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Sinonasal Tumours
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Alkis J. Psaltis, David K. Morrissey
The entire anterior skull base can be accessed endoscopically. When the intra-cranial component lies posterior to the anterior ethmoidal artery, targeted resection of the posterior skull base is usually sufficient for access. If the intra-cranial extent of the tumour lies anterior to the anterior ethmoid arteries, an endoscopic modified Lothrop procedure (EMLP) will typically be required to access the anterior aspect of the tumour. The EMLP also improves lateral access to lesions within the frontal sinus.
Common rhinology and facial plastics viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Surgery is always indicated: Endoscopic frontal sinus surgery Draf procedureI. I. Uncinectomy and removal of the agger nasi cells to clear frontal recess IIa. Opening of frontal sinus from lamina to middle turbinateIIb. Opening the frontal sinus from lamina to septum (requires drilling)III. Modified Lothrop (drilling out the frontal sinuses removing from the central bony septum) (lamina to lamina across the septum and posteriorly to first olfactory fibres and anteriorly to anterior table)Balloon sinuplasty may be considered in appropriate casesOpen approach
The Frontal Sinus
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
An OPF can be performed through a number of approaches. Coronal, brow and mid forehead incisions have all been used to expose the anterior table of the frontal sinus. Zigzag coronal incisions are better camouflaged in male pattern baldness. A combination of local anaesthesia (Lignocaine 1%), vasoconstrictors (adrenaline 1: 1000), steroid (Adcortyl 5 mg) and Hylase (I,500 iu) aid dissection and minimize bleeding. An incision is made down to the periosteum. Using a combination of blunt and sharp dissection the scalp flap is elevated to the supraorbital ridge and over the root of the nose. The flap is pulled caudally on both sides, leaving behind the periosteum and the bone, thus preserving the supraorbital and supratrochlear vascular nerve bundles. The next step is to precisely define the extent of frontal sinus pneumatization. Conventionally, a 6-foot Caldwell view (occipitofrontal view) X-ray was used as a template to mark out the margin of the frontal sinus. CT-generated frontal sinus templates are virtually identical to the Caldwell radiograph-derived templates and may obviate the need for additional imaging.80 As an alternative, transillumination can be used to outline the extent of the sinus. When available, surgical navigation has been shown to be more accurate and may reduce the risk of inadvertent intra-cranial entry.81 Others have developed 3D models of the frontal sinus using pre-operative CT data from which an accurate template is produced (Figure 99.14).82
Phrenology’s frontal sinus problem: An insurmountable obstruction?
Published in Journal of the History of the Neurosciences, 2022
Readers can still find the following lines in the 1890 edition of Combe’s A System of Phrenology, reiterating what can be found in earlier editions (e.g., G. Combe 1825, vol. 1, 32): There is one part of the skull where the external configuration does not always indicate exactly the size of the subjacent parts of the brain, and upon which objections have been raised. At the part of the frontal bone immediately above the top of the nose, a divergence from parallelism is sometimes produced by the existence of a small cavity called the frontal sinus. … It is formed between the two tables of the bone, either by the external table swelling out a little without being followed by the internal, and presenting an appearance like that of a blister on a biscuit, or by the internal table sinking in without being followed by the external. … Even granting the sinus to be an insuperable obstacle in the way of ascertaining the development of the organs over which it is situated, it is plain that, in ordinary cases, it interferes with only a few. (G. Combe 1890, 82–83)
Case series of 100 supraorbital mini-craniotomies in patients with good grade aneurysmal subarachnoid haemorrhage at a single neurosurgical Centre
Published in British Journal of Neurosurgery, 2022
Gopiga Thanabalasundaram, Wai Cheong Soon, Athiththan Ponnampalam, Howard L. Brydon
A period of reduced consciousness occurred in 18 patients and seven of them required a period of ventilation. Hydrocephalus needing VP shunts developed in nine patients and eight patients suffered post-operative seizures. One of these patients had seizures pre-operatively. An uncomplicated recovery occurred in 79% of patients. There were no instances of the facial nerve or frontalis palsy, temporalis atrophy, or jaw stiffness post-operatively. Three patients developed wound infections and two of them needed bone flap removal requiring a cranioplasty later. The third patient settled with antibiotics but needed a wound revision due to bone flap atrophy. Of these three patients, 2 patients had frontal sinus breach intra-operatively. Six patients stated that they were unhappy with the cosmetic outcome of the wound; one of them later had a filling of a forehead depression due to a partly atrophic bone flap and was then satisfied. Forehead numbness due to supra-orbital nerve palsy occurred in 21% of patients.
Frontal osteoplastic flap without frontal sinus obliteration for orbital roof decompression
Published in Orbit, 2021
Matthew Kim, Marc Otten, Michael Kazim, David A. Gudis
The patient is placed under general anesthesia and intubated orotracheally. Stereotactic image guidance (Fusion – Medtronic, Dublin, Ireland) is registered and calibrated. The nasal cavities are decongested bilaterally with cotton pledgets soaked in 1:1,000 epinephrine dyed with fluorescein. Attention is first turned to the frontal osteoplastic flap. A bicoronal incision is made extending from zygoma to zygoma through skin and galea. Next, a pericranial flap is elevated posterior to the skin incision and carried anteriorly to the supraorbital neurovascular bundle. Utilizing image guidance, the border of the frontal sinuses is outlined with drill holes along the anterior table. The bone flap is pre-plated, after which a sagittal saw is used to release it, beveling in toward the sinus to avoid intracranial injury. The bone of the anterior table was noted to be substantially thinned due to expansion of the lesion within the sinus. Next, the lesion is systematically resected using the drill, in combination with curette dissection off of the frontal sinus mucosa. Mucosa is preserved where possible, particularly along the posterior table. Resection of the lesion proceeds along the orbital roof from anterior to posterior, including bilateral orbital roof decompression with preservation of periorbita (Figure 3). The intraorbital component of the lesion in the right orbit, including an osteoma, is carefully dissected off of the periorbita. Finally, the frontal sinus drainage pathway is identified and cleared of the lesion bilaterally.