A Refinement of the External Frontoethmosphenoid Operation: A New Nasofrontal Pedicle Flap

Abstract

When an external operation for the treatment of suppuration of the frontal sinus fails it is usually for one of two reasons. Either the opening into the nose becomes inadequate or disease is left in supraorbital ethmoid extensions with continuance of symptoms.

Rhino‐Frontal Sinuseptotomy (RFS): A Combined Intra–Extra Nasal Approach for the Surgical Treatment of Severely Diseased Frontal Sinuses

“…In the beginning of the development of RFS, a septal mucosal flap based on the lateral nasal wall was used, according to the proposals of NcNaught, Tato, and Ogura. 31,34,35 In our experience, mucoperiosteal flaps are not always available, particularly not in patients who underwent previous resections of middle turbinates, removal of upper septal parts, or with polypoid alteration located in the base of the mucoperiosteal flaps. Furthermore, this technique has been abandoned soon because these entire flaps did not fit well to the irregular surface of the structures that had to be covered, and the size of those flaps was not sufficiently for complete epithelialization of the nasofrontal neocommunication.…”

“…Sewall, Boyden, and McNaught each reported techniques for the resurfacing of the nasofrontal communication. 29–31 They used rotational mucoperiosteal flaps either laterally or medially based to epithelialize one side of the nasofrontal communication. The remaining three sides of the track should spontaneously be epithelialized.…”

100 Years of Frontal Sinus Surgery

“…However, reports soon began to document recurrent infections, apparently a result of closure of the nasofrontal communication 3‐5,39 . McNaught 40 noted that granulation tissue on the orbital side of the external ethmoidectomy adhered to traumatized mucosa on the medial aspect of the nasofrontal communication, causing scar tissue and stenosis. In addition, the resection of a segment of the nasofrontal duct caused new bone formation and permitted the orbital soft tissue to herniate medially.…”

“…Multiple reports describing the use of the mucoperiosteal flap for resurfacing the region of the nasofrontal duct were published 56 . Sewall 57 and McNaught, 40 for example, demonstrated that an operative nasofrontal duct remains patent if epithelialized. These flaps were either laterally or medially based within the nasal cavity and were created through Lynch, Killian, or Lothrop approaches.…”

Treatment of Nasal Polypi, With Comments on Frontal Sinus Surgery

“…The first requisite is to remove sufficient bone at the correct site. Many cover the orbital periosteum that is left exposed in the nose with pedicled flaps of nasal mucosa (e. g., McNaught, 1936;Sewall, 1935;Bárány, 1924;Sourdille, 1930;Soderberg, 1938; others) ; this method I have tried and given up on finding pus accumulating under the pedicle (e. g., also Mygind,* 1938). In a number of cases I have applied a free graft of mucosa peeled off a piece of turbinal to the exposed orbital periosteum ; no advantage appears to have accrued from this procedure.…”