Frontal Sinus Surgery Anterior to the Ethmoid Bulla

Abstract

The frontal sinus surgery is difficult to perform but the ethmoid bulla is a relative, constant landmark in the middle turbinate that can improve the surgery. The purpose of this study was to evaluate the validity, security, and predominance of approaches to the frontal sinus via the route anterior to the ethmoid bulla. The data from 370 endoscopic frontal sinus surgery cases from our center were integrated and retrospectively analyzed. Three hundred twenty-nine patients underwent frontal sinus surgery via the route anterior to the ethmoid bulla. An additional 27 patients underwent frontal sinus surgery with mini-trephination, 13 patients with the Draf II procedure, and 1 patient had applied MELP (modified endoscopic Lothrop procedure). No serious complications occurred; however, there were 3 cases of eyelid ecchymosis and 1 case of anterior ethmoid artery bleeding. In all, 319 patients (86.2%) were cured, an improvement was noted in 36 of the patients (9.7%), and there was no improvement in 15 patients (4.1%). Frontal sinus surgery via the route anterior to the ethmoid bulla is valid, relatively safe, and can be applied in most cases involving frontal disease.

Safety and Efficacy of the Draf IIb Procedure: A Systematic Review

“…In fact, no recurrence was noted for mucoceles. 8,17,19,20,24,31 For CSF leak involving the posterior table, the closure was successful in all the studies. 12,13,17,19,24,26 Only 1 failure was noted in the series of Jahanshahi et al, requiring an open approach.…”

Frontal Sinusitis Management: Intact Ethmoidal Bulla Technique Vs Ethmoidal Bullectomy

“…This procedure also avoids surgical complications, as seen in the present study, since the relatively constant position of the bulla in the middle turbinate served as a guide, eliminating the difficulty in localizing the frontal sinus ostium, allowing an angle of operation that does not damage the cranial base, anterior ethmoid artery, orbit and nasal structures. 10,13,14 However, Ji et al 13 found 2 out of 329 cases developed eyelid ecchymosis with this procedure. They concluded that frontal sinus surgery via the route anterior to the ethmoid bulla is valid, relatively safe, and can be applied in most cases involving frontal sinus disease.…”

“…The rationale behind preserving the integrity of ethmoidal bulla lies in the resection of top part of uncinate process and ager nasi cells being the key to the operation, rather than ethmoidectomy, in order to open frontal drainage channel. 10,13,24 Landsberg et al 11 also concluded that chronic isolated frontal sinusitis develops secondary to frontal recess inflammatory changes and can be surgically treated by a targeted endoscopic procedure limited to the reestablishment of frontal sinus outflow. This procedure also avoids surgical complications, as seen in the present study, since the relatively constant position of the bulla in the middle turbinate served as a guide, eliminating the difficulty in localizing the frontal sinus ostium, allowing an angle of operation that does not damage the cranial base, anterior ethmoid artery, orbit and nasal structures.…”

“…11,12 These complications can be overcome by FESS anterior to the ethmoidal bulla. 13,14 Since ethmoidal bulla is a relatively constant landmark, this intact bulla technique reduces the difficulty associated with locating the ostium of the frontal sinus, eliminating the possibility of injury to the anterior skull base, anterior ethmoid artery, papyraceous lamina as well as nasal and other surrounding structures. Hence, it provides a safe, simple and minimally invasive therapeutic option for frontal sinusitis patients.…”

“…Hence, it provides a safe, simple and minimally invasive therapeutic option for frontal sinusitis patients. 10,11,13,14 The entire procedure of the intact bulla technique can be performed with a 0° endoscope. The technique helps keep dissection anterior to the vulnerable lateral lamella of the cribriform plate and the anterior ethmoidal artery.…”