Looking around the corner: A review of the past 100 years of frontal sinusitis treatment

Abstract

Over the past 100 years, developments in imaging studies, endoscopic evaluation, medical treatment, and surgical techniques, particularly those employing endoscopic approaches, have led to improvements in our ability to treat frontal sinusitis. Providing "around the corner" views of the frontal recess, 30 degrees and 45 degrees endoscopes have allowed the meticulous preservation of the mucoperiosteum and restoration of normal sinus physiology, even in difficult areas of the frontal sinus outflow tract. Rarely is it necessary to perform radical or obliterative frontal sinus procedures, although the osteoplastic flap obliteration approach advocated by Montgomery continues to be the gold standard for treatment of frontal sinusitis, which has failed medical treatment and endoscopic approaches, at least in the minds of many prominent surgeons. The endoscopic modification of Lothrop's approach has gained favor in the experience of many, however, despite its technical difficulty and failure rate of up to 20%. Technical advances, such as computer-assisted endoscopic surgery and, more recently, intraoperative imaging have shown promise and may lead to further improvement in treatment outcomes. Finally, we will all benefit from further advances in outcomes assessment, which will provide better scientific proof of our clinical observations.

The place of the osteoplastic flap in the endoscopic era: Indications and pitfalls

“…This has grown to encompass treatment of chronic sinusitis, sinonasal tumors, and skull base pathology, and the applications of this technique continue to expand . Despite the increasing utility of endoscopic surgery, there is still a place for open procedures in the treatment of paranasal sinus pathology, though the scope of indications for these procedures is continuing to narrow . The osteoplastic flap (OPF) is one such procedure due to its continued use brought on by limitations of the minimally invasive approach.…”

“…1 Despite the increasing utility of endoscopic surgery, there is still a place for open procedures in the treatment of paranasal sinus pathology, though the scope of indications for these procedures is continuing to narrow. 2 The osteoplastic flap (OPF) is one such procedure due to its continued use brought on by limitations of the minimally invasive approach. There have only been a handful of studies looking at the OPF over the past 10 years, and only two that include more than 20 total patients.…”

The value of frontal sinusotomy for chronic rhinosinusitis with nasal polyps—A cost utility analysis

“…The increased surgical complexity associated with frontal sinusotomy must also be considered, as well the potential for intraoperative and postoperative complications . Despite these considerations, the development of improved endoscopic instrumentation and techniques have resulted in a rapid rise in the rate of endoscopic frontal sinus interventions performed over the past decade . However, clinical outcomes data regarding the addition of frontal intervention during routine endoscopic sinus surgery (ESS) remain limited, with most studies utilizing subjective, nonvalidated outcomes measures …”

Computed Tomographic Analysis of Frontal Sinus Drainage Pathway Variations and Frontal Rhinosinusitis

“…[1][2][3] Although incidence of frontal rhinosinusitis complications decreased because of increase in antibiotic use, 4 there is still significant degree of morbidity and mortality associated with these complications. 1 Therefore, evaluation of risk factors for frontal rhinosinusitis and complications, correct and timely diagnosis, and intervention are vital to avoid and treat chronic frontal rhinosinusitis and its complications.…”

“…2 The uncinate process (UP) is the most important structure along with agger nasi cell in frontal recess anatomy and surgery. 5 The superior attachment of the UP (SAUP) is a landmark for the location of the frontal sinus drainage pathway, and its variations affect the dimensions of the frontal sinus ostium and the size of the frontal beak.…”