title: Image-guided frontal trephination: a minimally invasive approach for hard-to-reach frontal sinus disease.
abstract: OBJECTIVE
  Peripherally located frontal sinus pathology may be unreachable with standard endoscopic techniques. Patients with superiorly or laterally based lesions often undergo osteoplastic flap with or without obliteration. Image-guided frontal trephination (IGFT) can localize pathology and provide excellent exposure. We present 13 patients in whom this technique was applied.
  
  
  METHODS
  Medical records of 13 patients undergoing IGFT were retrospectively reviewed.
  
  
  RESULTS
  The patients' mean age was 49.2 years, (range 14-79); follow-up time was 29.9 months (range 12-39). Indications for IGFT were superiorly or laterally based mucoceles (3), fibrous dysplasia or osteoma (3), type 4 frontal cells (3), and frontal recess stenosis or ossification (4). In five patients, IGFT was combined with endoscopic transethmoid frontal sinusotomy; eight patients were treated through a trephination approach, and three patients underwent trephination with unilateral frontal sinus obliteration. One patient required revision; all others remain symptom free.
  
  
  CONCLUSIONS
  IGFT offers an attractive alternative to osteoplastic flap.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health Systems, Detroit, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Zacharek
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Fong
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005626:Frontal Sinus / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014207:Trephining / Q000379:methods*