Isolated primary frontal sinus aspergillosis: role of endonasal endoscopic approach

Abstract

Minimally invasive endonasal endoscopic sinus surgery was found to be an effective and a safe approach for managing primary frontal sinus aspergilloma, even in cases with larger bony defects involving the posterior table of the frontal sinus.

Frontal Sinusitis with Mixed Bacterial Colonies Treated with the Combination of Endoscopic Modified Lothrop Procedure and External Approach

“…Since the definitive diagnosis is based on pathological examination with specific staining, which could not be performed intraoperatively, we adopted the surgical technique used for frontal sinus fungus ball. Frontal sinus fungus ball has previously been treated with conventional external incision, including external fronto-ethmoidectomy, osteoplastic flap, and trephination of the frontal sinus [5]. The endoscopic approach has only recently been advocated to treat frontal sinus fungus ball [5, 6, 10].…”

“…Frontal sinus fungus ball has previously been treated with conventional external incision, including external fronto-ethmoidectomy, osteoplastic flap, and trephination of the frontal sinus [5]. The endoscopic approach has only recently been advocated to treat frontal sinus fungus ball [5, 6, 10]. Sixteen cases of primary frontal sinus aspergillosis, including fungus ball (4 cases) and allergic fungal rhinosinusitis (12 cases), were treated first by endoscopic sinus surgery, and the recurrent 3 cases were treated by the EMLP [5].…”

“…The endoscopic approach has only recently been advocated to treat frontal sinus fungus ball [5, 6, 10]. Sixteen cases of primary frontal sinus aspergillosis, including fungus ball (4 cases) and allergic fungal rhinosinusitis (12 cases), were treated first by endoscopic sinus surgery, and the recurrent 3 cases were treated by the EMLP [5]. Two other cases were treated with Draf type II frontal sinusotomy or with the external approach via coronal incision because neoplasm was suspected based on a large defect in the posterior wall of the frontal sinus [6].…”

“…The standard treatment of fungus ball is complete removal of the fungus and wide opening of the ostium of the diseased sinus. Fungus ball of the frontal sinus is extremely rare, with fewer than 40 cases reported in the English literature [5, 6]. The surgical procedure is more difficult than those used in the maxillary and sphenoid sinuses because the possible maximum opening in the case of frontal sinus is relatively small [7].…”

“…The surgical procedure is more difficult than those used in the maxillary and sphenoid sinuses because the possible maximum opening in the case of frontal sinus is relatively small [7]. Previously, almost all cases were treated with an external approach [5]. Recently, with the development of new instruments and innovations in endoscopic techniques, the Draf type III/endoscopic modified Lothrop procedure (EMLP) has been widely used to treat intractable frontal sinus disease [8].…”