الفهرس | Only 14 pages are availabe for public view |
Abstract Although, the frontal sinus is considered a part of the paransal sinuses, its surgery is considered a major problem. The approaches to the frontal sinus has been advanced, as a result of the rapid progress of the instrumentations and telescopes that make a paralleled progress in surgical techniques due to more obvious sinus field. The good identification of the frontal sinus anatomy has a role in its surgical technical advancement. These approaches to the frontal sinus include external approach endonasal approach and combined one. The external approach either by fronto- ethmoidectomy or by the osteoplastic flap approach. With the rapid steps of creating a new instrumentations the endonasal frontal sinus surgery approach is established approach, several techniques of this approach are reported, which include: Endoscopic frontal sinusotomy, reported by Kuhn and Javer (2001). Draf (types) frontal sinusotomy, reported by Weber et al (2001). Modified transnasal endoscopic Lothrop procedure reported by Becker et al, (1995). All of these techniques aim at removing the obstruction of the fronto-nasal connection elsewhere, and conserving the frontal sinus vitality and function. Some variations of this classic techniques of endoscopic endonasal frontal sinus approaches include: Endoscopic trans-septal frontal sinusotomy technique. Revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement technique, and recommended the management of chronic frontal sinusitis after partial or total middle turbinate resection, in cases of bone erosion, frontal sinus osteitis or osteoneogenesis or intracranial complication of chronic frontal sinusitis. In some cases the external frontal sinus approach is used in combination with the endonasal endoscopic approach, as in, recurrent purulent sinusitis or phelgmons of the facial skin or orbit from purulent exacerbation, mucocele or pyocele or tumours of frontal sinus. Stenting of frontal sinus postoperatively has a role in keeping the diameter of the frontal sinus ostium without decrease in size. In spite of the presence of all this techniques, till now there is no single technique which is safe and conserves the frontal sinus and frontonasal duct vitality and function without complications. |