Failed Endoscopic Sinus Surgery: Spectrum of CT Findings in the Frontal Recess

Abstract

Since its introduction over 2 decades ago, functional endoscopic sinus surgery (FESS) has revolutionized the surgical management of chronic sinusitis. Performed over 200,000 times annually in the United States to treat medically refractory sinusitis, FESS has success rates as high as 98%. When surgical failure occurs, it is typically due to postoperative scarring or unaddressed outflow tract obstruction in the region of the frontal recess. The most common causes of surgical failure in the frontal recess include remnant frontal recess cells, a retained uncinate process, middle turbinate lateralization, osteoneogenesis, scarring or inflammatory mucosal thickening, and recurrent polyposis. Computed tomography (CT) of the paranasal sinuses has become indispensable in evaluation of patients with FESS failure, particularly in the frontal recess, a location that can be difficult to visualize at endoscopy. Familiarity with the complex anatomy of the frontal recess and knowledge of the most common causes of surgical failure are essential for proper interpretation of sinus CT images obtained in patients being considered for revision FESS of the frontal sinus.

Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques

“…7,48 This procedure en hances endoscopic access to olfactory meningiomas since the anterior limit of transnasal dissection for olfactory tumors is the posterior wall of the frontal sinus. 15 The primary advantages of a modified Lothrop procedure are enhanced visualization, easier repair of the skull base defect, and reduced potential for mucocele formation. An EEEA for anterior skull base meningiomas with transsphenoidal, transplanum, and transcribriform modifications offer a keyhole basal craniectomy for successful resection of these tumors, with a posterior nasoseptal flap to prevent CSF leakage.…”

ANATOMIC VARIATIONS OF PARANASAL SINUS ON MULTIDETECTOR COMPUTED TOMOGRAPHY EXAMINATIONS for FUNCTIONAL ENDOSCOPIC SINUS SURGERY

“…Variations such as hypertrophy, deviation and pneumatization may affect the drainage, generating abnormalities in the ostiomeatal complex and predisposing to obstruction (11,12). Pneumatization of the uncinate process (uncinate bulla) is a rare entity and this anatomic variation may result in anatomic narrowing of the infundibulum and can impair sinus ventilation (13,18).…”

Variações anatômicas das cavidades paranasais à tomografia computadorizada multislice: o que procurar?

“…Other ethmoid cell variations may be found in the frontal recess (Figure 12 fluencing its architecture that is determined by the patency of walls and boundaries of adjacent structures (9) , such as frontal cells which are classified into four types (14) , as follows: a) type 1: detected in 37% of frontal recesses; defined as a single ethmoid cell located anteriorly to the frontal recess and above the agger nasi cell; b) type 2: detected in 19% of cases; two or more ethmoid cells located anteriorly to the frontal recess, above the agger nasi cell ( Figures 12A and 12B); c) type 3: represents 6-8% of cases; a single, voluminous cell detected above the agger nasi cell, with extension to the frontal sinus; d) type 4: rarely found, it represents 2-4% of cases, corresponding to an ethmoid cell within the frontal sinus, with no connection with the agger nasi cell. …”