[History of frontal sinus surgery and current view of the problem. Part 2]. / Istoriya khirurgii lobnoi pazukhi i sovremennyi vzglyad na problemu. Chast' 2.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

Assessment of the necessity of frontal sinostomy in cases of frontal sinusitis associated with fungus ball of the maxillary sinus.

PURPOSE: This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone. METHODS: This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. RESULTS: In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up. CONCLUSION: These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

Pott Puffy Tumor Caused by Dental Infection: A Case Report and Literature Review.

ABSTRACT: Pott puffy tumor (PPT), first described by Sir Percivall Pott in 1760, is a rare clinical entity characterized by a subperiosteal abscess associated with osteomyelitis of the frontal bone caused by direct or hematogenous spread. Although rare in this modern age of antibiotics, this tumor usually occurs as a complication of sinusitis. Moreover, intracranial complications such as subdural abscess, meningitis, sinus thrombosis, or brain abscess can occur concomitantly with the underlying sinusitis, despite the administration of antibiotics. Herein, we present the case of a 48-year-old man who was diagnosed with PPT using computed tomography and treated medically and surgically. The infection remained uncontrollable after surgery and drain removal, owing to the persistence of the original dental focus of the infection. This case highlights the importance of treating the source of the infection in addition to the local area of inflammation, to facilitate complete infection control in PPT.

[The efficacy of the extended endoscopic frontal sinus drill-out in cases of repeatedly operated polypous-purulent pansinusitis accompanied by a whistle in the front wall of the frontal sinus]. / Effektivnost' rasshirennoi endonazal'noi endoskopicheskoi frontotomii pri mnogokratno operirovannom khronicheskom polipozno-gnoinom pansinusite, oslozhnennom formirovaniem svishcha perednei stenki lobnoi pazukhi.

Treatment of patients with severe chronic and recurrent forms of frontal sinusitis, often caused by scarring as a result of repeated interventions in the frontal sinuses, is a difficult task. In such cases, for adequate drainage of the frontal sinus and ensuring stable patency of the nasolabial anastomosis, an endoscopic extended frontotomy can be the choice operation, the possibility of which certainly depends on the experience of the surgeon, anatomical features of the structure of the frontal sinus and the nature of the pathological process. The article shows the effectiveness of surgical treatment of chronic purulent frontal sinusitis that developed after 5 interventions on the paranasal sinuses with external and combined access, accompanied by the development of a fistulous passage of the anterior wall of the frontal sinus. For wide drainage of the frontal sinus and stable preservation of patency of the nasolabial fistula, the patient underwent extended endoscopic frontotomy (Draf III operation according to the international classification).

Comparison between the endoscopic scores of bolgerization versus partial resection of the middle turbinate for management of the postoperative lateralization in the early follow-up period after endoscopic frontal sinusotomy: A randomized controlled study.

BACKGROUND: Frontal sinusotomy is a challenging procedure that needs meticulous handling due to its unique anatomical position. Postoperative middle turbinate lateralization is critical comorbidity for the success rate, and many techniques are adopted to prevent it. The study aimed to compare the effect of middle turbinate bolgerization and partial resection on the postoperative endoscopic scores and assess their impact on the middle meatus and the frontal recess outcome. PATIENT AND METHODS: This prospective study was conducted on forty-one patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis. Nasal cavities were randomized so that partial middle turbinate resection technique was done alternately with bolgerization approach in every patient. Each participant acted as their control. Both sides were compared using Lund Kennedy Endoscopic Score (LKES) and Perioperative Sinus Endoscopy Score (POSE) at the baseline, 1st, 3rd, and 12th-month intervals postoperatively. Also, middle turbinate status was assessed at the end of the 12th-month interval using POSE score. RESULTS: The total frontal sinus patency rate was 82.9% (63/76 operated sinus). Baseline scores, LKES (3.79 ± 0.777 vs 4.05 ± 0.769, p = 0.142, for the side of resection and the side for bolgerization respectively) and POSE (1.79 ± 0.413 vs 1.82 ± 0.393, p = 0.777, for the side of resection and the side for bolgerization respectively). Regarding LKES, the differences between both operated sides were fluctuating with p values: 0.001*, 0.171, and 0.044* for the 1st, 3rd, and 12th months follow-up intervals, respectively. Regarding the POSE score of the frontal sinus, the difference between both groups was steadily increasing with p values: 0.318, 0.119, and 0.017* for the 1st, 3rd, and 12th months follow-up intervals. The middle turbinate's POSE score at the 12th month was significantly higher in the side allocated for bolgerization (p-value = 0.008*). CONCLUSION: Partial middle turbinate resection showed favorable endoscopic outcomes than bolgerization at the 12th month follow up period in patients undergoing primary ESS for chronic frontal sinusitis.

Dual Purpose of De-Epithelialized Latissimus Dorsi Musculocutaneous Flap for Treatment of Chronic Frontal Sinusitis and Frontal Bone Defect.

ABSTRACT: Treating frontal sinusitis refractory to endoscopic sinus surgery and complicating frontal bone defect remains a challenge. One surgical option determined is free flap transfer, which has the versatility to accommodate adequate sinus obliteration and reconstruct skin and bone defects. After successful free flap transfer, forehead recessus deformity can emerge as an esthetic problem for patients waiting for cranioplasty. Hence, the authors examine three cases in which they performed free latissimus dorsi musculocutaneous (LDM) flaps for chronic frontal sinusitis with frontal bone defect. All LDM flaps survived without complications, and all patients achieved passable forehead contours without cranioplasty and with no occurrence of infection. In our procedure, the muscle portion of the LDM flap was used to obliterate the frontal sinus, which is similar to conventional free LDM flap. Conversely, our procedure also uses the de-epithelialized skin paddle of the LDM flap filled with the frontal bone defect, which is distinct from conventional free LDM flap. Thus, preventing postoperative forehead recessus deformity has been the identified as primary advantage of our procedure. The use of the free de-epithelialized LDM flap transfer fulfills two goals: controlling chronic frontal sinusitis and restoring a passable forehead contour.

The prognostic variables affecting the frontal sinusotomy patency outcome and how to manage: A prospective study.

OBJECTIVES: The study aimed to assess the factors affecting the frontal sinus patency after endoscopic frontal sinusotomy. DESIGN: A prospective cohort study. SETTING: Tertiary centre hospital. MAIN OUTCOME MEASURES: Fifty patients with refractory chronic frontal sinusitis (83 operated frontal sinuses) had frontal sinusotomy and followed up for six months. Multiple operative factors were included the type of the procedure, intraoperative sinus findings, degree of mucosal preservation and middle turbinate stability. Other factors were also assessed, including smoking, the presence of allergic rhinitis, asthma, gastroesophageal reflux and other associated medical comorbidities. RESULTS: The sinus patency success rate was 75.9%. There was a significant difference regarding the intraoperative anteroposterior sinus ostium diameter (5.36 ± 1.45 mm vs 8.88 ± 2.38 mm, P-value: .001* in the failed group and the success group, respectively). There was a significant association between the patency outcome and the presence of associated medical comorbidities (P-value: .001*), the presence of allergic rhinitis (P-value: .001*), the degree of sinus mucosal preservation (P-value: .012*) and the degree of middle turbinate stability (P-value: .001*). The multivariate analysis showed that the intraoperative anteroposterior diameter of the sinus ostium, middle turbinate stability and presence of allergic rhinitis were significant predictors (P-value: .012*, .042* and .013*, respectively). CONCLUSION: Sinuses with anteroposterior ostium diameters less than 5.36 mm are more susceptible to restenosis. The flail middle turbinate increases the risk of postoperative middle meatus synechia and frontal sinus patency failure. The presence of allergic rhinitis has a negative impact on the patency outcome.

The impact of bolgerization versus partial resection of the middle turbinate on frontal sinusotomy patency outcome: A randomised controlled study.

OBJECTIVES: This study aimed to compare the effects of middle turbinate resection vs bolgerization on the incidence of middle meatus synechia and their prognostic value on the patency outcomes after frontal sinusotomy. DESIGN: A randomised controlled study. SETTING: Tertiary centre hospital. MAIN OUTCOME MEASURES: Thirty-eight patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis were included. Partial middle turbinate resection was alternated with bolgerization in both nasal cavities of every patient. The Lund-Kennedy endoscopic scores (LKESs) for both sides were compared at the first, third and sixth months postoperatively. Middle meatus synechia was assessed using the visual analogue score (VAS). Sinus patency was assessed at the end of the sixth month using a 70° nasal endoscope. RESULTS: The sinus patency outcome was significantly higher in the resected group (34\38) than the bolgerized group (26\38), (P = .047*). The VAS scores suggested that the middle turbinate bolgerization group showed a significantly higher incidence of middle meatal synechia than the partial middle turbinate resection group (4.47 ± 2.617 vs 3.29 ± 2.301; P = .040*). CONCLUSION: Middle turbinate resection showed more favourable results than bolgerization concerning the sinus patency outcome after frontal sinusotomy. It also showed a lower incidence of middle meatus synechia postoperatively.

The preoperative radiological findings associated with failure of frontal sinusotomy: A prospective study.

OBJECTIVES: The study aimed to assess the association between the preoperative CT findings and the patency outcome of the frontal sinus after endoscopic frontal sinusotomy in the early follow-up period. DESIGN: A prospective cohort study. SETTING: Tertiary hospital centre. MAIN OUTCOME MEASURES: The study measures the association between the frontal sinusotomy outcome and the standard preoperative radiological scores, including Harvard, Kennedy and Lund-Mackay. It also measures the impact of the degree of sinus mucosal thickness on the outcome. Furthermore, it measures the effect of the anteroposterior lengths of both the frontal sinus ostium and the frontal recess on postoperative frontal sinus patency. RESULTS: Harvard, Kennedy and modified Lund-Mackay scores showed no evidence of association with the frontal sinusotomy patency outcome (P-values .397, .487 and .501), respectively. Still, the Lund-Mackay score showed a negative correlation with symptom improvement. Sinuses with a high-grade mucosal thickness on CT scan were associated with high failure rates (P-value: .009*). The anteroposterior length of the frontal sinus ostium significantly affects the outcome (P-value: .001*). In contrast, there was no association between the anteroposterior length of the frontal recess and the outcome (P-value: .965). CONCLUSION: The Harvard, Kennedy and Lund-Mackay scores could not predict the frontal sinusotomy patency outcome. Failed cases were associated with advanced degrees of mucosal pathology in the preoperative CT scan. Sinuses ostia with anteroposterior diameters less than 5.36 mm showed more susceptibility for sinus restenosis postoperatively. The variability of the anteroposterior length of the frontal recess did not affect the surgical outcome.

Pott's puffy tumour of the frontal and Parietal bones with subgaleal abscess as a complication of acute sinusitis - a case report.

Acute sinusitis is a frequent medical condition that can affect any age group and may lead infrequently to very serious life-threatening complications. These complications include the spread of infection to frontal and other cranial bones, meninges, and other intracranial structures that require urgent medical actions to prevent mortality and morbidity. We report the case of acute frontal sinusitis in a 14 years old male who presented with fever, severe headache, and fluctuant swelling of the nasal root, and right supraorbital and frontoparietal regions. Imaging studies demonstrated signs of left-sided sinusitis, osteomyelitis of the frontal bones, and right parietal bone. Urgent surgery was performed with drainage of the abscesses and samples were sent for culture and sensitivity. Bilateral antral washout and trephination of the left frontal sinus was performed and pus was evacuated. Growth of Staphylococcus aureus and Peptostreptococcus micros was reported and according to the sensitivity report, the patient was kept on intravenous meropenem, 1500 mg per day and vancomycin 1500 mg per day was added on the 7th postoperative day. The patient was discharged from the hospital in good health on the 25th postoperative day and kept on oral vancomycin for one month.

Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery.

PURPOSE: Endoscopic sinus surgery (ESS) is a well-established treatment for chronic rhinosinusitis (CRS). However, ESS for frontal sinusitis remains complicated and challenging. The aim of this study was to identify the relationship between residual frontal recess cells and primary ESS failure in the frontal sinus. METHODS: We prospectively collected information on 214 sides of 129 patients with CRS who underwent standard ESS from June 2010 to May 2011. To identify risk factors, we retrospectively analyzed clinical data and computed tomography (CT) images before and 3 months after surgery. RESULTS: The posterior side of the frontal recess cells remained relatively common: suprabullar cells (SBCs) were found in 12.2% (16 sides), suprabullar frontal cells (SBFCs) in 20.3% (12 sides), and supraorbital ethmoid cells in 23.7% (14 sides). In contrast, the anterior side of the frontal recess cells, agger nasi cells, supra agger cells, and supra agger frontal cells remained at < 10.0%. Frontal septal cells persisted in 25.0% (5 sides). The presence of residual frontal recess cells was an independent risk factor for postoperative frontal sinus opacification as were well-recognized risk factors such as nasal polyps, the peripheral eosinophil count, and the CT score. Among residual frontal recess cells, SBCs and SBFCs were independent risk factors for opacification. CONCLUSIONS: Residual frontal recess cells, especially SBCs and SBFCs, were independent risk factors for postoperative opacification of the frontal sinus. Complete surgical excision of frontal recess cells may improve surgical outcomes.

Odontogenic sinusitis involving the frontal sinus: is middle meatal antrostomy enough?

OBJECTIVE/HYPOTHESIS: Inflammatory conditions of the posterior maxillary teeth may cause odontogenic sinusitis (OS), which most commonly involves the maxillary sinus due to its proximity to those teeth. The infective process frequently spreads outside the maxillary sinus, involving the anterior ethmoid and the frontal sinuses. The underlying odontogenic condition must be addressed before or during the surgical procedure. The role of frontal sinusotomy in this setting has not been studied. The aim of this study is to present the surgical outcome of patients who presented with OS involving the frontal sinus and were managed by middle meatal antrostomy alone. STUDY DESIGN: Prospective cohort study. METHODS: All patients operated in our department due to OS involving the frontal sinus from November 2015 to December 2017 were recruited. Their demographics, complaints, imaging and endoscopic findings, surgical features and outcome were analyzed. RESULTS: Twenty-five patients (male-to-female ratio 9:16) with a median age of 49 years (IQR = 43-53) were enrolled. The maxillary, frontal and anterior ethmoid sinuses were involved in each case, and each patient underwent maxillary middle meatal antrostomy alone. The median follow-up was 10 months, and no signs of active frontal disease were detected by postoperative endoscopy in any patient. CONCLUSION: Frontal sinusotomy is apparently not necessary to resolve OS involving the frontal sinus. The frontal sinusitis may reflect a reactive process that regresses spontaneously once the underlying odontogenic condition is addressed and a middle meatal antrostomy had been performed. LEVEL OF EVIDENCE: 2B.

Surgical and pathogenetic considerations of frontal sinus fungus ball.

Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and non-atopic subjects. Involvement of the frontal sinus is extremely rare. We report two cases with frontal sinus fungus ball that underwent endoscopic endonasal frontal Draf type IIb or III sinusotomy with complete removal of the cheesy clay-like material. There were no intra-operative or postoperative complications, and no recurrence of disease was evident during the follow-up of 51 and 26 months, respectively. The Draf type IIb or type III frontal sinusotomy seems to be highly effective for the treatment of frontal sinus FB and can represent a valid alternative to the traditional external approaches.

Superior Branch Palsy of the Oculomotor Nerve Caused by Frontal Sinusitis.

Chronic rhinosinusitis is one of the most common inflammatory diseases with a significant impact on the affected patients. Orbital complications, one of the emergent complications of chronic rhinosinusitis, can be occurred in frontal sinusitis. For early diagnosis and therapy of orbital complications, proper evaluation is essential to prevent loss of vision.Recently, the authors diagnose and treat completely a 60-year-old man with isolated unilateral superior branch palsy of the oculomotor nerve caused by frontal sinusitis. Four days after draining the frontal sinusitis, the patient recovered fully from superior branch palsy of the oculomotor nerve. Frontal sinusitis can cause isolated superior branch palsy of the oculomotor nerve in patients with a history of facial trauma.

Pott Puffy Tumor in Children: A Rare Emergency Clinical Entity.

OBJECTIVES: Pott puffy tumor (PPT) is defined as soft tissue swelling of the forehead due to subperiosteal edema, accumulation of pus, or granulation tissue. It is associated with osteomyelitis of frontal bone secondary to frontal sinusitis. Pott puffy tumor can be complicated by preseptal and orbital cellulitis and intracranial infection. METHODS: Six patients diagnosed with and treated for PPT in Pediatric Clinic of Uludag University Faculty of Medicine from 2010 to 2015 were reviewed retrospectively. Age, sex, presenting symptoms and signs, laboratory and radiological findings, as well as intracranial complications and treatment modalities of all patients were evaluated. RESULTS: The authors present 6 pediatric patients of PPT, 5 males and 1 female with a mean age of 11 years (age range, 7-18 years). All patients presented with headache, fever, and tender frontal swelling. Two of the patients had epidural abscess and 1 had preseptal orbital cellulitis in addition to PPT. All of them had computed tomography scan and/or magnetic resonance imaging. Endoscopic sinus surgery was performed in 4 patients and 2 patients underwent neurosurgical intervention with antibiotherapy. CONCLUSIONS: Pott puffy tumor may be associated with potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality. Imaging plays an important role in the diagnosis of the disease and the detection of its complications.

Approach on rehabilitation of patients after functional endonasal surgery of the frontal sinus.

INTRODUCTION: Endonasal surgery of the frontal sinuses is associated with impaired mucosal integrity, the aerodynamics of the nasal cavity, the configuration of intranasal structures. At the stage of early postoperative period, it is important to achieve rapid epithelialization of the mucous membrane, with the restoration of the functioning of the mucociliary transport system, drainage and ventilation of the sinuses, nasal congestion and as a result, early clinical recovery of the patient. AIM: to prove the clinical efficacy of formulations containing sodium hyaluronate in the postoperative period in patients undergoing endoscopic endonasal surgery of the frontal sinus. MATERIALS AND METHODS: the study was conducted on 36 patients, including 23 of a test, and 13 - a control group. All patients underwent endonasal surgery of the frontal sinus. Postoperatively, the patients of the main group, in addition to standard therapy, received products based on sodium hyaluronate, control - standard therapy. The study used a medical gel based on sodium hyaluronate Deviskar®.The results of the study were based on rhinoscopic diagnostic, rhinomanometry, subjective methods of patient questionnaires. CONCLUSIONS: the use of study preparation in complex treatment of patients with chronic sinusitis allows to achieve the best results the restoration of the mucous membrane of the nasal cavity and nasal breathing function, which has been proved for objective and subjective criteria. The study results allow us to recommend the use of sodium hyaluronate intraoperative and postoperative patients who underwent rhinosurgery intervention as an effective anti-inflammatory agent and mucous reducing agent.

Use of a Foley catheter balloon as a tool during endoscopic frontal sinus surgery in a resource-poor environment.

OBJECTIVE: This study aimed to evaluate the non-Food and Drug Administration-approved off-label use of a 10F Foley catheter as a tool during endoscopic frontal sinus surgery. METHOD: A cohort of 40 patients with chronic frontal rhinosinusitis was prospectively evaluated using the Sino-Nasal Outcome Test (SNOT-22), computed tomography (CT) imaging, and endoscopic examination. Endoscopic sinus surgery (ESS) was performed in the usual fashion, however, when approaching the frontal sinus, a 10F Foley catheter was inserted and the balloon inflated in the frontal outflow. Patients were assessed postoperatively with SNOT-22, CT imaging, and endoscopic assessment at 6 months. RESULTS: Successful intraoperative dilation of the frontal recess was achieved in 62 of 69 frontal sinuses (90%). No cerebrospinal fluid leak or orbital entry occurred. Six months postoperative, SNOT-22 scores showed significant improvement, whereas endoscopic assessment revealed patent frontal recess in 55 of 62 (89%) frontal sinuses. Computed tomography imaging was completed in 25 patients comprising 41 operated frontal sinuses with no mucosal thickening seen in 37 of 41 (90%). CONCLUSION: The 10F Foley catheter is an effective tool to dilate the frontal recess by compression of edema during ESS. It may be a safe and cost-effective alternative to high-cost commercially available sinus balloons, especially in resource-poor environments.

Endoscopic Management of Chronic Frontal Sinusitis: Prospective Quality of Life Analysis.

BACKGROUND: Previous studies of endoscopic frontal sinus surgery have been primarily retrospective and focused on symptom relief only. OBJECTIVES: To prospectively assess the impact of endoscopic frontal sinus surgery on frontal sinus ostium patency and disease-specific quality of life as measured by the Rhinosinusitis Disability Index (RSDI). STUDY DESIGN: A 60-patient cohort with chronic frontal sinusitis (100 diseased frontal sinuses) was prospectively evaluated using the RSDI, computed tomography (CT) imaging, and endoscopic examination. Image-guided endoscopic frontal sinusotomy (Draf 2a) was performed in each case. Patients were assessed with RSDI and endoscopic assessment at least 6 months postoperatively. RESULTS: At a mean follow-up of 10 months, endoscopic assessment revealed patent frontal recesses in 90 of 100 frontal sinuses (90%), with significant improvement in the total RSDI score (41.98 ± 26.48 preoperatively to 17.15 ± 15.66 postoperatively) as well as each of its physical, emotional, and functional subscales from 16.3 ± 9.03, 12.23 ± 10.55, 13.45 ± 9.59 preoperatively to 5.95 ± 5.71, 5.55 ± 5.66, 5.65 ± 5.72 postoperatively, respectively. Similar improvement was seen in patients with asthma, polyps, and those undergoing revision sinus surgeries. CONCLUSIONS: With frontal recess mucosal preservation and meticulous postoperative endoscopic surveillance, endoscopic frontal sinusotomy results in high rates of frontal sinus ostium patency with significant improvement in quality of life.

Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis.

OBJECTIVE: The objective of this study was to radiologically determine frontal sinus drainage pathway variations with respect to superior attachment of uncinate process (SAUP) and their effect on prevalence of frontal rhinosinusitis. DESIGN: This was a retrospective cohort study. METHODS: Computed tomography scans of the 919 frontal sinus sides of 460 patients (252 female, 208 male; mean age, 35.1 ± 10.5 years) who were candidates for endoscopic sinus surgery were evaluated retrospectively between August 2012 and January 2013 by 3 radiologists to determine the SAUP types and the presence of frontal rhinosinusitis. RESULTS: The frontal sinus outflow tract was localized medial to the SAUP in 651 frontal sinus sides and lateral to the SAUP in 268 sides. We determined 3 types (types 7, 8, and 9) of SAUP in addition to 6 types defined in literature. The most common type of SAUP was type 3 (n = 332, 36.1%) followed by type 2 (n = 256, 27.8%) and type 7 (n = 160, 17.4%). Of the evaluated sides, 316 (34.3%) had frontal rhinosinusitis. Frontal rhinosinusitis was more common in the sides where the frontal sinus outflow tract was localized medial to the SAUP than those localized lateral (37.2% vs 27.6%, P = 0.006). CONCLUSIONS: Endoscopic approach to frontal recess usually requires uncinectomy, and it is necessary to know SAUP to prevent postoperative retained superior portion of the uncinate process. The location of frontal sinus outflow tract on the SAUP affects the prevalence of frontal rhinosinusitis as well. Frontal rhinosinusitis is significantly more common when the frontal sinus outflow tract was localized medial rather than lateral to the SAUP. LEVEL OF EVIDENCE: 2b.

Frontal sinus obliteration with autologous calvarial bone graft: indications and results.

Despite increasing advances in endonasal frontal sinus surgery, frontal sinus obliteration (FSO) is sometimes necessary after failure of other surgical techniques. This procedure has been reported with autologous tissue or synthetic material, but few studies have reported results with autologous calvarial bone graft. The aim of this study was to report our experience with osteoplastic FSO calvarial bone graft. A retrospective review was performed on 11 patients operated upon for FSO with autologous calvarial bone graft from 2005 to 2011. Obliteration was indicated for chronic symptomatic frontal sinusitis with nasofrontal duct stenosis in five cases of nasal polyposis with a history of endoscopic sinus surgery, two cases of frontal trauma, two of surgery for frontal inverted papilloma and two of chronic frontal purulent sinusitis. Ten patients had a history of one or two previous functional endoscopic sinus surgery (FESS) procedures. On outcome assessment, eight patients had no residual complaints after FSO and all patients showed improvement in symptoms. Frontal sinus obliteration with autologous calvarial bone graft showed low donor site morbidity and good aesthetic results. This procedure should be considered in severe frontal sinusitis after repeated FESS procedures have failed.