title: Transblepharoplasty approach to sequestered disease of the lateral frontal sinus with ophthalmologic manifestations.
abstract: BACKGROUND
  Sequestered disease within the lateral extent of the frontal sinus that has eroded into the orbit through the frontal sinus floor may be difficult to address with standard ESS techniques. We describe an approach to this problem using a transblepharoplasty incision concealed in the upper eyelid crease.
  
  
  METHODS
  Five consecutive patients with lateral frontal sinus disease involving the orbit were treated with combined ESS/transblepharoplasty approach. This used an upper lid incision and elevation of a myocutaneous flap. The preexisting dehiscence in the sinus floor was exposed, permitting extraction of fungal debris and marsupialization of the mucocele. Frontal sinusotomy was performed via combined above/below technique
  
  
  RESULTS
  The study group included 5 patients with mean age of 50 years. Two patients had post-traumatic mucopyocele, two had allergic fungal sinusitis, and one exhibited both entities. All patients had signs of ophthalmopathy: proptosis with increased IOP (5/5), gaze restriction (5/5), and decrease in visual acuity (2/5). Ophthalmologic symptoms improved postoperatively in 5/5, but 2 patients eventually required revision endoscopic surgery. No complications occurred, and incision healing was excellent in all patients.
  
  
  CONCLUSIONS
  In patients with sequestered disease of the lateral frontal sinus and ophthalmologic manifestations, the transblepharoplasty approach in combination with ESS affords excellent access while preserving cosmesis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Knipe
authors.forename: Parag D
authors.initials: PD
authors.lastname: Gandhi
authors.forename: James C
authors.initials: JC
authors.lastname: Fleming
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chandra
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus; D015522:Frontal Sinusitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009078:Mucocele / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome