DOCSLIB.ORG

Frontal Sinus Surgery: the State of the Art 1Michael J Marino, 2Edward D Mccoul

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Frontal Sinus Surgery: the State of the Art 1Michael J Marino, 2Edward D Mccoul IJHNS Frontal10.5005/jp-journals-10001-1257 Sinus Surgery: The State of the Art REVIEW ARTICLE Frontal Sinus Surgery: The State of the Art 1Michael J Marino, 2Edward D McCoul ABSTRACT classification, and instrumentation have been essential in pacing that evolution.1 There has been increased interest Aim: Review and describe the essential components of modern frontal sinus surgery. in rigorous outcomes assessments that are necessary for Background: Frontal sinus surgery has evolved considerably an evidence-based approach to frontal sinus surgery. State- over the last century, and advances in imaging, optics, and of-the-art frontal sinus surgery is the product of techno- instrumentation have contributed to contemporary treatment logical advancements and growing outcomes evidence. paradigms. Outcomes assessment has had an important role in This review addresses the elemental components of identifying indications for surgery and future areas of research. modern frontal sinus surgery. Included are a discussion of Review results: Numerous advancements are part of modern frontal sinus surgery and the treatment of frontal sinusitis. Ana­ the relevant anatomical considerations and contemporary tomic studies have revealed variations that are associated with indications for frontal sinus surgery. Open approaches disease and pose challenges for surgery. Open approaches to the frontal sinus are addressed and remain relevant remain relevant in situations of difficult disease or as part of in the endoscopic era. Nevertheless, advancements in combined approaches. Endoscopic surgery, however, is central to contemporary surgical management of frontal sinus disease. optics have propelled endoscopic approaches to the Evolving instrumentation and the development of new implan­ forefront, and are described in detail. Instrumentation table devices are increasingly relevant in the endoscopic era. and implantable devices serve as important adjuncts, Outcomes research has refined indications for surgery and identifies areas for ongoing research. and their application in modern frontal sinus surgery is considered. Outcome studies form the framework for Conclusion: State­of­the­art frontal sinus surgery is the pro­ duct of significant evolution and advancement. Modern surgery evidence-based treatment of frontal sinus disease and is reflective of improved optics and new instrumentation, and the identify areas for future research. central role of endoscopic approaches in treating frontal sinus disease. Outcomes research has been essential for developing FRONTAL SINUS ANATOMY an evidenced­based approach to frontal sinus surgery. Clinical significance: A review of the essential components The frontal sinus represents a complex anatomical region of state­of­the­art frontal sinus surgery for the practicing oto­ with wide variation between patients and sides.2 This has laryngologist. important consequences for frontal sinus disease, techni- Keywords: Chronic sinusitis, Draf procedure, Endoscopic sinus cal considerations during surgical dissection and potential surgery, Frontal sinus, Minimally-invasive surgery. complications. Preoperative evaluation of the radiographic How to cite this article: Marino MJ, McCoul ED. Frontal Sinus anatomy by computed tomography (CT) is an essential Surgery: The State of the Art. Int J Head Neck Surg 2016;7(1): 5-12. part of performing frontal sinus surgery. The location of the nasofrontal duct, also called the frontal recess or fron- Source of support: Nil tal outflow tract, can often be determined preoperatively Conflict of interest: None from the CT scan. Familiarity with common anatomic variations enhances interpretation of preoperative images INTRODUCTION and is helpful during frontal sinus dissection. Frontal sinus surgery has evolved considerably over The frontal sinus is thought to be the last paranasal the last century. Advances in imaging, optics, anatomic sinus to develop,3 and may represent superior and late- ral pneumatization of an anterior ethmoid cell.4 This may account for the significant variation in frontal sinus 1 2 Clinical Instructor, Associate Professor anatomy between patients and even between sides in the 1 Department of Otolaryngology-Head and Neck Surgery, Tulane same patient. Variation of the ethmoid sinuses also impact University School of Medicine, New Orleans, Louisiana, USA drainage and ventilation of the frontal sinus due to the 2Department of Otorhinolaryngology, Ochsner Clinic Foundation University of Queensland School of Medicine, Ochsner Clinical proximity of the ethmoid sinuses to the nasofrontal duct. School, New Orleans, Louisiana, USA These include variations, such as the agger nasi cell (pre- Corresponding Author: Edward D McCoul, Department of infundibular ethmoid cell) pneumatization, prominent Otolaryngology 1514 Jefferson Highway, CT-4, New Orleans ethmoid bullae and supraorbital cells. Louisiana, USA, Phone: (504)-842-4080, e-mail: emccoul@ Ethmoid air cells may be contained wholly within gmail.com the frontal recess or frontal sinus, and are termed frontal International Journal of Head and Neck Surgery, January-March 2016;7(1):5-12 5 Michael J Marino, Edward D McCoul cells (Fig. 1). Bent and Kuhn proposed a classification particularly as endoscopic approaches have become the scheme with 4 types of frontal cells.4 In a type I frontal standard for the treatment of frontal sinusitis. cell, a single air cell is located superior to the agger nasi cell, while in a type II frontal cell a tier of cells is located INDICATIONS FOR SURGERY within the frontal recess superior to the agger nasi cell. The indications for frontal sinus surgery are not, in prin- Both type I and II frontal cells are cephalad to the agger ciple, different from those for endoscopic sinus surgery. nasi cell, but remain inferior to the frontal sinus floor. A Surgery may be indicated for the treatment of chronic type III frontal cell represents a single large cell that has rhinosinusitis (CRS), cerebrospinal fluid leak, and benign pneumatized superiorly into the frontal sinus, and may and malignant tumors of the frontal sinuses. Defining be anterior or posterior to the frontal sinus outflow tract. indications for the surgical treatment of CRS can be Finally, a type IV cell is a single, isolated air cell contained complex. Surgery typically follows maximal medical entirely within the frontal sinus. Type IV frontal cells therapy, but a consensus as to what this entails has not may be difficult to appreciate on CT due to thin walls been established. Nevertheless, maximal medical therapy and surrounding inflammatory mucosa. is often considered to include intranasal steroids, nasal Frontal cells occur as an anatomic variant in a substan- saline irrigations, and oral antibiotics, with oral steroids tial minority of patients. An analysis of 768 coronal CT used in cases of polypoid disease. Failure of medical scans indicated the overall prevalence of frontal cells was therapy warrants CT imaging and surgical evaluation. 20.4%.5 Type I frontal cells were present more frequently Maximal medical therapy also prepares the operative (14.9%) than type II (3.1%), type III (1.7%), or type IV cells field for surgery, which is especially important in the (2.1%). Frontal sinus hyperpneumatization, in general, frontal sinus where the anatomy can be challenging.2 was associated with the presence of frontal cells, while Of particular importance when considering indica- hypopneumatization was negatively associated with tions for frontal sinus surgery is selecting the appropriate these variations (Fig. 2). In the original classification of procedure. The majority of primary procedures for CRS frontal cells, these variations were described as treatable can be addressed by a limited endoscopic sinusotomy causes of frontal sinus obstruction with associated case (Draf 1 or 2A). More challenging is identifying indications reports.4 The study by Meyer et al, found a statistically for extended approaches (Draf 2B and 3). These procedures significant increase in maxillary, ethmoid, and frontal will be detailed in a subsequent section. Failed prior sinus mucosal thickening in the presence of type III and IV frontal sinus surgery is the most common indication for frontal cells.5 an extended endoscopic approach. Neo-osteogenesis and Frontal sinus anatomy is highly variable. This includes lateralized middle turbinate are also potential indications variation of the pneumatization within the frontal sinus for extended approaches, and are often seen with failed itself and of the surrounding anterior ethmoid cells. prior frontal sinus surgery. Pre sence of a mucocele may These variations have been described as causes of frontal also necessitate an extended endoscopic approach. Anom- sinus obstruction and resultant frontal sinus disease. Fur- alous frontal sinus anatomy, including type III and IV thermore these variations can pose surgical challenges, frontal cells, can also be an indication for extended Fig. 1: Sagittal CT showing a large anterior ethmoid cell Fig. 2: Coronal CT showing a hyperpneumatized frontal sinus with pneumatizing into the frontal sinus lumen multiple frontal cells (types 3 and 4) within the lumen. The sinuses are completely opacified due to polyposis 6 IJHNS Frontal Sinus Surgery: The State of the Art approaches. Conversely, narrow anterior-posterior dimen- During cranialization a pericranial flap can be raised sion at the nasofrontal beak may be a relative contraindica- and sutured in continuity with the dura.8 Direct external
Load more

Recommended publications
  • Septation of the Sphenoid Sinus and Its Clinical Significance
    1793 International Journal of Collaborative Research on Internal Medicine & Public Health Septation of the Sphenoid Sinus and its Clinical Significance Eldan Kapur 1* , Adnan Kapidžić 2, Amela Kulenović 1, Lana Sarajlić 2, Adis Šahinović 2, Maida Šahinović 3 1 Department of anatomy, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina 2 Clinic for otorhinolaryngology, Clinical centre University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina 3 Department of histology and embriology, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina * Corresponding Author: Eldan Kapur, MD, PhD Department of anatomy, Medical faculty, University of Sarajevo, Bosnia and Herzegovina Email: [email protected] Phone: 033 66 55 49; 033 22 64 78 (ext. 136) Abstract Introduction: Sphenoid sinus is located in the body of sphenoid, closed with a thin plate of bone tissue that separates it from the important structures such as the optic nerve, optic chiasm, cavernous sinus, pituitary gland, and internal carotid artery. It is divided by one or more vertical septa that are often asymmetric. Because of its location and the relationships with important neurovascular and glandular structures, sphenoid sinus represents a great diagnostic and therapeutic challenge. Aim: The aim of this study was to assess the septation of the sphenoid sinus and relationship between the number and position of septa and internal carotid artery in the adult BH population. Participants and Methods: A retrospective study of the CT analysis of the paranasal sinuses in 200 patients (104 male, 96 female) were performed using Siemens Somatom Art with the following parameters: 130 mAs: 120 kV, Slice: 3 mm.
    [Show full text]
  • A Forensic Case Report
    Skeletonized body identified by analysis of frontal sinus morphology and characteristics of osteosynthesis material: a forensic case report Rhonan Ferreira-Silva1, Andréa Pinheiro de- Abreu Meirelles2, Isabela Machado3, Lívia Graziele Rodrigues4, Roberta Gomes-Resende5, Alicia Picapedra6, Carlos Sassi7 DOI: 10.22592/ode2018n31a10 Abstract Forensic dentistry is essential for the identification of highly decomposed and charred bodies, as well as skeletal remains. This study reports a case of human identification by analyzing the morphology of the frontal sinuses and osteosynthesis material. In the anthropological assess- ment of skeletal remains a surgical plate used for osteosynthesis was detected in the periorbital regions. Relatives of the potential victim provided ante-mortem (AM) radiographs which re- vealed the presence of an osteosynthesis plate. Post-mortem (PM) imaging exams were per- formed to reproduce the AM data. Similarities were observed between the AM and PM radio- graphs, especially regarding the morphology of the frontal sinuses and the position and outline of the surgical plate used for osteosynthesis. The comparison of AM and PM images made it possible to identify the victim and to aid the criminal investigation. It also highlighted the role of radiographs and anatomical characteristics in the process of human identification. Keywords: forensic dentistry, forensic anthropology, frontal sinus, radiography. 1 Professor of Forensic Dentistry, School of Dentistry, Universidad Federal de Goiás. Criminal Expert at the Scientific Police of Goiás (Goiânia, Goiás, Brazil). ORCID: 0000-0002-3680-7020 2 Undergraduate Student, School of Dentistry, Universidad Federal de Goiás (Goiânia, Goiás, Brazil). ORCID: 0000-0002-1290-3755 3 Undergraduate Student, School of Dentistry, Universidad Federal de Goiás (Goiânia, Goiás, Brazil).
    [Show full text]
  • Benign Tumors of the Frontal Sinuses with and Fibro-Osseous Tumors of the Frontal Sinus: Their Propensity to Recur and Cause Local Open Approaches
    Chapter 18 Benign Tumors 18 of the Frontal Sinuses Brent A. Senior, Marc G. Dubin Management of Benign Lesions of the Frontal Sinus . 157 Core Messages Preoperative Evaluation . 157 í Surgical Treatment of Bony Benign tumors of the frontal sinuses with and Fibro-osseous Tumors of the Frontal Sinus: their propensity to recur and cause local Open Approaches . 157 injury present unique challenges to the Surgical Treatment of Bony otolaryngologist and Fibro-osseous Tumors of the Frontal Sinus: Endoscopic Approaches . 158 í Fibro-osseous lesions may be managed ex- Cases: Fibro-osseus Lesions of the Frontal Sinus . 159 pectantly, or may be removed in the setting Case 1: Endoscopic Resection of Tumor of symptomatic pathology such as cosmet- in the Frontal Recess . 159 ic or functional deformity Case 2: Open Resection of Tumor of the Frontal Sinus . 160 í Inverted papillomas with their high rate of Surgical Management of Inverted Papilloma: associated malignancy should be complete- Open and Endoscopic . 161 ly removed Cases: Inverted Papilloma of the Frontal Sinus . 161 Case 1: Recurrent Inverted Papilloma of the Frontal Sinus . 161 í Tumors that in the past required open ap- proaches may now be managed successful- Postoperative Considerations . 162 ly with endoscopic approaches alone or Conclusions . 163 with combined approaches, lowering over- References . 163 all morbidity while not sacrificing outcome í Cases must be individually assessed in or- der to determine the appropriate manage- ment approach Introduction Management of disease of the frontal recess and frontal sinus is one of the greatest challenges in rhi- nology. Despite advances in the understanding of the Contents anatomy and physiology of this area along with in- creased comfort with endoscopic techniques, man- Introduction .
    [Show full text]
  • Nasoconchal Paranasal Sinus in White Rhino
    IDENTIFICATION OF A NASOCONCHAL PARANASAL SINUS IN THE WHITE RHINOCEROS (CERATOTHERIUM SIMUM) Author(s): Mathew P. Gerard, B.V.Sc., Ph.D., Dipl. A.C.V.S., Zoe G. Glyphis, B.Sc., B.V.Sc., Christine Crawford, B.S., Anthony T. Blikslager, D.V.M., Ph.D., Dipl. A.C.V.S., and Johan Marais, B.V.Sc., M.Sc. Source: Journal of Zoo and Wildlife Medicine, 49(2):444-449. Published By: American Association of Zoo Veterinarians https://doi.org/10.1638/2017-0185.1 URL: http://www.bioone.org/doi/full/10.1638/2017-0185.1 BioOne (www.bioone.org) is a nonprofit, online aggregation of core research in the biological, ecological, and environmental sciences. BioOne provides a sustainable online platform for over 170 journals and books published by nonprofit societies, associations, museums, institutions, and presses. Your use of this PDF, the BioOne Web site, and all posted and associated content indicates your acceptance of BioOne’s Terms of Use, available at www.bioone.org/page/ terms_of_use. Usage of BioOne content is strictly limited to personal, educational, and non-commercial use. Commercial inquiries or rights and permissions requests should be directed to the individual publisher as copyright holder. BioOne sees sustainable scholarly publishing as an inherently collaborative enterprise connecting authors, nonprofit publishers, academic institutions, research libraries, and research funders in the common goal of maximizing access to critical research. Journal of Zoo and Wildlife Medicine 49(2): 444–449, 2018 Copyright 2018 by American Association of Zoo Veterinarians IDENTIFICATION OF A NASOCONCHAL PARANASAL SINUS IN THE WHITE RHINOCEROS (CERATOTHERIUM SIMUM) Mathew P.
    [Show full text]
  • Macroscopic Anatomy of the Nasal Cavity and Paranasal Sinuses of the Domestic Pig (Sus Scrofa Domestica) Daniel John Hillmann Iowa State University
    Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 1971 Macroscopic anatomy of the nasal cavity and paranasal sinuses of the domestic pig (Sus scrofa domestica) Daniel John Hillmann Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Animal Structures Commons, and the Veterinary Anatomy Commons Recommended Citation Hillmann, Daniel John, "Macroscopic anatomy of the nasal cavity and paranasal sinuses of the domestic pig (Sus scrofa domestica)" (1971). Retrospective Theses and Dissertations. 4460. https://lib.dr.iastate.edu/rtd/4460 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. 72-5208 HILLMANN, Daniel John, 1938- MACROSCOPIC ANATOMY OF THE NASAL CAVITY AND PARANASAL SINUSES OF THE DOMESTIC PIG (SUS SCROFA DOMESTICA). Iowa State University, Ph.D., 1971 Anatomy I University Microfilms, A XEROX Company, Ann Arbor. Michigan I , THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED Macroscopic anatomy of the nasal cavity and paranasal sinuses of the domestic pig (Sus scrofa domestica) by Daniel John Hillmann A Dissertation Submitted to the Graduate Faculty in Partial Fulfillment of The Requirements for the Degree of DOCTOR OF PHILOSOPHY Major Subject: Veterinary Anatomy Approved: Signature was redacted for privacy. h Charge of -^lajoï^ Wor Signature was redacted for privacy. For/the Major Department For the Graduate College Iowa State University Ames/ Iowa 19 71 PLEASE NOTE: Some Pages have indistinct print.
    [Show full text]
  • MBB: Head & Neck Anatomy
    MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina
    [Show full text]
  • Frontal Sinus Cerebrospinal Fluid Leaks Chapter 17 145
    Chapter 17 Frontal Sinus Cerebrospinal 17 Fluid Leaks Bradford A. Woodworth, Rodney J. Schlosser Contents Core Messages Introduction . 143 í Identification of a CSF leak etiology; Anatomic Site . 144 accidental trauma, surgical trauma, Etiology . 147 tumors, congenital, or spontaneous; Trauma . 147 is essential for successful repair Tumors . 148 Congenital . 148 í Anatomically, frontal sinus CSF leaks are Spontaneous . 148 divided into those located adjacent to the Diagnosis . 149 frontal recess, within the frontal recess, or Surgical Technique . 149 within the frontal sinus proper Endoscopic Approaches . 149 Extracranial Repair . 150 í Pre-operative evaluation may include beta- Intracranial Repair . 151 2 transferrin, radioactive/CT cisternogram, Adjuncts and Postoperative Care . 151 high-resolution CT, MRI, or intrathecal flu- orescein and should be individualized for Conclusion . 151 the purposes of diagnosis and localization References . 151 í Frontal sinus CSF leaks adjacent to or with- in the frontal recess are typically amenable to endoscopic repair Introduction í CSF leaks affecting the posterior table Pathology of the frontal sinus represents one of the within the frontal sinus proper may require most challenging and technically demanding areas external approaches, such as frontal tre- for the sinus surgeon to reach endoscopically. Cere- phine or osteoplastic flap. Combined endo- brospinal fluid (CSF) leaks in other parts of the sino- scopic and external techniques are useful nasal cavity have been repaired with relatively high
    [Show full text]
  • Level I to III Craniofacial Approaches Based on Barrow Classification For
    Neurosurg Focus 30 (5):E5, 2011 Level I to III craniofacial approaches based on Barrow classification for treatment of skull base meningiomas: surgical technique, microsurgical anatomy, and case illustrations EMEL AVCı, M.D.,1 ERINÇ AKTÜRE, M.D.,1 HAKAN SEÇKIN, M.D., PH.D.,1 KUTLUAY ULUÇ, M.D.,1 ANDREW M. BAUER, M.D.,1 YUSUF IZCI, M.D.,1 JACQUes J. MORCOS, M.D.,2 AND MUSTAFA K. BAşKAYA, M.D.1 1Department of Neurological Surgery, University of Wisconsin–Madison, Wisconsin; and 2Department of Neurological Surgery, University of Miami, Florida Object. Although craniofacial approaches to the midline skull base have been defined and surgical results have been published, clear descriptions of these complex approaches in a step-wise manner are lacking. The objective of this study is to demonstrate the surgical technique of craniofacial approaches based on Barrow classification (Levels I–III) and to study the microsurgical anatomy pertinent to these complex craniofacial approaches. Methods. Ten adult cadaveric heads perfused with colored silicone and 24 dry human skulls were used to study the microsurgical anatomy and to demonstrate craniofacial approaches in a step-wise manner. In addition to cadaveric studies, case illustrations of anterior skull base meningiomas were presented to demonstrate the clinical application of the first 3 (Levels I–III) approaches. Results. Cadaveric head dissection was performed in 10 heads using craniofacial approaches. Ethmoid and sphe- noid sinuses, cribriform plate, orbit, planum sphenoidale, clivus, sellar, and parasellar regions were shown at Levels I, II, and III. In 24 human dry skulls (48 sides), a supraorbital notch (85.4%) was observed more frequently than the supraorbital foramen (14.6%).
    [Show full text]
  • Approach to Frontal Sinus Outflow Tract Injury
    Arch Craniofac Surg Vol.18 No.1, 1-4 Archives of Cr aniofacial Surgery https://doi.org/10.7181/acfs.2017.18.1.1 Review Article Approach to Frontal Sinus Outflow Tract Injury Yong Hyun Kim, Frontal sinus outflow tract (FSOT) injury may occur in cases of frontal sinus fractures and Baek-Kyu Kim nasoethmoid orbital fractures. Since the FSOT is lined with mucosa that is responsible for the path from the frontal sinus to the nasal cavity, an untreated injury may lead to complica- Department of Plastic and Reconstructive tions such as mucocele formation or chronic frontal sinusitis. Therefore, evaluation of FSOT Surgery, Seoul National University Bundang is of clinical significance, with FSOT being diagnosed mostly by computed tomography or Hospital, Seoul National University College of Medicine, Seongnam, Korea intraoperative dye. Several options are available to surgeons when treating FSOT injury, and they need to be familiar with these options to take the proper treatment measures in order to follow the treatment principle for FSOT, which is a safe sinus, and to reduce com- plications. This paper aimed to examine the surrounding anatomy, diagnosis, and treatment of FSOT. No potential conflict of interest relevant to this article was reported. Keywords: Frontal sinus / Frontonasal / Recess / Duct INTRODUCTION the anatomy of the frontal sinus, and it is important to maintain sinus function, restore facial aesthetics, and prevent complications Frontal sinus fracture and nasoethmoid orbital fracutre accounts [4]. Being FSOT injury present is of special clinical significance, for approximately 10% of all craniofacial fractures and it occurs because complications associated with FSOT injury can include from high velocity impact with the main cause of injury being mucocele formation or chronic frontal sinusitis (infection) [1,3].
    [Show full text]
  • Surgical Anatomy of the Paranasal Sinus M
    13674_C01.qxd 7/28/04 2:14 PM Page 1 1 Surgical Anatomy of the Paranasal Sinus M. PAIS CLEMENTE The paranasal sinus region is one of the most complex This chapter is divided into three sections: develop- areas of the human body and is consequently very diffi- mental anatomy, macroscopic anatomy, and endoscopic cult to study. The surgical anatomy of the nose and anatomy. A basic understanding of the embryogenesis of paranasal sinuses is published with great detail in most the nose and the paranasal sinuses facilitates compre- standard textbooks, but it is the purpose of this chapter hension of the complex and variable adult anatomy. In to describe those structures in a very clear and systematic addition, this comprehension is quite useful for an accu- presentation focused for the endoscopic sinus surgeon. rate evaluation of the various potential pathologies and A thorough knowledge of all anatomical structures their managements. Macroscopic description of the and variations combined with cadaveric dissections using nose and paranasal sinuses is presented through a dis- paranasal blocks is of utmost importance to perform cussion of the important structures of this complicated proper sinus surgery and to avoid complications. The region. A correlation with intricate endoscopic topo- complications seen with this surgery are commonly due graphical anatomy is discussed for a clear understanding to nonfamiliarity with the anatomical landmarks of the of the nasal cavity and its relationship to adjoining si- paranasal sinus during surgical dissection, which is con- nuses and danger areas. A three-dimensional anatomy is sequently performed beyond the safe limits of the sinus.
    [Show full text]
  • Development of the Ethmoid Sinus and Extramural Migration: the Anatomical Basis of This Paranasal Sinus
    THE ANATOMICAL RECORD 291:1535–1553 (2008) Development of the Ethmoid Sinus and Extramural Migration: The Anatomical Basis of this Paranasal Sinus SAMUEL MA´ RQUEZ,1* BELACHEW TESSEMA,2 PETER AR CLEMENT,3 2 AND STEVEN D SCHAEFER 1Departments of Anatomy and Cell Biology; Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York 2Department of Otolaryngology, New York Eye & Ear Infirmary, New York Medical College, New York, New York 3Department of Otorhinolaryngology, University Hospital-Free University Brussel, Belgium ABSTRACT Frontal and/or maxillary sinusitis frequently originates with patho- logic processes of the ethmoid sinuses. This clinical association is explained by the close anatomical relationship between the frontal and maxillary sinuses and the ethmoid sinus, since developmental trajectories place the ethmoid in a strategic central position within the nasal com- plex. The advent of optical endoscopes has permitted improved visualiza- tion of these spaces, leading to a renaissance in intranasal sinus surgery. Advancing patient care has consequently driven the need for the proper and accurate anatomical description of the paranasal sinuses, regrettably the continuing subject of persistent confusion and ambiguity in nomencla- ture and terminology. Developmental tracking of the pneumatization of the ethmoid and adjacent bones, and particularly of the extramural cells of the ethmoid, helps to explain the highly variable adult morphology of the ethmoid air sinus system. To fully understand the nature and under- lying biology of this sinus system, multiple approaches were employed here. These include CT imaging of living humans (n 5 100), examination of dry cranial material (n 5 220), fresh tissue and cadaveric anatomical dissections (n 5 168), and three-dimensional volume rendering methods that allow digitizing of the spaces of the ethmoid sinus for graphical ex- amination.
    [Show full text]
  • Anatomical Variations of the Frontal Sinus
    Int. J. Morphol., 26(4):803-808, 2008. Anatomical Variations of the Frontal Sinus Variaciones Anatómicas del Seno Frontal *José Marcos Pondé; *Raimundo Nonato Andrade; *José Maldonado Via; **Patick Metzger & **Ana Clara Teles PONDÉ, J. M.; ANDRADE, R. N.; VIA, J. M.; METZGER, P. & TELES, A. C. Anatomical variations of the frontal sinus. Int. J. Morphol., 26(4):803-808, 2008. SUMMARY: An anatomical study of the frontal sinus in 100 macerated skulls. The study introduces an innovation on the literature by means of the measurement of the sinus’s volume. All the found information in the literature attained to other aspects including the diameters of the sinus and the geometric area of the same. Objective: Evaluation of the measures of the frontal sinus frequently involved in cranial base surgeries and supraorbital craniotomies in order to help the surgical approaches that cross this anatomical route Methods: The measurement included: sagital, transverse and antero-posterior diameter acquired with a paquimeter and the volume obtained after filling the sinus with sand. Results: They are in accordance with the literature that shows the male’s predominance in all measurements done. KEY WORDS: Frontal sinus; Supraorbital craniotomy; Paranasal sinus. INTRODUCTION The minimally invasive surgeries have acquired a indicate the absence, presence or size of the frontal sinus. The growing importance in surgical interventions in order to avoid extension upwards beyond the frontal bone may be a small tissue damage and reduce surgical time. one, while the orbital part may be bigger. In some cases, a sinus may be overlapping in front of the other one.
    [Show full text]