasal al' external, is detennined essentially by the rat e of res tenosis of the froutal sinus outflo w tra ct OI' neo-osti utn postop erat ively. Long-terin sten ting f or a period ofseveral months significantly reduces the rate of resteno sis, particularly in difficult cases. We retrospecti vely re viewed the cases of 12 pa tients who recei ved 21 fro ntal na sa l ste nt s, which were left in pla ce f or 6 months. Based on outcoines nieasures that included endos copy O I' rad iologicfindings and pati ents ' self-evaluations, we cone lude that fro ntal nasal stents that a re left in pla ce fo r 6 months are mar e ejfective than stents that are renioved earlier. We recommend that th is type of managem ent be co nsi de red in difficult rev isio n cases and befo re performing an ext ernal operation.

Septal perforation is an avoidable complication of septal surgery, but it can also occur because of a variety of traumatic, iatrogenic, caustic, or inflammatory reasons. Symptoms usually are related to disruption of the normally laminar flow of air through the nasal passages. Crusting, bleeding, parosmia, and neuralgia can develop, leading the patient to seek medical care. When local hygiene and conservative care are unsuccessful in relieving symptoms, closure of the perforation is considered. Repair is often difficult because of the limited exposure and limited amounts of friable mucosa with impaired vascular supply. The failure of attempted closure of septal perforations can be as high as 80 percent. The authors have developed a graduated approach to the closure of septal perforations that tailors the surgical approach to the size and location of the defect. Perforations 0.5 to 2.0 cm in size were closed in 92.9 percent (13 of 14) of patients using an extended external rhinoplasty approach and bilateral posteriorly based mucosal flaps. Larger perforations (2.0 to 4.5 cm) were closed in 81.8 percent (18 of 22) of patients by a two-staged technique, using a midfacial degloving approach to medially advance posteriorly based, expanded mucosal flaps. With careful preoperative management and selection of the appropriate surgical technique, even moderate-to-large perforations can be repaired reliably with limited operative morbidity.