Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair

Grayson, Jessica W.; Jeyarajan, Hari; Illing, Elisa A.; Cho, Do‐Yeon; Riley, Kristen; Woodworth, Bradford A.

doi:10.1002/alr.21897

Cited by 54 publications

(69 citation statements)

References 53 publications

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“…Management of frontal sinus fractures with CSF leak and significant posterior table displacement has historically been managed with cranialization of the sinus . Surgical techniques have recently evolved to incorporate endoscopic approaches into the treatment algorithm …”

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

“…The endoscopic approach to frontal sinus CSF leaks is supported by several case series with high success rates and low morbidity. In a prospective case series regarding transnasal endoscopic management of 46 frontal sinus traumatic fractures, 40 patients with active CSF leaks from comminuted posterior table fractures as large as 5 cm (average 17 mm × 9 mm) were successfully sealed using the endoscopic approach. Repairs were tailored to the type of skull‐base defect.…”

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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151

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Primary Csf Rhinorrheamentioning

confidence: 99%

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

Self Cite

151

279

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“…Recently, the Woodworth group published a call to change the current dogma on the repair of traumatic frontal sinus injury. 26 They report a new prospective case series of 46 patients who underwent endoscopic frontal sinus repair after trauma with notable success. The majority were posterior table injuries and repairs were done with porcine submucosal graft, nasoseptal flap, cadaveric pericardium, or a combination.…”

Section: Discussionmentioning

confidence: 99%

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Miller

Weisbrod

Beahm

et al. 2019

J Neurol Surg B Skull Base

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Background Cranialization or obliteration is widely accepted intervention for traumatic or intentional breach of the frontal sinus. These techniques, however, result in the loss of frontal sinus function and have a persistent risk of cerebrospinal fluid (CSF) leak and mucocele. Compartmentalization is an open technique for repair of the frontal sinus using allograft onlay and a vascularized periosteal flap that allows for preservation of frontal sinus function. Objective The main objective of this article is to describe the technique for compartmentalization of the frontal sinus and demonstrate its efficacy and complication rate with an early patient series. Methods Our technique includes the following key components: harvesting of a pedicled periosteal flap, frontal sinus repair through a bifrontal craniotomy with minimal mucosa removal, ensuring the patency of the nasal frontal outflow tract, and separation of the brain from the frontal sinus with a dual layer of periosteum and allograft.All cases of frontal sinus repair using the compartmentalization technique at our institution were reviewed. Charts were reviewed for CSF leak, mucocele, and other complications. Results Twenty-three patients underwent the described frontal sinus repair technique 17 for tumor and 6 for trauma. There were no CSF leaks and no mucoceles. One patient experienced postoperative anemia and a “parameningeal reaction” that were managed with a short course of antibiotics. Conclusions Compartmentalization, due to its sinus preservation and low complication rate, represents a meaningful step forward in neurosurgical technique for open frontal sinus repair. However, long-term outcomes are necessary to fully evaluate risk of mucocele.

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“…In repairing these defects, in addition to a wide frontal sinusotomy, supportive packing and temporary stenting is recommended. 26 FSOT involving injuries are managed across multiple surgical specialties with backgrounds in oral and maxillofacial surgery, otolaryngology, and plastic surgery, each with unique training backgrounds. In a 2016 cross-sectional survey across these specialties, plastic and oral and maxillofacial surgeons were more likely to perform obliteration of anterior fractures requiring repair with a concomitant injury to the FSOT.…”

Section: Frontal Sinus Outflow Tract Injuriesmentioning

confidence: 99%

Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches

Arnold

Tatum

2019

Craniomaxillofacial Trauma & Reconstruction

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Frontal sinus fractures are an uncommon injury of the maxillofacial skeleton, and account for 5–15% of all maxillofacial fractures. As the force of impact increases, fractures may extend beyond the anterior table to involve adjacent skull, posterior table and frontal sinus outflow tract (FSOT). Fractures at these subsites should be evaluated independently to assess the need for and type of operative intervention. Historically, these fractures were managed aggressively with open techniques resulting in obliteration or cranialization. With significant injuries, these approaches are still indispensable. However, the treatment of frontal sinus fractures has changed dramatically over the past half-century, and recent case series have demonstrated favorable outcomes with conservative management. Concurrently, there has been an increasing role of minimally invasive endoscopic techniques, both for primary and expectant management, with a focus on sinus preservation. Here, we review the diagnosis and management of frontal sinus fractures, with an emphasis on subsite evaluation. Following a detailed assessment, an appropriate treatment strategy is selected from a variety of open and minimally invasive approaches available in the surgeon's armamentarium.

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Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair

Abstract: Frontal sinus trauma has traditionally been treated using open approaches. Our findings show that endoscopic management should become part of the management algorithm for frontal sinus trauma, which challenges current surgical dogma regarding mandatory open approaches.

Cited by 54 publications

References 53 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches

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