title: Image-guided osteoplastic frontal sinusotomy.
abstract: BACKGROUND
  A 6-ft Caldwell radiograph template and transillumination, typically, are used to elucidate the frontal sinus outline for osteoplastic frontal sinusotomy (OFS). These techniques can be fraught with imprecision. The consequences of imprecise OFS may result in significant complications. Computer-aided surgery may offer a safe and accurate alternative to these techniques in selected cases. Several disadvantages were noted with early computer-aided assistance. Current infrared and electromagnetic systems have eliminated many of these disadvantages. We describe our technique and experience with an infrared image-guidance system (The LandmarX Evolution; Medtronic Xomed, Jacksonville, FL) to create a precise OFS that maximizes exposure while minimizing morbidity.
  
  
  METHODS
  We describe the use of an infrared image guidance system, the LandmarX Evolution for OFS in three cases.
  
  
  RESULTS
  The LandmarX Evolution allowed for accurate placement of the OFS in each of the three cases and successful treatment of two symptomatic frontal sinus osteomas and a recurrent inverted papilloma. No complications were encountered.
  
  
  CONCLUSIONS
  Image-guided OFS results in a confident and accurate entry into the frontal sinus. Image-guided OFS creation should be considered for select cases (i.e., complete opacification and altered anatomy) where performing an OFS by standard techniques may increase the complication rate. More experience with the technique and increased accessibility to image-guided equipment must be made possible before establishing this technique as a standard.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: William
authors.initials: W
authors.lastname: Innis
authors.forename: Patrick
authors.initials: P
authors.lastname: Byrne
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005624:Frontal Bone / Q000601:surgery*; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007259:Infrared Rays; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D015641:Radiography, Interventional; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014207:Trephining / Q000379:methods