Endoscopic Endonasal Orbital Transposition to Expand the Frontal Sinus Approaches

Abstract

The endoscopic endonasal orbital transposition seems to facilitate the endoscopic management of selected far-lateral frontal sinus lesions. However, it is a demanding procedure that requires experience and skill to avoid intraoperative skull base and orbital complications.

Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta‐analysis

“…The EMLP has become more commonplace due in part to advancements in frontal sinus instrumentation and surgical navigation. Recent reports of favorable outcomes in larger cohorts with longer follow‐up times have also helped to increase acceptance …”

“…Recent reports of favorable outcomes in larger cohorts with longer follow-up times have also helped to increase acceptance. 13,14,[19][20][21][22][23][24][25][26] Modifications of technique have also helped to make the technique more accessible, including transseptal, axillary flap, and outside-in approaches; the use of mucosal grafts; and minitrephination. [27][28][29][30] An example of technique modification has been an evolution toward maximizing the AP diameter by lowering the frontal T toward the olfactory neurons.…”

Role of endoscopic surgery in the management of sinonasal and skull base schwannomas

“…The management of frontal sinus disease still remains a challenging issue for rhinologists. Although endoscopic frontal sinus surgery has significantly evolved over the last few years, there are still tumors involving the frontal sinus, in which the external osteoplastic approach has to be combined . In our series, 3 cases of schwannomas involving the frontal sinus were observed and all of them were treated with a combined endoscopic‐osteoplastic flap approach.…”

“…Although endoscopic frontal sinus surgery has significantly evolved over the last few years, there are still tumors involving the frontal sinus, in which the external osteoplastic approach has to be combined. 39 In our series, 3 cases of schwannomas involving the frontal sinus were observed and all of them were treated with a combined endoscopic-osteoplastic flap approach. In these cases, although the Draf type IIb/III procedures were associated, it was not possible to remove the tumor exclusively transnasally because of massive involvement of the frontal sinus with or without erosion of the anterior or posterior table and/or lateral extension.…”

Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma

“…These approaches are extensive and often require large bone windows . The Draf procedure and orbital lateralization techniques have been used to expand and extend the access of the standard endoscopic approach . The transpalpebral orbitofrontal minicraniotomy is a versatile approach that provides a direct corridor to the entire frontal sinus and anterior cranial base and can be performed with minimal morbidity .…”